Amputation or an experiment?

Either way, in Joseph Smith's life, the terrible trauma of a major surgery without anesthetic. If you look at the stories of Joseph Smith’s boyhood operation,

a dozen doctors trailing along and all of the details of that entourage on horseback arriving at the Smith’s home, it sounds almost—could it really be?

That’s coming up next on the Joseph Smith Papers.

K-jazz television, in cooperation with the Church History Department of The Church of Jesus Christ of Latter-day Saints, presents this weekly series highlighting the research of scholars and historians as they prepare for the publication of the Joseph Smith Papers. And now your host, Glenn Rossin. It was probably sometime in 1813.

The Smiths were living in West Lebanon, New Hampshire. Father Smith was working as a day laborer.

And young Joseph was about seven years of age.

A typhoid fever epidemic overwhelmed the area, and many died. The Smiths were hit hard, especially Joseph and his sister Sophronia.

The family began to recover, but for a young Joseph,

it wasn't over yet. Osteomyelitis developed in his left leg.

And had it not been for the fact that the Smiths were living where they were, practically neighbors to the only man in the world who could have helped them,

it’s likely that young Joseph would have lost either his leg

or even his life.

It has been said that Nathan Smith, physician surgeon, was perhaps the only doctor in the United States at that time that could have saved Joseph Smith’s leg. If so, that would be remarkable.

And not only remarkable because he had the skill, but because he was present.

He had, for example, already agreed with Yale University to leave and go to Connecticut. New Haven, Connecticut, to help found a new medical school at Yale.

But he stayed behind because of the same epidemic,

the typhus epidemic that resulted in the injury and disease to Joseph Smith's leg.

So he was the right man at the right place at the right time.

Nathan Smith was a very unusual character, very unusual doctor,

a great medical educator in his time.

He wanted to become a doctor early on in his life.

Yes. Nathan Smith wanted to become a doctor.

Now, he’s revered and respected today because he didn’t perform an amputation of Joseph Smith's leg.

And yet, paradoxically,

it was an amputation that launched Nathan Smith's career in the first place.

But there happened to be an amputation in his neighborhood in those days. And amputation was brutal and it took strong man to assist the surgeon. You only did an amputation when it was the last possible measure to save someone's life.

And indeed, it sometimes cost a man's life or a woman's life.

So brutal was the technique.

It happened that it was in his neighborhood, a Doctor

Goodhue, and he volunteered to help.

Now, this took firmness and strength and resolve.

And he came through it with a conviction that he wanted to be a physician, which is remarkable in itself.

So he talked to Dr. Goodhue and basically begged to be

an apprentice. And Dr. Goodhue,

not much older than Smith himself, but one who had spent some years as apprentice and already was in his career as a doctor,

was appalled at the state of New England medicine

and determined to help upgrade the medicine across the communities. And so he told Nathan Smith,

I cannot take you as an apprentice because you have no background.

Go get an education and then come back to me and we'll talk.

He not only told him that, he gave him a referral.

He said, go see the Reverend Samuel Widing. He will help you.

Turns out this was a great referral.

The Reverend Whiting was a wonderful tutor and scholar.

And for three years, Nathan Smith worked with Reverend Whiting

and came back with some background

and the agreement with the doctor that he now could be an apprentice. He went through with the apprenticeship and the schooling to get the Bachelor of Medical Science degree from Harvard, the fifth graduate of Harvard Medical School.

And then he went back and established his own practice,

but always with the intention of helping to perpetuate education, just like his mentor, Dr. Goodhue, had.

He had learned from some of his mentors at Harvard that the place for the best medical education was Europe,

actually the British Isles.

So he made arrangements and moved for a brief few months to Edinburgh, which was the seat of medical learning in Great Britain When Nathan Smith returned,

he set up his practice as a doctor.

He also began to fulfill another lifelong goal, and that was teaching medicine.

He established medical schools at Yale,

the University of Vermont at Bowdoin,

and also Dartmouth Medical College at Hanover, which, by the way, was just down the road from the Smiths, who lived in Lebanon.

