THE CASE OF JOHN AMES ANDREWS, OF SHOOTER’S GREEN, ABBOT'S RIPTON, IN THE COUNTY OF HUNTINGDON: TO WHICH ARE ADDED SOME OBSERVATIONS ON THE UNFORTUNATE CASE OF ROBERT BOND OF HUNTINGDON. BY C. DESBOROUGH, SURGEON. HUNTINGDON; Printed and Sold by Ann Jenkinson. Price One Shilling. iii TO JAMES EARLE, Esq; Surgeon in Extraordinary to his Majesty’s Houshold, and to St. Bartholomew’s Hospital. Dear Sir, I am so totally unused to the dedicatory stile of writing, that I cannot hope to ac- quit myself otherwise than very indiffe- rently in this my first assay; and I must depend on your goodness to make allowances for my defects, as you have always been wont to do;—I think, I have observed, that the first and principal intention of most or indeed all Authors, in dedicating their Writings, is to insure to themselves the Patronage of the Public, thro’ the influence and recommendation of some one eminent person, whom they may have chosen to address on such occasions—it is with this disposition of mind, I believe, that most men pen their dedications—but not so with me—I have no other end in view by this address, but to make a public acknow- ledgement of my gratitude to you, Sir, for a2 the iv the reiterated marks of esteem, which I have experienced at your benevolent hands;— these are favors, that are the more invalu- able, because they were bestowed by a Gen- tleman, who is at once an ornament and head of that Profession, of which I am but an humble follower and admirer. The liberty you have given me to use your Name, Sir, in this place, is truly pleasing on another account; as it is a further con- vincing proof of your friendship for me, than which nothing can be more reputable to me as a Surgeon, or more flattering to me as a man—for this and many other marks of regard, with which you have ever distinguished me, what suitable return can I make?—I have nothing to offer but my sincere and grateful thanks. I am, with the greatest respect and regard, Dear Sir, Your much obliged, grateful, and very humble Servant, C. DESBOROUGH. HUNTINGDON, March, 1786. [1] THE CASE OF MR. J. A. ANDREWS, &c. AS the following Case has been very much the subject of conversation in this Town and many of the adjacent Villages, and has been essentially misrepre- sented in some respects; I am induced to lay before the Public, a true statement of it;—for which purpose, I have been very assiduous to obtain every particular, that can be in the least interesting, or material to ren- der the Case clear and comprehensive, and as easily to be understood, as my poor abili- ties and the nature of the thing itself will admit; in describing some parts of the Case however, and more especially in my account of the diseased appearances in the Limb, A after [2] after amputation, by dissection; I have been necessitated to use a kind of language and manner of expression, that can only be well understood by medical Men; these, tho' they certainly will not enlighten the subject to any others than those who have made the art of Surgery their study, will not, I hope, obscure the more material parts in which all other classes of people are more immediately concerned, and which, in con- sequence they must be the more desirous to become acquainted with. I have certainly had very fair opportunities to accomplish my undertaking, having been nearly from the beginning of the illness, a constant and frequent attendant on the young Man, who is the subject of this paper, and I have watched him with more than ordinary anxiety [3] anxiety on account of some peculiarly cruel and aggravating circumstances, in which his dreadful Case has been involved, and to which, much of his sufferings may very just- ly be imputed, A man, who is entrusted with the health and life of sick persons, and in whom (next to their GOD) they repose their hope and implicit confidence; if en- dued merely with common feelings, must necessarily be exceedingly solicitous for the recovery of them: it is a trust of such im- portance, in which the interests as well as passions of a Physician or Surgeon are so nicely blended, that it would be idleness in me to take any pains to prove so palpable a truth; I will therefore only add, that to a Man of fine feeling, such anxiety and solici- tude, must needs be much heightened, when A2 a Case [4] a Case like this, which I am about to relate, falls under his inspection and care; when the Patient (as but too frequently happens) besides the necessary and unavoidable sufferings, to which he is subjected by the na- ture of his disease, considered abstractedly, has been cruelly and wantonly maltreated by an ignorant pretending Empiric, and his misfortune, thereby considerably and grie- vously increased: I have experienced these sensations, in an eminent and painful degree, during my attendance on the unfortunate young Man (my Father’s patient in this Case) who has been so much injur’d, by the dis- honest and inhuman maltreatment of a Bone- setter in this Country, as to make it absolutely necessary, that he should compound for his life, by the loss of a Limb;—the recollection and [5] and mention of these distressful circum- stances, irksome as they are, is a kind of indulgence, now they are at an end and their cause has ceased to act, which I could not deny myself; but, I should be extremely sorry to advance any thing in this place, that might bear the most distant resemblance to vanity or boasting; therefore, I am not without my fears, that I have said rather more of myself, than, as an Author, in de- cency I ought to do; but I am not ashamed of my feelings—I glory in them,—and if I have spoken of them on this occasion, without oftentation or impertinence, I trust they will do me no disservice with the can- did and humane part of the World, to whom I would be understood particularly to address myself. I will not deny, that I have another motive [6] motive, and that a powerful one too with me, for making public this Case; and that is, to set in a clear, conspicuous and true point of view, the character of a Man, possessed of a monstrous reputation in this Country; I mean Mr. F—, the notorious Bonesetter just now alluded to: I am very well aware, that to offer any thing here, to the prejudice of so great a favorite as Mr. F—, would only be, to exasperate a certain description of people against myself, with whom I had rather be on good terms; but to speak of this Man as he deserves, (which I shall do without reserve) is a duty I owe myself and the public; and I have some hope thereby to render an essential piece of good service, to those very persons, whom, I am conscious, I run no small risque of offending, by taking such [7] such a step; and I hope it will not be impu- ted to me as a crime, that I was not deterred from doing what I conceived to be my duty, because in this single instance, it may happen to run counter to my interest. I will not scruple to confess, that it is a mortifying cir- cumstance, that a Man allowedly devoid of any knowledge of the Anatomy of the Human Body, (the very groundwork of good Surgery, and on which all Practitioners ought to build) should so frequently have a preference shewn him, in cases of the utmost importance in the art, where the greatest judgment united with the nicest manage- ment is required; I will venture to assert, that in no cases that can present themselves, is a just knowledge, in plain and practical* * I mean by these terms, that part of Anatomy, which teaches us the precise situation and disposition, the different attachments and great variety of powers, incident to the Muscles, Nerves, Tendons, Ligaments, Cartilages, Blood Vessels, &c. &c. [8] Anatomy, more indispensibly requisite, than in fractures (be they simple or com- pound) of the bones of the extremities, and in dislocations of the joints; for the truth of this assertion, I appeal to all good Surgeons, who are certainly the best judges in this mat- ter, and also, to all people of common sense, who are competent judges too, if they would think for themselves in this, as well as other affairs of less importance—for I would ask these last—how is it