Joseph Smith’s Surgeon

The only man in America who could save his leg was just five miles away.

Church members have been thrilled by the story of eight-year-old Joseph Smith’s courage during the time when the bone in his leg became infected and amputation seemed the only solution. We remember his willingness to endure the pain of an alternative operation in his father’s arms, rather than dull its edge with alcohol.¹ As a surgeon I have always wondered about Joseph Smith’s operation and particularly about the physicians who successfully carried it out.

This was, after all, 1813, in the most rural area of New Hampshire. The infection in Joseph’s bone (osteomyelitis) followed in the wake of an epidemic of typhoid fever that affected all the Smith children. In those days and up until the discovery of antibiotics in this century, osteomyelitis was a devastating problem. Since the days of Hippocrates of ancient Greece, the standard method of treatment had been the simple application of poultices and plasters to the inflamed flesh. This had little effect: when infection occurs in the bone, long segments of the bony shaft die, and the body, growing new bone, encases the dead material within a living layer. Inevitably, the dead bone separates and lies in the center of an abscess cavity, draining continuously or spreading infection to other parts of the body, resulting in death. Usually in the late stages the leg had to be amputated.

In 1874 the techniques of operating on the bone to remove the dead fragments and allow drainage were described and widely accepted. This operation, known as sequestrectomy, became standard procedure after World War I.

That was a century later. But here is Lucy Mack Smith’s description of the operation in 1813:

“The surgeons commenced operating by boring into the bone of his leg, first on the one side where it was affected, then on the other side, after which they broke it off with a pair of forceps or pincers. Thus they took away large pieces of bone.”²

What Lucy Smith is here describing is the technique that became known in 1874! How was such a surgical feat possible eighty years before its time in the tiny community of Lebanon, New Hampshire?

The answer is one that Latter-day Saints would hardly call coincidence. In a little known note to the Manuscript History of the Church, Joseph named his doctors: “Smith, Stone and Perkins” of Dartmouth Medical School in Hanover, New Hampshire,³ five miles from the Smith home.

These were not the ordinary, poorly trained country physicians so commonly found in those days. Nathan Smith, graduate of Harvard Medical School, sole founder of Dartmouth Medical School, later to found three additional New England medical schools, was also president of the New Hampshire Medical Society and had, prior to treating Joseph Smith, accepted the position of the first professor of medicine and surgery at Yale Medical School.⁴ He had delayed moving to New Haven so he could care for the victims of the 1813 typhoid epidemic in the communities surrounding Hanover, New Hampshire.

Cyrus Perkins was Nathan Smith’s former pupil and a graduate of the Dartmouth Medical School. Perkins had later returned to the area to become the professor of anatomy and to join his former teacher in a medical practice.

Stone was very likely also a former student of Smith’s: earlier class rolls of the Dartmouth Medical School list several Stones.

Even more significantly, Nathan Smith was one of early America’s greatest medical men and had, on his own, devised an operation for osteomyelitis as early as 1798 that he would later publish in 1827 but that would lapse into disuse for two generations.⁵ In other words, generations ahead of his time, he was the only man in America who could have saved Joseph Smith’s leg.

Without a college education, Nathan Smith apprenticed himself to a country physician for three years, then began his own practice in Cornish, New Hampshire. Dissatisfied with his preparation, he applied to the newly founded Harvard Medical School three years later. He became its fifth graduate and returned to his country practice in 1790.

Now his sense of mission included raising medical standards and proficiency among his colleagues as well. He petitioned Dartmouth College trustees to establish a medical school and spent a year in Edinburgh, Scotland, accumulating equipment, books, and clinical experience. His opening lecture in 1797 was the beginning of Dartmouth’s medical college.

For thirteen years, he singlehandedly taught anatomy, chemistry (Daniel Webster was enrolled in that course), surgery, remedies, and the theory and practice of medicine, until the New Hampshire legislature allowed Perkins to join him as professor of anatomy in 1810.

Neither one received a salary for the teaching; tuition fees and their joint medical practice made up their income. Since Dr. Smith had trained many of the physicians in upper New England, he was consulted on many difficult cases, which meant traveling up to a hundred miles on horseback over rough dirt roads. He routinely invited ten to twenty of his medical students along on these trips as part of their training.

This pattern was repeated in Joseph Smith’s case. After Dr. Stone had unsuccessfully performed two operations on Joseph’s diseased leg, his mother insisted on another opinion and requested a “council of surgeons.” Nathan Smith, his partner, Cyrus Perkins, and medical students from Dartmouth came to carry out the necessary surgery.

At first an amputation was suggested; Lucy Mack Smith instead asked for the experimental operation of removing only the diseased bone. Her description of the procedure is accurate and parallels the description of the operation found in early Dartmouth medical student notebooks.

The operation was successful, and Joseph’s wounds healed. The fact that a wound with the exposed shaft of bone healed so readily is truly miraculous; however, Nathan Smith had achieved an unusual record of good results—he never described amputation following his operation. Joseph used crutches for three years but his life and his leg were spared.

After the epidemic and the operation, both Nathan Smith and Joseph Smith left New Hampshire, Nathan Smith to occupy his chair at Yale Medical School and Joseph to return to Vermont for three years before moving to Palmyra, New York, where he eventually began his great work.

It is hard to call it an accident—a boy plucky enough to refuse amputation despite two unsuccessful operations; a mother who requested the experimental procedure, not knowing Nathan Smith was the only surgeon in the United States who had such a successful experience treating osteomyelitis; and the undramatic conjunction between the right man and the right time.