He taught everything. He was the professor of anatomy, physics,

chemistry, pharmacology, medicine.

Daniel Webster at one point took a course of chemistry from Nathan Smith.

Oliver Wendell Holmes said of Nathan Smith that he

didn’t occupy a chair of medicine there, he occupied an entire settee, because he taught everything.

We know more about the story of Nathan Smith because of this book,

which is a wonderful biography, published 10 years ago after many years of research of

folks who cared about Nathan Smith's legacy in New England and in American medical history.

The book is titled, “Perpetuate, Perfect, and Improve.”

His idea was, you learn new techniques,

you improve by a scientific method of observing

and dissecting after with diagnosis confirmed.

And you perpetuate that through medical education.

And he was an extraordinary pioneer of medical education in New England. It was early America, and there was really very little in the way of any kind of medical education.

There were three other medical schools before Nathan Smith founded Dartmouth. There were no state boards. There were no medical boards. There was no licensing.

There was no accreditation. In New England, there wasn’t a single hospital in 1810, 1813.

There wasn't a hospital anywhere in New England.

There were no operating rooms. There were no recovery rooms. There were no—

There was no anesthesia.

There was no sterilization because the concept of the bacterial cause of disease was not yet discovered.

So this was all done—all medical care was done in the homes.

There were no offices.

The doctors did not have a private office where patients came to their office.

Instead, they rode out to the homes on horseback

and conducted their medical practice

on horseback all over New England.

There weren’t very many operations on the body cavities, or none. It was 1813 when there was a typhoid—

well it was called a typhus epidemic. Typhus,

we now know as typhoid fever,

which is a bacterial infection from the organism salmonella typhosa. And it’s a gastrointestinal disease,

lots of diarrhea, fluid loss, wasting,

and very, very highly contagious.

Now, Lucy Mack Smith's family was hit hard.

All the children had it, Hyrum had it, and then Saphronia almost died.

And when you read Lucy Mack Smith's account, it sounded like she even had maybe a respiratory arrest

and then was brought back by her mother,

who had to take care of all these sick kids. She had a bunch of kids then. She was about, what, 37?

Yeah, she was a middle aged mother and had a house full of kids and all became very sick.

Joseph Smith developed it and became sick,

but recovered from the typhoid fever.

Joseph developed a complication

of the typhoid. As soon as he recovered,

he and she both describe and

a swelling that occurred under his left arm or in the left,

what we call [INAUDIBLE]. And it was seen by a Doctor Parkhurst a couple of times. And finally he opened this

and they record that he drained about a quart of pus from the swelling, now this must have been a large swelling. He was a seven year old boy, not a—

And so a quart of pus is a quite an abscess.

When that was drained,

Joseph reported that he felt immediate pain in his left tibia or shinbone. And then that began the ordeal with the osteomyelitis. Bacteria from the sepsis spread through the blood stream down into the bone marrow of his left tibia.

And then that began a several week illness, through which Joseph suffered quite a bit. Now, as we mentioned,

osteomyelitis was the disease that Joseph developed in his left leg. This surgical procedure that Dr. Smith performed was being done nowhere else in the world, and evidently no one else could do it.

Regarding this surgical procedure,

Dr. Smith was recorded as having said the following in a student lecture.

“It occurred to me that I could save young

people and spare them an operation

if I operated on the bone directly.” In those days, when

we talk about the osteomyelitis, there was no treatment.

There was no surgical treatment anywhere in the world that I could find.

No one operated on bone directly, there was no x-ray.

There's no way to localize it.

But he knew through physical examination, and

through his experience, where to go and exactly what to do.

Osteomyelitis is the bacterial infection of bone, and it’s spread by the bloodstream, generally.

The bacteria settle in the bone marrow, where where they proliferate and form an abscess, they form pus. And this can occur on the outside and also on the inside of the bone. If untreated,

and if there’s a lot of pus formation, that can interfere with the circulation to the bone itself and cause a portion of the bone to die

or become, as Nathan Smith called it, necrotic,

and then one is left with a infected bone with surrounding pus on the inside and the outside of the bone.