possible think you, that a man should properly reduce a fracture or dislocation, who is not thoroughly acquainted, in the former sort of accident, with the moving Muscles of a Bone, their origin and insertions, and the motions each individual Muscle is capable of performing? And in the latter sort of injury, with the structure of a joint and its particular mode [9] of articulation; not only the parts more im- mediately concerned in its conformation, such as the bursal Ligaments, Cartilages, and other appendices; but also, parts more remotely concerned, such as those Muscles, which have their attachment either above or below, and pass over a luxated Joint, &c.? as these all are of more or less importance to be considered, in proportion to the effects they can produce on a joint, in its natural state, or in its preternatural state, in consequence of such a degree of violence committed upon it, as to occasion a dislocation. Every thinking person will readily discover, that the broken ends of a Bone in cases of frac- ture, and the head or heads of Bones in dislocations, are, and must be passive, and tho’ removed out of their proper places, by an [10] an act of violence, that they are still liable to be moved, and are in fact, frequently acted upon by the Muscles, which are the only moving powers in an Animal Body; and therefore, that it is only by an exact knowledge of those parts, that these two cases can be scientifically treated, with satisfaction to an honest Surgeon, or with tolerable ease to those who have received such injuries*. Mr. F—'s hereditary knowledge, let him have ever so large a portion of it, can never have taught him these things; they are only to be learned by labor, industry, and application—I will not deny that he may, and does perhaps, by mere strength, bring the broken ends of a fractured Bone into coaptation; because I know, this may * It is hardly necessary to observe, that there is no other way of acquiring such knowledge as this, but by dissecting these parts with one’s own hands, and studying them with the minutest attention. be [11] be done, tho’ all the Muscles of a Limb, by improper position, are made to exert their powers, and consequently to counteract the intention of a Bonesetter, when a superior degree of power is applied to them—but surely I need not tell people of sense, that a very small degree of force, when judicious- ly used, will avail much more than HERCULEAN strength ill-directed; and the same argument holds good in dislocation: but this is not all, for the success or failure of either of these cases, and more particular- ly the fracture, depends very much on a Limb's being properly or improperly dis- posed, after a broken bone has been set, or a luxated joint reduced. I know it will be said by Mr.F—'s friends, that tho’ this reasoning, and these B2 arguments [12] arguments be very good and just, for ought they know to the contrary—yet they prove nothing, or, at least nothing detrimental to the reputation of Mr. F—; for say they, we all know, and are frequently witnesses of the great cures wrought by him, and that he does more bonesetting business than all the Surgeons in this country*. That Mr. F—does a great deal of busi- ness, I have no reason to dispute; but of the great cures he has the reputation of per- forming, I must beg leave to doubt—a great part of them, I must take the liberty to deny—many cases have come under my cognizance, wherein this man has pretended to detect a fracture or dislocation, and has * Insomuch indeed, that he has been said to set of broken bones and dislocations, ten or twelve in a morning. in [13] in course treated them as such, and no doubt, according to his best ideas of such cases, if he has any idea at all about them; and has by that means essentially injured several persons, who have put themselves under his hands; while others have been more fortunate, being suffered to escape with only suffering in their pockets; the bulk of the fee on these occasions being al- ways nicely determined by the circumstan- ces of the Patient's purse,—a great number of instances of this sort might be adduced, if they were necessary to confirm my asserti- on, that have happened in a series of years, and have come to my Father's knowledge; and, I believe, almost all the Surgeons in this country have, at one time or other, had abundant proofs of the ignorance and kna- very, [14] very of the Bonesetter in question—but the particular case I am to relate, which has come more immediately under my eye, has been attended with more cruel circumstan- ces, and in its event, has been more truly deplorable, than ever, I hope, befell any of the unfortunate people, that have at any time subjected themselves to Mr. F—'s merciless and unskilful hands, and will sufficiently illustrate this point. If then Mr. F— be that impostor, which this Case will prove him to be; if he pretend to set fractures and dislocations, when in re- ality there has been no such injury done, will you suffer that man to impose upon you any longer? Does he deserve your countenance and support? What hope or chance can honest merit have of succeeding among you [15] you, if such a man as this, whose real cha- racter I have here depicted, is encouraged by you, and enriched by his wicked and injurious impositions? I know very well, that the public will not easily be persuaded to give up a man, who has been so fortunate as to continue in their favor for a considerable time— I love them for their fidelity I admire their constancy—but I would have them to despise the man, who abuses their confidence and friendship, by a fraudulent and iniqui- tous practice—desirable as their favor is, I would starve, beg in the street, or die, ra- ther than purchase it at so dear a rate*. * It may be said, that these expressions favor not a little of the extravagant;—in their defence, I would gladly be indulg’d in a very short quotation, from a favorite Author of mine—“ in “transports of this kind, the Heart in spite of the understanding “will always say too much". Sentimental Journey. To [16] To these motives, I shall add another that has had its particular influence with me, on this occasion, and which will, I dare say, be thought of more weight than any one, or all of those, I have already enlarged upon; I mean, that it was at the earnest request of the young Man and his Friends, that I un- dertook to make this Case public; at first, I gave them but little encouragement to ex- pect that I would undertake so arduous a task—but I was importuned so much, that at last I could no longer refuse to comply, and actually engaged to fulfil their request in the best manner I was able; but not with- out a great deal of fear and dissidence, much doubting in my own mind of the reception such a publication would meet with, and having no small dread of the difficulties I must [17] must necessarily encounter to accomplish it, either to my own satisfaction or without giving offence to many people—having said thus much, as to the motives that have in- duced me to print the following case, I hope they will sufficiently apologise for my pre- sumption in obtruding myself upon the Public—resting on this hope and their well- known generous and humane disposition, I will risque the performance with all its inac- curacies and imperfections, which I have neither time nor penetration to discover, nor the power to correct, and will, without tresspassing any farther unnecessarily on their time, proceed to THE CASE. JOHN AMES ANDREWS, is the beloved Son of his very affectionate C Parents, [18] Parents, who are reputable Farmers, at Shooters Green, in the Parish of Abbots Ripton, in this County—if I felt myself equal to do justice to so amiable a family as this is, I would not let slip so fair an op- portunity, of bestowing upon them that praise, which is so eminently their due; but the fear of rating their enviable qualities too low, makes me silent on this head. With my young friend, their Son, how- ever, I shall use a little more freedom, promising faithfully, that whatever I say of him, shall be altogether as void of