There's a lot of pain with osteomyelitis, tremendous pain.

And it's unrelenting. It doesn't go away.

Night and day. Sometimes the patients could not sleep

because the intensity of the pain.

What happens with osteomyelitis is when the shaft of the bone, when a portion of the shaft of the bone dies,

the surrounding membranes of the bone called

a periosteum lays down new bone

so that you end up with two cylinders of bone.

There's the original cylinder on the inside that's dead

and [INAUDIBLE], full of pus.

And then you have the surrounding bone, which is called [INAUDIBLE], which is new bone,

so that there's also always an integrity to the bone itself.

So he would have had something like that.

There would have been a swollen bone,

[INAUDIBLE], with dead bone on the inside of that, the original shaft of tibia. The Smiths called in a Dr. Stone to help young Joseph and his pathetic condition.

He made two incisions into Joseph's leg to help reduce the pain caused by the swelling.

But this did nothing to treat the diseased bone.

After a time, Dr. Stone came to feel that Joseph’s leg was beyond help, and he recommended amputation.

Lucy Mack Smith

wasn't going to buy that,

and she asked for a second opinion is what we would call today. She called it a council of Surgeons.

We call it a second opinion.

And somehow they got Nathan Smith to come over.

Now, he had quite a reputation in New England,

but it still would be surprising if the Smiths absolutely knew about him just because they were in in the neighborhood, a few horse rides away.

They did know about him more directly because Hyram Smith was going to school at Dartmouth.

Clearly, the Hyrum connection at Dartmouth helps explain why this remarkable surgeon was known to them and made the trip out to the Smith home for this operation that saved Joseph Smith’s leg. It wasn’t at all unusual for Nathan Smith and his students to travel considerable distances

to provide medical services.

In fact, by horseback,

he would go 25 miles for a patient more or less routinely.

He also did a lot of charity work.

He was always struggling to pay his own bills,

struggling to get his patients to pay their bills.

His account books show that this was a lifelong struggle,

but nonetheless, he always seemed to be available and agreeable to do service wherever he was needed.

This started from his very first assignments as an apprentice.

The description of that entrance of Nathan Smith is classic Nathan Smith. She said they rode up to the door. There were,

I believe she said, 11 of them.

They all came as a cavalry of medical care, rode up to the door, parked their horses, and she let them in their small house for another opinion. Now,

I think up to this point,

Nathan Smith was not in the picture,

because he never once recommended amputation for osteomyelitis,

although everybody else in the world practiced it, including England, everywhere as far as we could tell.

The treatment of choice was amputation. He would teach vehemently that anybody who did that was a quack

and didn't understand surgery and didn't understand medicine.

We have those verbatim quotes from his student lectures. We have two accounts of this operation.

The first one and the most detailed was given by Lucy Mack Smith in 1844 and ’45 when she dictated her history.

The other was given by Joseph Smith himself.

In 1842,

he dictated an account for an inclusion in his history.

He recorded the events as follows.

“I endured the most acute suffering for a long time under the care of Drs. Smith, Stone, and Perkins of Hanover.

At one time, 11 doctors came from Dartmouth Medical College at Hanover, New Hampshire, for the purpose of amputation.

But young as I was, I utterly refused to give my assent to the operation. But I consented to their trying an experiment by removing large portions of the bone from my left leg, which they did.

Fourteen additional pieces of bone afterwards worked out before my leg healed, during which time I was reduced so very low that my mother could carry me with ease. After I began to get about,

I went on crutches till I started for the state of New York.

If you look at the stories of Joseph Smith's boyhood operation,

a dozen doctors trailing along and all of the details of that entourage on horseback arriving at the Smith’s home, it sounds almost—could it really be?

Did Lucy exaggerate? Did she get the story right?

We have notes from some of Dr. Smith’s students, lectures,

lecture notes, and the procedures that Lucy describes were the procedures he taught. It's interesting to read the interplay between her and the doctors. She was a—she was a tough mom.