flattery as abuse, and I am sure he will have no good reason to complain of me—He is a lad of an excellent understanding, and a heart that would be an ornament to the brightest genius—he has, besides, more learning than young [19] young men of his age and condition gene- rally possess—he is an excellent penman and accomptant, draws and paints in a very pretty stile, and is very well qualified for the business of a Surveyor of land;—with such a disposition, and such qualifications, he will, doubtless, have it in his power, to get a good livelihood at least, in spite of the heavy and irreparable misfortune he has sustained in the loss of a Limb. August 25, 1785, my father was first sent for to visit the poor fellow;—he found him in bed, and very ill with a fever, which he had had several days;— my father was pro- ceeding to prescribe for him, when Mr. Andrews desired him, first of all, to examine his son’s Leg, which, he said, he feared was in very bad condition, and then turning C2 aside [20] aside the bed-cloths, presented a sight terrible to behold—not only the Foot and Leg, but the Thigh also, was swolen and inflamed to a very high degree, within a very little of gangrene, except a small part of the Leg, just above the Ancle, which was bound immoderately tight with strong filleting*; this my father expeditiously unloosed, which afforded the poor fellow, if not ease, at least some respite from pain; but alas! for a very short time indeed—in this interval, how- ever, my father collected the following circumstances, nearly verbatim from the patient and his father and mother — viz. That * The parts inclosed in this tight bandage, were so girded, that, there was no possibility of any circulation being carried on thro' them, in the state of the limb at this time; when first ap- plied, it must have retarded considerably the return of venous Blood and other fluids, and in a short time, did effectually prevent the course of the Arterial Blood thro' the canals appropriated for this purpose—hence increase of pain at first, and tumefaction, ob- structions and even incipient gangenre.—This bandage very rationally explain'd all the dreadful appearances in the limb, without seeking further, or having recourse to other more remote or occa- sional causes. [21] That he had been seized about eight days before, with a pain at his Ancle joint, which he did not pretend to account for, by any thing that occurred to his own observation or recollection, such as a fall, sprain, &c. or in short, any external violence; the pain became more violent by degrees, and in a very short time was accompanied with irre- gular shiverings and fever and sundry other symptoms denoting inflammatory mischief in the Joint;—redness, but very little or no tumefaction at first, and an inability of bearing on the Limb. After three or four days from the first attack of pain, the disorder not abating, but on the contrary growing from bad to worse, every one of the symptoms enumerated, be- ing by this time considerably increased, the poor [22] poor fellow was carried, partly by the advice of his misguided friends, and partly of his own accord, to Mr. F—, the bonesetting man of this country. Mr. F— assured the poor boy and his friends*, who all piously and implicitly believed in him, that (to use the man's peculiar expressions, which are indeed extremely characteristic) the main Bone of the Leg was split and the Ancle out of Joint—how cruel was this decision! how grossly impudent and ab- surd!—but what he said (really as if he had been a God) was law, absolute law to his hearers—he was not only Judge in the Case, but Executioner too—he put the poor boy to the rack, he inhumanly and unfeelingly * But not till he had examin’d or twisted the joint (which in the language of this Bonesetter are synonimous terms) and thus prepared the poor deluded sufferer for the Tragedy, that must ne- cessarily succeed this probationary kind of punishment. [23] unfeelingly tortured a fellow creature, whose pains were already intolerable, and almost beyond his strength. This new torment he could not possibly bear without repining; nay, he even went so far as to declare, in the extremity of his suffering, that indeed, upon his word, he had gotten no hurt, no fall, no sprain*; Mr. F—paid no sort of regard to these sincere expressions, persisted obstinately in his * It is necessary to observe, that these questions had been put to the young man repeatedly, by his friends, previous to his visit to Mr. F—, and the same were reiterated by him;—the young man constantly and steadily deny’d, that he had received any injury from any external cause whatever;—upon which, Mr. F— desired that he might not be press’d any more, nor be teased with any more questions upon that subject. I will not go into a par- ticular examination of the Bonesetter's motives for this conduct, as that must be totally unnecessary, the smallest degree of penetration will enable any person to see thro’ such ingenious directions—how- ever, from this account, (the truth of which nobody will deny) this was clearly no case of fracture, fissure or luxation; the only vio- lence inflicted upon the bone and joint in question, being the rough treatment they received at Mr. F—’s hands—can any thing be more compleat then, than the imposition and deceit of the Bonesetter, in this instance?—and even supposing for a moment, the case to be such, as Mr. F—said it was, his manner of treating it, was utterly wrong and extremely reprehensible. [24] in his first decision*, set as he calls it, the pretended dislocation and split-bone, bound him up, as I have observed above, and strictly enjoined him and his friends, that the bandage should not be unloosed upon any account—then sent him home (a ride of six miles) and desired they would meet him again at Huntingdon, at the end of a week, which they faithfully promised to do;—but herein they failed.—the poor fellow at this time, took a final leave of Mr. F—:he was taken home and put to bed, had more pain than ever; the disease now extended itself thro’ the whole Leg, including the knee Joint and great part of the * I cannot avoid making use of that word decision, tho' it may seem to be improperly applied, and that I ought to have said opinion, but as I do not believe Mr. F—could entertain such an opinion of the Case, whatever he might think of it, I hope it Will be allowed me, that the former of the two words is most applicable. [25] the Thigh, in consequence of the tight ban- dage*, his feverish symptoms were encrea- sing upon him with rapidity, and when my Father first saw him, the time of his dissolu- tion seemed to be near at hand—but in the book of providence it was ordained, that he should sufFer yet much more—GOD had not as yet done with this Child of sorrow, upon whom he had (wisely no doubt) cho- sen to exercise his chastening. D This * I say, this dreadful change and increase of the disease, de- pended chiefly on the tight bandage put on by Mr. F—, and I have not a doubt in my own mind about this matter—every body knows the common effects of a tight bandage or ligature (which in this case are exactly the same thing) upon any found part, viz that at first it impresses a disagreeable kind of sensation, which presently amounts to a painful one; and if continued beyond or up to a certain pitch, inflammation and obstructions come on, and mortifi- cation inevitably ensues;—these are known to be the common effects of a ligature apply’d to found parts—every person will see at once, that the effects of this, upon a diseased part, and more especially upon an inflam’d one, cannot possibly be at all more favourable or less dreadful; and they will agree with me, that the tight bandage in this case (to which I impute most of the mischief) together with the operation of setting the pretended dislocation, &c. will very reasonably account for the course this disease took, after such cruel and improper treatment. [26] This tale, as much as I have dwelt upon it, did not take up any considerable time in the plain recital, and no time was lost in administering as much comfort to the