She was a good mom. And

she wasn’t going to hear about amputation.

They mentioned amputation, I guess the original doctors, when they came, they wrote up and they had this council and they sat with Mother Smith. She was the one that did all the talking.

According to her account, her husband was—

Joseph Smith Senior was shaken up.

He sat down, he put his head in his hands and wept over the prospects of his son losing a leg.

But she was adamant and persistent

in trying to get to a different kind of an operation.

The encounter was interesting

as they talked about amputation, they presented amputation, and

the mother wouldn't hear of it.

And Joseph said he wouldn’t, he didn’t want to have it done.

But Joseph said he consented to they’re trying an experiment.

Now, he was only seven years old. And somehow that word experiment

lasted him when he remembered that.

I don't even know if he knew what an experiment was,

but he said we'll try an experiment. Instead of amputating the leg,

we’ll try to explore the bone and take out what’s diseased and see what happens. As awful as amputation sounds, in attempting to save Joseph’s leg, Dr Smith's procedure was rough.

It was merciful in the long run, yes.

But by today's standards, that was brutal.

The operation was interesting.

And they began to to restrain the patient.

In those days they would spread eagle the patient with cords.

They would tie the wrists and the hands and the feet to the edges of the bed—

this was all done in bed,

done at home—to restrain the patient so they could operate. There was no anesthesia. There's no way to dull the pain.

And they had to restrain the patient

so that they could actually do the surgery.

There were anywhere from seven to eleven medical students there, along with Smith and Perkins and Dr. Stone. So there were a lot of people in that room.

Some of the medical students would probably be used to restrain the patient. He refused. Joseph refused to be tied down.

He said he would go ahead with the surgery if his father could sit next to him.

I don’t think his father restrained him,

I think that was the job of the medical students. Then

they had a little discussion about

liquor, which was the only analgesic.

Sometimes they would get the patient stuporous in an alcoholic state, and then the pain wouldn’t be quite so bad.

But Joseph refused any form of liquor and

and then just, they went ahead with the surgery.

They excused Mother Smith, she had to leave.

And they began the surgery and she described it very accurately.

Now, she didn't see it,

but her husband saw it and probably told her.

And they describe the surgery as drilling into the bone,

breaking off pieces, and probably breaking off a piece that was lodged on the inside.

And what they had to do was to drill holes in the bone,

create a window to go into the bone marrow cavity,

to get out the dead bone, so they would drill holes,

connect these holes with a little saw,

take a window of bone out, reach in with bone forceps,

and then pull out what dead bone that they would encounter in the center of this thing.

That’s when he cried out.

Nathan Smith reported that the drilling and the sawing of the bone really didn't hurt that much, except for the pressure on the bone.

It didn't cause acute pain.

But if you pulled a piece that was attached to something live,

that would cause terrific pain, like a tooth, I guess.

And so they broke off one piece and pulled it out, and he let out a holler and his mother came running into the room and they had to take her out, and they restrained her outside of the door.

Can you imagine being a mother and having to watch your son go through something like this?

In her history, Lucy gave us this account: “When they broke off the first piece,

Joseph screamed so loudly that I could not forbear running to him. On my entry in his room, he cried out, ’Oh, mother, go back, go back.

I do not want you to come in.

I will try to tough it out, if you will go away.′

When the third piece was taken away,

I burst into the room again and oh my God,

what a spectacle for a mother's eye.

The wound torn open, the blood still gushing from it, and the bed literally covered with blood.

Joseph was as pale as a corpse

and large drops of sweat were rolling down his face, whilst upon every feature was depicted the utmost agony.

I was immediately forced from the room and detained until the operation was completed.

But when the act was accomplished, Joseph put upon a clean bed,

the room cleared of every appearance of blood and the instruments which were used in the operation removed.

I was permitted again to enter.

They left this wound open. They didn't close anything. They didn’t sew anything shut.

The wound was open so that there was an open wound over the shin bone that went down into the marrow of the bone.