poor fellow, as the nature of the Case would admit—my father recommended the anti- phlogistic regimen in a moderate degree, as much indeed as the fever would admit, which was of a disagreeable kind and mani- festly tending to putrescency, and ordered the proper applications to be made to the Limb, to favor, as much as could be, the suppuration that must necessarily ensue from so violent an inflammation,— in a few days, there was a fluctuation to be felt on each side of the Leg, very near the Ancle; two pretty large incisions were made at these points, and there was a vast discharge [27] discharge of fœtid Pus, which, in point of consistence, was rather thin than otherwise; its complection was variegated, some clots of extravasated blood issued out of the wounds, and, which was very striking, a considerable quantity of an oily matter, very distinct from the other contents of the imposthumation;—this at first sight, I con- ceived, might be part of the contents of the membrana adiposa, not yet gone into sup- puration, but liquesied by the intenseness of the inflamation; but after examining the cavities on each side with a probe, and find- ing that the Bones Tibia on one side and Fibula on the other, were denuded of their Periosteum, I concluded that this oily matter could be no other than the Medulla of the Bones, and that they were diseased. D2 The [28] The poor fellow did not experience that ease, which almost invariably follows the opening of a common abscess come to matu- rity; tho’ the swelling and inflammation had a good deal subsided, yet the Limb remained preternaturally large, could not bear hand- ling, even in the gentlest manner, and the Knee in particular and anterior surface of the Tibia in its whole length, were exceed- ingly painful: He had still a great deal of fever, accompanied with irregular rigors, which plainly indicated the formation of more matter, which pointing upon the Thigh in two or three places, was let out, and se- veral other openings were made round about the Knee, and in different parts of the Leg, as they became necessary for the discharge of pus. By [29] By one of these openings upon the Leg, the anterior surface of the Tibia, including its anterior and internal edges, and in length about three or four inches, was laid bare, the Bone in this place was no other- wise diseased, than as it was of too white a color, for a living bone, in a subject of the age of our patient; it was firm and im- moveable, but had lost its periosteum, and at this time, there was no circulation carri- ed thro’ it—it was a dead bone to all intents and purposes, as truly so indeed, as if it had been amputated. The sides of the wound in this part, which I should observe, was made by cau- stic, were hard, tho’ covered by spongy granulations, and even bony, and stood very high above the surface of the tibia—I then suspected [30] suspected this case would prove to be an in- stance of internal exfoliation, and my suspi- cion was strengthened every day; the bony sheath, the principal diagnostic in this disease, being in a short time very plainly to be dis- tinguished, thro’ the teguments from the upper angle of the wound, as far as the Knee; and in it there was a division or separation, which was a continuation of that deficiency in the sheath, which the wound detected, of a pyramidal figure, whose base was to- wards the wound, and its apex came very near the Knee. This opening in the sheath was capable of admitting my sore finger at its greatest width, and both edges of it might very ea- sily be made out thro’ the teguments, which were exceedingly thin in this place—from the [31] the lower angle of this wound towards the Ancle, the bony sheath could not be so distinctly felt, by reason ofthe greater thick- ness of the teguments in this part of the Leg; by introducing a probe, however, an edge of the sheath was to be felt, even here, at the distance of about an inch or an inch and a half from this lower angle of the wound; but the examination gave him some pain, and occasioned a slight flux of arterious blood, from a ramification of a vessel, whose dia- meter was increased very considerably; the hemorrhage, however, was easily restrained, by the application of a bit of dry lint with a gentle pressure, continued for two or three minutes*. These * At last the amputation of the Leg afforded me a sad op- portunity of confirming my idea of the case, as will appear when I come to describe the diseased appearances, &c. [32] These things took place successively in a period of thirteen or fourteen weeks, in all which time, the poor fellow had scarce a moment of ease, that was not procur’d him, by the exhibition of an opiate—he was by this time almost a shadow, exceedingly ema- ciated, and had colliquative diarrhæa and night sweats alternately, and sometimes both together; when the one remitted at all, the other was but so much the more increased; and we expected to hear of nothing so much as his death for many days;—however, with the advantage of a good constitution, and the assistance of Cortex Peruvianus & Elixir Vi- trioli, Decoctum Album & Tinctura Thebaica, and a generous diet, he not only withstood the repeated attacks of these dreadful and pernicious symptoms, but at length gain’d a sort of mastery over them; not a [33] a compleat one, however, since they now and then returned, tho’ not with their usual and original violence*—his health growing bet- ter, and the case still likely to be very tedious, and our patient requiring more attendance, than he could possibly have at his Fathers house, on account of its distance from Hun- tingdon—he was convey’d from Shooter’s Green, to Mr. J. Read’s, at Godmanchester, where there was a commodious and comfort- E able * About this time, my Father was very much inclin’d to am- putate the Limb, being very certain, that both the Bones of the Leg and the Tarsal Bones, were very much diseased: the hazard from the operation, would not have been so great, as the colliqua- tions, occasioned by the irritation and absorption of pus, were dangerous and destructive;—but these did somewhat abate of their violence, and which was of great consequence, the Knee was now visibly improving in every respect, the pain at this Joint, which had been exquisite and without remission, now gave way to ease, which was more than a bare privation of pain, it diminish’d in size,—every wound near it, and there were many, discharg’d a pus of good condition, and was evidently healing—all these favorable appearances induc’d my Father to hope that the Knee might be saved, and as this was an object of great consideration, I think it justified him in his determination to wait longer—the attempt was a glorious one, and worthy of an humane Man and a good Surgeon, tho’ it failed in the event. [34] able room prepared for his reception,—in this family he experienced the most friendly treatment, and the very active part Mr. Read took, in rendering every assistance and com- fort in his power to his young friend (being unto him as a nurse and second Father) deserves to be recorded, as it does honor to Humanity, Christianity in general and the Quakers in particular. He continued at Mr. Read’s during the remaining part of his ill- ness, a period of six months;—in the former part of this time, I may say up to the time when the leg was amputated, the diseased Limb passed thro’ a vast variety of changes, which, it would be as irksome for me to write, as the account would be tedious in the reading, and as so very full and minute a de- scription, would be very unnecessary and superfluous, [35] superfluous, I hope the omission will be rea- dily forgiven, and I shall take notice of every circumstance that is curious and interesting, and worthy of observation in this case, in my account of the diseased appearances, &c. by dissection. The state of our patient’s health, bating an interruption of a day or two sometimes, con- tinued at about the same standard, which was wonderfully good, considering the discharge, which was at all times plentiful, tho’ he now scarce ever complain’d of violent pain, as he had been wont to do; he was sometimes, however, as I have observed, disordered by new imposthumations of which, there were several, some very considerable, others of little or no importance, and these things re- tarded the cicatrisation of the wounds in the E2 neighborhood [36] neighborhood of the knee;— he slept very well and without the use of Opium,—had no profuse sweats nor purging stools, that had been so inimical to his strength, which last was now increas’d, tho’ he was yet very far from being robust or muscular—his appe- tite was very good—he was able to sit up the greatest part of the day without any fatigue;—he remain’d in this sort of way nearly four months I believe, and then fever, inflammation, pain and their consequent train of evils returned with redoubled vio- lence—the whole of the Limb was affected to a great degree, the Knee sympathiz’d with the other parts of it, was again enlarged and very painful, and the foot which had always been in a very quiet state hitherto, now par- ticipated in the general injury done to the Leg, [37] Leg, &c. the feverish symptons having con- tinued seven or eight days, were now vanish- ing gradually, and a vast quantity of pus, which was very deeply situated, found its way out, by some of the original openings, near the inner Ancle, and then the tumult which its formation and detention had crea- ted, entirely subsided;—the poor fellow was very much extenuated by this last severe trial, and life was once again at an exceed- ing low ebb—the appearances of the Leg, were so changed for the worse, that we had now no longer any hope of saving any part of it—the Patient saw it exactly in the same light, and it was his proposition that it should be taken off—this proposal so ac- corded with my Father’s idea of the case, at this time, that he immediately and gladly gave [38] gave into it, and the necessary steps previous to the operation, were taken without loss of time—Dr. Hopkins was consulted, and he too advised the amputation of the Limb, as the most probable means of saving the Pati- ent's life. On Tuesday, February the 1st, 1786, my Father performed the operation above the Knee, Dr. Hopkins, Mr. J. Stephenson, and myself, being his assistants—the poor fellow bore the operation (which took up more time than usual, on account of the great number of vessels which required lig- atures) with the fortitude of a Hero and the resignation of a Christian; he passed the first eight days (in which time most of the infor- tunia consequent upon the operation of amputation take place) with more than com- mon [39] mon quietude; he had very little of the symptomatic fever, I think I may say none at all, ’til the 6th and 7th evenings, and then in a slight degree only—the sympathetic pains were not so favorable—they were exceedingly violent at times, but, for the most part, by a moderate use of Opium, he was tolerably free from these and all other kinds of pain. The 7th Day from the operation the dres- sings (being now rather offensive) were removed, and discovered a much healthier looking Stump than we could possibly ex- pect, considering the flabby state of the Muscles, and universal debility of the habit of our Patient; the Bone had not yet thrown out any granulations, but by the timely ap- plication of the flannel roller, it was, at the next [40] next dressing (being two days from the first) well covered, and a good suppuration esta- blished; the ligatures came away in due time, and the Stump healing very rapidly—the health of our Patient now began to amend in good earnest, his appetite for food, his spirits, and natural sleep all return’d, as it were by inchantment; he grew fat and strong all on a sudden, and at this time, six weeks from the operation and seven months from the begin- ning of the disease and his confinement, he was well enough in every respect to get out of the house, if it had not been for the incle- mency of the weather;—he tells me, how- ever in confidence that in spite of the cold and wet season we have had, and the orders of his Surgeons, he has already been once or twice out of doors—and now, nothing mate- rial or worthy the attention of those who are not [41] not as much interested in this case, as the Patient and his Surgeons are, can be foreseen; therefore it is high time for me to conclude this history, which I am afraid will be thought too prolix and exuberant in some parts, as I have not been so careful to shorten the account, as to render it plain, intelligible and satisfactory—if I have been so fortunate as to accomplish this ultimatum of my wish- es, I shall not so much dread the keen sar- castic remarks of the most learned critic, as I shall rejoice, and with good reason too, in the thanks and excuses of the candid, hu- mane, and more unlearned reader. Thus having finished the account of our Patient, I have only to add some account of the most remarkable and curious appearan- ces in the diseased amputated Limb by F dissection [42] dissection, which I had the honor to demon- strate to Dr. Hopkins and my Father, and then I shall have acquitted myself of my promise to my Friends and the Public. Appearances in the diseased amputated Limb by dissection. THE Leg (including the Knee, Ancle and Foot) was preternaturally large, but not œdematous—the superficial series of Veins were very numerous and varicose, and the lymphatic vessels were manifestly ex- ceedingly dilated, the Skin being taken off, the Membrana cellulosa was found to be uni- versally loaded with a hard disagreeable kind of fatty substance, and from it there issued a small quantity of lymphatic or serous fluid—this fatty substance (which was thicker [43] thicker in some parts than others) made up a considerable part of the bulk of the Limb; the Muscles were all of them very much dis- temper’d being of a very loose and flabby tex- ture, a good deal wasted, and the fibres almost white; in short, they scarce preserv’d one of their common characters, and were as unlike Muscles, as any other part of an Animal Body. Of the Bones, it is necessary to begin with the state of the Tibia, as until that is explain’d and understood, every other part of the subsequent account must be inex- plicable and obscure—indeed the Tibia was the most curious, and remarkable of the diseased parts and very worthy to be recorded;—it presented a disease, F2 which [44] which is very rarely seen* and which is very properly called Internal Exfoliation, as that name is exceedingly descriptive of the ap- pearances in this wonderful disease;—this Bone bore most indisputable marks of it— the original Bone Tibia, or more properly the remains of it, was really inclosed in a Sheath * Mr. SHELDON, Professor of Anatomy to the Royal Academy of Arts, whose very superior abilities and acquirements in Anatomy and Physiology, must ever be acknowledged and ad- mired by every impartial person, and for whom I have the highest respect, had, when I attended his lectures a twelve month ago, only one preparation of this disease, in his collection of diseased bones, which is very large, and continually increasing;—I am inform’d by a correspondent in London, that Mr. S. has not yet found another instance of this sort; but I have found in the London Medical Observations and Inquiries, vol. 2d. art. 25th. a short account of of a case nearly similar to this (tho’ not under the same name) communicated to the Society, by the late Dr. WM . HUNTER, which is illustrated by two engravings, of the diseased Bone, to which, I must beg leave to refer my reader, as these will give a more just idea of the Phenomena of this case, than I possibly can by words; in those engravings it will be observed, that the callus or adventitous Bone commences at the Symphysis of the Epiphyses and body of the Tibia at both ends—in the case before us, the Epiphyses of the original Bone had suppurated away, and the sheath was a regeneration of Bone, even from the joint of the Knee to the Ancle;—excepting in these particulars, and the exfoliation from the inferior extremity of the old Bone, which lay loose in the sheath, in this case, I believe the circumstances