And this is a very complex, complicated wound. Even today, it’s a very, very bad wound.

They treated it simply. He didn’t allow anybody to touch the bone or anything within the bone.

And Joseph reported that 14 additional pieces of bone worked its way out through this opening until it healed over.

He was on crutches for three years. Joseph's recovery, well, that took years.

He became so weak and frail in the aftermath of that operation that he said his mother could carry him about with ease.

In 1816, when the family moved to New York,

Joseph was still on crutches.

It is said that for the rest of his life,

he walked with a slight limp.

But thanks to Dr. Nathan Smith,

he kept that leg and was vigorous and active throughout his life.

But then he went down to Yale and became a very renowned professor of medicine and surgery at Yale.

He died at age 64. He was interesting, he had 10 children.

And had a large family and a busy practice.

Now, it's interesting that the surgery that he performed did not take, did not catch on.

Nobody seemed to be able to do it.

There were a few reports of students of his trying the operation, but it fell essentially into disrepute. Nobody could do it. That surgery for infected bone was not

the treatment during the Civil War.

Amputation continued to be the treatment.

And there were thousands and thousands of legs amputated during the Civil War.

At the turn of the century,

people began to try to do this operation [INAUDIBLE].

That is, a direct operation on bone, and they began doing it again. It became the treatment during the First World War.

And when the X-ray machine was invented around that time,

it became easier to treat.

The treatment then continued to be surgical with poor results

in the first part of the 20th century.

Mortality from the surgery was high.

The complications were significant,

and patients usually had many, many operations.

The thing that changed was the introduction of penicillin,

which then became the standard treatment for osteomyelitis.

One would have—and even today, one would get a six week course of intravenous antibiotics either in the hospital or at home. So the operation was lost, and

there was an article, a

centennial review of surgery, of American surgery

1876.

And they mention Nathan Smith and his operation. They said that nobody could do it.

He could do it, but nobody else could do it.

And so they didn't endorse it.

Now, Nathan Smith lived to see the face of New England medicine changed. Eventually, he had

medical students all over New England, some of whom were professors on their own.

And as I mentioned, helped found a number of colleges of his own.

So the fact that he was innovative,

that he was industrious as a teacher,

that he had lots of students to come with him,

that he prepared new techniques that worked,

including the one that saved Joseph Smith’s leg.

That's all according to the record, as we understand the career of Dr. Nathan Smith,

extraordinary surgeon and medical educator in New England. Dr. Nathan Smith distinguished himself as a great doctor and as a teacher. Joseph Smith also went on to become great.

Now, while it's true that adversity and difficulty can help mold our character and sometimes make us great,

there are those who have attempted to make more out of this traumatic experience in young Joseph's life than the evidence will support. There isn't a lot of evidence that he was crippled psychologically by this, although some people have tried to make the argument.

It seems like he, as Nathan Smith himself, with that first amputation,

was able to face a situation, man up to it, as we say today,

and even though he was a boy,

he was able to tough that through and be grateful for it,

and got himself back together and got back to health.

People will continue to argue whether this was

an event that somehow left him an emotional or psychological cripple.

But those who really study his career,

I think those of us who know him more closely from his documents and his records would say there is no way, we don’t see the evidence of it.

This was the first miracle that we know about in the life of Joseph Smith. It's a miracle in several ways.

I mean, it's nice to be able to explain a miracle scientifically.

It’d be great if we could do it to all of them.

But it’s a miracle that there was somebody there, five miles away from their home, who had a great experience in treating this.

It’s unusual that a man would be inspired to do that, 100 years ahead of his time.

It took the medical profession many years to catch up with Nathan Smith. Given the rigorous physical demands that were placed on Joseph later in his life,

Dr. Nathan Smith then proved to be a great benefactor.

Now, next week on the Joseph Smith Papers,

the Joseph Smith Translation of the Bible,

an important and integral part of his ministry and also his role as a religious innovator. That's next week.

I’m Glenn Rossin. Thanks for joining us.