of the Tibia and sheath were exactly alike in both of them. [45] Sheath of newly formed Bone—the epiphy- ses had suppurated away from both ends of the old bone; and from the lower extremity, a considerable piece of the body of the Bone in its whole substance, had been exfoliated, and this lay loose in the Sheath—the upper extremity of the old Bone, had not made any sensible exfoliation, the epiphysis only was deficient here, but had a very irregular scabrous surface, and was putrefying away in a slow and almost imperceptible manner, excepting at its two extremities, this Bone had not undergone any material alterations, it was a dead but not a diseased Bone;— that portion of its anterior surface which had been for a considerable time expos’d to atmos- pheric air, was become yellow and even brown; by way of explaining these appearances, I must [46] I must take the liberty to observe, that the disease was seated originally, or commenced in the lower epiphysis of the Tibia and periosteum of that Bone;* the disease (I’ll call it an inflammation) extended its baleful influence up the Limb above the Knee, in consequence, I must repeat it again, of the rough handling of Mr. F—, and the tight bandage, hence increase of pain, inflammation, swelling, fever, large suppurations, and every bad symptom—the periosteum in consequence of the inflammation, sloughed away, and this membrane being the medium of supplies to the Bone (the vessels nourishing the Bone and those destined for the secretion of me- dulla, * Perhaps the Tarsal Bones might be affected, as early as the first complaints of the Patient, and these Bones being so thoroughly distemper’d at the time of the amputation, makes very much for that idea. [47] dulla, running thro' it) the course of the fluids in these was impeded, and at length compleatly obstructed; the Bone, therefore, died for want of its necessary and accus- tomed supplies, and the vessels, which before this time, were appropriated to pass into the substance of the Bone, and furnish it with its proper juices, being now deprived of their employment, and put out of office as it were made a grand effort, and began to form a new Bone, that might supersede the old one, and answer every purpose of that Bone,—the epiphyses of the Bone being of a more spongy texture than the body of it, had gone into suppuration, and there were now no remains of these parts, the body being more compacted, had not undergone any material change, there was a large piece, as [48] as I have observed, exfoliated from the lower end, and these things must have taken place previous to the death of the Bone, suppura- tion and exfoliation being both effected by distinct operations of Nature, and not to be brought about by Art—the remaining part of the Bone being depriv’d of life, and all its supplies, was now left to putrefy—the Sheath was incompleat—at its upper end where it had made a new articular surface with the Os Femoris, and an Anchylosis was form’d; there was an opening capable of ad- mitting one’s finger, which being introduc’d easily reached the ragged end of the old Bone—there was also, a deficiency of a piece of several inches in the fore part of it; at its lower end, where it had also formed a new articular surface and an Anchylosis, with [49] with the Astragalus, there were three open- ings, one of them between it and the remains of the Astragalus, and the other two, one on each side, very near the extremity; these three last, communicated one with another and were each of them capable of admitting a finger; that one, however, between the Sheath and Astragalus, was most capacious, and by it I extracted with my finger, the exfoliated Bone, being one large piece and two or three smaller ones—and now intro- ducing my finger again into the Sheath, I was not able to reach the end of the old Bone—in every other part, the Sheath was compleat and found, preserving the common characters of the Tibia, whose place it was intended to supply, it was not so smooth as that and most other Bones are, being not G yet [50] yet so highly finished, but would very pro- bably have served every purpose of that Bone, could Nature have rid herself of the old one, which could be considered in no other light at this time, than as an extrane- ous body, or could such a thing have been effected by Art—but the Patient must have died before Nature could have accomplished the work in her gradual manner, tho’ she had certainly made a considerable progress in her attempt, and it was utterly impossible that any warrantable efficient or successful operation in Surgery, could materially assist the Dame in this undertaking—what an amazing and stupendous piece of work had Nature wrought in the formation of this Sheath! how wonderfully industrious and indefatigable must she have been, working under [51] under the many and great disadvantages which she did, to accomplish so elaborate a composition, as the making such a quantity of new Bone!!! I will not enter into a particular descrip- tion of the mode by which this Sheath of Bone was built up; all Medical Men know very well, that it was done by a set of Ves- sels, which Anatomists call the absorbent system*, and it is unnecessary and almost im- possible to explain this matter, in a satis- factory manner, to any other class of people, in the limits I have prescribed to myself, G2 in * Mr. SHELDON when speaking of this System, used to draw a parallel (and not unaptly I think) between these vessels and the Mason—he would say, the exhalant Arteries, which are com- prehended in the same term, are the laborers bringing down the materials, to be properly disposed and worked upon by the Lym- phatics, which having executed their office, those vessels, which are most properly called Absorbents, are employed in carrying away the refuse—I think this very operose and complicated performance, could not have been rendered more familiarly, more justly, or more intelligibly, than by this allusion. [52] in writing this case; I shall, therefore, finish this part of it by saying, that I broke the Sheath, by twisting it in my hands, near the lower extremity, which was its weakest part;—the old Bone remained in the upper part of the Sheath, which I drew out with little or no force, being entirely detached from the inside of the Sheath, and from all other living parts,—I now discovered that the inside of the Sheath was lined with a Membrane which was purulent, and even ulcerated in some parts, where the ragged ends of the old Bone had been in contact with it. The Patella had formed a genuine Anchy- losis with the Os Femoris, anteriorly and externally, and considerably higher than it ever is in the strongest contractions of the extensor [53] extensor muscles of the Leg; its articular surfaces had none of the cartilage common to this and all moveable joints, this being compleatly eroded and a bony union formed between it and the Os Femoris;—it was already immoveable, in a soft state and easi- ly penetrated by a knife—the articulation of the Os Femoris with the Sheath of new Bone, was partially anchylosed, enjoying still a little motion; the Cartilages and Liga- ments, however, were compleatly gone from hence too, and a bony union had begun to take place—the Condyles of the Os Femoris, and articular surface of the Sheath were so soft, that an impression could easily be made upon them with a Finger—this Joint had doubtless gone thro' every stage of disease, having lost its Ligaments, Cartilages, articular [54] articular Surfaces, &c. but this part of the case was now in a convalescent state, and it had made a great progress towards the natural cure. The Fibula, as I have before observed, had been diseased, but was now perfectly found, firm, not even penetrable by a knife;—it preserved its situation, but had lost its original shape, was anchylosed by its articular surface to the Sheath above; and where it came in contact with it below, had also formed a bony union;—it was also rigidly anchylosed with the Astragalus—the Fibula was probably another instance of a regeneration of Bone—the Bones of the Tarsus were all in a carious state at this time, the disease having made a further progress in some of the Bones than it had in others, the [55] the Cartilages forming the articular surfaces, in most of them, were eroded and Anchylo- ses begun; the articulation of the Ossa Cuneiformia and Os Cuboides with the Metatarsal Bones, were not yet injured, but those Tarsal Bones were diseased and in a very soft state— the Astragalus Os Calcane- um and Os Naviculare had suffered most of all—all of them, being so much eroded, and having lost so much of their substance, that they could be known by no other cha- racter or mark than their situation. The Metatarsal Bones had never been dis- eased, were at this time perfectly found, as were the Bones of the Toes. POST- [56] POSTSCRIPT. SINCE these sheets were sent to the press, I have been called in, together with Dr. Hopkins, to attend Mr. R. Bond of this Town, deceased.—This young man’s Case, has been a good deal talked of, and, like that of my former Patient, Mr. J. Andrews, has been variously misrepre- sented; I propose, and I hope it will not be unacceptable, to give the public, as much of the history of this case, as has come within my own knowledge and observation: it will serve to illustrate and confirm, what I have lately advanced, respecting the mal- practice of the Bonesetter so frequently alluded to in the course of the foregoing narra- tive; and if it be allowed me, that the preceding [57] preceding case is a proof of his knavery, I have no doubt, but this case, will be still a stronger proof, as well of the ignorance, as the dishonesty of that man—I shall not take up my readers time with reciting the various and contradictory accounts of the friends of the deceased young man, and of those who have seen him in his confinement, nor shall I take any notice of others, which I know to be untrue, as this would be beside my de- sign in this postscript, and would lead me far beyond what is necessary that I should relate. About ten weeks ago, this unfortunate young man, had the misfortune to be over- turned in a cart, which fell upon him and broke his Thigh Bone, about three inches above the Knee-joint, the broken end of the superior portion of the Bone, protruded H thro’ [58] thro’ the Muscles and Integuments, on the external side of the Thigh—this was a terri- ble accident! but it was not the worst part of the young man’s misfortune—by the help of the best Chirurgical Means, he might have been restored—but he was yet more unfortunate, in being put into the hands of an ignorant and wicked Bonesetter—this was, eventually, fatal to him. On Thursday the 23d of March, Doctor Hopkins and myself were desired to visit him, being now at the point of death, and his friends dissatisfied, at length, with Mr. F—’s manner of treating, or rather neg- lecting him—the following was the state of his Body and Limb at this time. He was in as low a state, as ever I remem- ber to have seen any person, and seemed to have [59] have but a few days, to drag on a miserable existence, and an insupportable load of dis- ease; he was exceedingly emaciated, his skin was dry and scaly, or more like shri- velled parchment than any thing else perhaps,—his pulse was very small and tremulous, but yet astonishingly quick, it was hardly possible to reckon them; when I say, they were at the rate of an 150 strokes in a minute, I do not exceed the truth—the heat of his Body was not much, it did not amount to a feverish heat, I think—his Tongue was brown, his Breath very offensive, his eyes were sunk in their orbits, and had that glassiness or lack lustre, which is so striking to the beholder, and yet cannot be described—tho’ he was so ex- ceedingly low, as I have observed, yet he was as far from despondency as he was from H2 hope [60] hope—he appeared, as one who had from long protracted sufferings, lost all irritability, and sensibility—tho’ his mouth was furred, and his tongue parched with thirst, he scarce ever asked for drink—he seldom or never complained of pain, which, it is ex- tremely hard to conceive, he could be entirely or indeed at any time free from;— he took hardly any food—I cannot say that he was utterly void of reason, or other- wise; he had just so much of his mental faculties left, as would enable him to return a just answer to any question that might be put to him, concerning himself and his im- perfect feelings. His nurse told me that he had been pretty nearly in the same sort of way for several weeks, but that he was now worse than ever [61] ever*—the Toes, Foot and Ancle of the Limb that had received no injury be- fore, were now, thro’neglect, cold, languid circulation, &c. mortifyed—in the superi- or and external part of the fractured Thigh, there was a large collection of matter, which had made a bag for itself in this place, ha- ving no other vent, than an opening of the bigness * Whilst I am enumerating the variety of ills the young Man labored under, notwithstanding my late determination, not to animadvert upon the different stories that have been told, I think, I ought in Justice to the ashes of the defunct, and for the satis- faction of his inconsolable friends, contradict a report, that has been maliciously circulated, which is a very injurious one to the repu- tation of the young man, as to his moral character, and which it plainly appears, he is by no means deserving of;—I am sorry to say, it has gained a degree of credit in the minds of some people—it is a report, which has no sort of foundation in the world, that I can find; and seems to be taken up only, with the benevolent idea of taking off, from the odium Mr. F—may have incurred by his fatal maltreatment of the case.—It has been industriously spread abroad, that this abused young Man had the Venereal Disease, at the time of his accident, and that this distemper was one great and efficient cause of his death—this report is as untrue, as it is scandalous and cruel—I make the assertion with the more boldness, because I was enabled to ascertain this fact, by carefully examining the body, after the decease of the Patient, which I did with a particular view to this object, having heard of the report previous to his death;—and I do take upon me to affirm, that he had no one symptom, either pathognomonic or equivocal of that disease. [62] bigness of a pin’s head, on the anterior part of the Thigh, where the Skin had given way to the efforts of the confined pus; this, for want of a more favorable and depending opening, was diffused extensively in every possible direction, by means of the reticu- lar membrane, and had made its way in the interstices of the Muscles of the Thigh and Leg; the end of the superior portion of the fractured Bone, as I have observed, protrud- ed forth from the wound it had made in the Muscles and Integuments about two Inches, and this part was as rotten and dry as a piece of touchwood; this protruded end of the Bone was, within a very little, as low down as the head of the Fibula or small Bone of the Leg—examining it, I found, the fracture was very oblique, there being a manifest deficiency of Bone in that side of it [63] it next the Thigh; there was a vast discharge of sanious and offensive matter by this wound, which at first I imagined was sup- plied by the bag, at the superior part of the Thigh beforementioned; but as the dis- charge by this wound did not lessen, when that bag was laid open, and there was now no longer any detention of matter, this was an improbable conjecture. I could easily feel the broken end of the inferior portion of the Bone thro’ the Integu- ments, &c. and I thought the two ends of the broken Bone, were at least six inches asunder—the Knee-joint was rigid—the Leg had several small openings upon it; these were chiefly upon its anterior surface, and a few only on its external surface— introducing a probe at any one of these, I found [64] found they all communicated one with ano- ther—they each of them discharged matter, which came originally from the Thigh. With the consent of Dr. Hopkins, I made an incision into the bag of matter at the su- perior part of the Thigh, extending from the great Trochanter, about three inches downwards; a great quantity of matter fol- lowed the knife, and I found that the mus- cular Fibres were exposed; the matter had been formed and confined under the Fascia lata of the Thigh. I also enlarged some of those openings, that were most depending, and favorable to the discharge of matter on the Leg—as to the fractured Bone, nothing could be attempted at present—if the poor young man had survived, and recovered his health and [65] and strength, an incision must have been made thro’ the Integuments, and the rotten end, at least, of the superior portion of the Bone, must have been sawn off—there was no other way of reducing the fracture, at this stage of it—an operation of this mag- nitude, in which the Patient would have been liable to a Hemorrhage, which would probably have been exceedingly trouble- some to stop, which he could but illy support, and which would necessarily have given him great disturbance, could not be proposed at this time, on account of the debilitated state of the Patient;—it would have been an artificial way of shortening his existence. Dr. Hopkins prescribed the Bark for him, to be taken as frequently, and in as large doses as his Stomach would bear, and we I thought [66] thought, with some advantage at first—but this idea was vain— he took a Dram of the Powder of Bark with a grain or two of Rhu- barb in the form of a Bolus every fourth hour for 48 hours;—and afterwards, till 4 o’clock on monday morning the 28th of March, the same dose, once in two or three hours—at that time, he begged to be ex- cused taking any more bitter doses, and his nurse presently afterwards perceived that he was very much changed—he became now, for the first time, delirious; he was very importunate for a pan of coals to be brought to him, that he might warm his hands, he said—which indeed were now very cold— I saw him about half an hour past eight o’clock in the morning, when he was sink- ing very fast, and the near approach of Death [67] Death was but too visible in his distorted features—I desired he might not be disturb- ed—he died, about half an hour past ten o’clock the same morning, a Martyr to that infatuation, which prevails so astonishingly in some parts of this country with regard to Mr. F—. I obtained permission of the friends of this unfortunate deceased young man, to examine the Thigh and the state of the fractured Bone—I dissected off the Skin, and with it the Fascia of the Thigh, under which last, and in the interstices of the Muscles, matter was universally diffused—I could not but ob- serve, that the lymphatic Vessels and Glands, were amazingly enlarged, tho’ it was hardly necessary to take notice of this circumstance in this place—I then cut immediately thro’ I2 the [68] the Muscles (which were in general much injured by the destructive matter) from the Groin to the Knee;—when I came over the fracture, my knife plunged into a pond of Matter, in the midst of the muscular mass, from whence flowed the discharge, that was continually dripping from the wound by the protruded portion of the Bone. Having cleared away this Matter, the in- ferior portion of the broken Bone now be- came an immediate object of my senses, it was in a very diseased and carious state—yet from its side just above the external Condyle and below the Caries, it had thrown out healthy granulations, and these were now bony—the superior portion of the Bone, just above the rotten end, had thrown out granu- lations all round, so that where it passed by, and [69] and came in contact with the side of the infe- rior portion, a slight union was formed— from the broken end of the superior protrud- ed portion of the Bone, to the broken end of the inferior portion of the same, there was a space of six inches at least;—I did not mea- sure these parts exactly, but I am certain, I am considerably within bounds when I say, there was only a space of six inches between the broken ends of the Bone. It appears plainly enough from this ac- count of the case, comprehending only the last four or five days of his life, and the ap- pearances of the Limb after death, that the poor young man had derived no earthly advantage from the Art of Surgery, which in this enlightened age one might reasonably expect, that he would have received consi- derable [70] derable benefit from; and that he literally and truly perished thro’ the ignorance or negligence, or both, of Mr. F— The broken Bone had never been reduced, or if it had, the fracture had never been pro- perly secured; I found the broken end of the superior portion of the Bone protruding two inches at least (and it had always pro- truded more or less from the time of the accident) but so much of it was absolutely rotten; an union too was formed, at about the distance of two inches, from the rotten piece of the Bone, by its side, to the side of the inferior fractured portion, just upon or rather above the external Condyle; now this union, slight as it was, could not have been effected in less time than five or six weeks (and it frequently does not happen in twice that [71] that time) in the most favorable case of com- pound fracture, even under the best manage- ment;—in this case then, which was complicated with so many adventitious ills, and involved in so many untoward circum- stances, one could not suppose a priori, that any union could have been formed at all; it must have been begun from the very time of the accident, or at least, in a very early stage of it, and could have met with no interruption by any attempt of the Bone- setter to reduce the fracture—why was not this done? This is professedly Mr. F—’s business; the answer is obvious enough—he clearly did not know how to set about the operation;—for I cannot suppose him to be so ignorant or so negligent as to leave so necessary and indispensible a part of his business [72] business undone, if he had been sufficiently skilful in the art he pretends to be so emi- nently master of, and which he practices with such seeming extraordinary success. The abscesses, that had been formed in the inflammatory state of the Limb, had not been laid open, as they always ought to be in this sort of case; but the matter of them was suf- fered to diffuse itself throughout the Limb, to the destruction of it, and the Patient’s life—in short, the Bonesetter, to whose sole care and management this case was commit- ted, who had the effrontery and wickedness to undertake to cure it, had done no one thing that was proper and necessary to be done, with any prospect of good to the Pati- ent—surely then his conduct, on this occasi- on, was extremely reprehensible, and deserves [73] deserves to be reprobated, on two accounts particularly—first, because he undertook the management of a case, which, it is but too evident, he did not know how to treat; and secondly, because he cruelly and in the most scandalous manner, persisted in his attendance upon the young man, till it was too late for the most judicious Chir- urgicai means to render him any sort of good. If he had given up this case to abler hands, as he ought to have done, when he was first applied to, it might possibly have been cured and a valuable life saved;—or the Limb might have been amputated, if that had been thought most expedient, with a reasonable hope of the same happy event—at all K events [74] events, the Patient would certainly have had a better chance of recovery, with the assis- tance of the most effectual means, exerted by the hands of Judgment and Science, than from the Supineness and Ignorance of Impu- dence and Empiricism—therefore, tho’ I allow, that this young man might have sunk under his first misfortune, in spite of the most powerful aid of Surgery, yet upon the whole, I do believe, that he died for the want of such timely assistance, as the Arts of Physic and Surgery, would have afforded him.—Let them tremble, who have been in any wise instrumental, in debarring the un- fortunate deceased Youth of such feasible, and comfortable aid—in the awful day of Retribution, his Blood, no doubt, will be required of them. FINIS.