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.

  •   1.

    Lucy Mack Smith, Biographical Sketches of Joseph Smith, the Prophet and His Progenitors for Many Generations (Liverpool: Published for Orson Pratt and S. W. Richards, 1853), pp. 62–66.

  •   2.

    Ibid., p. 65.

  •   3.

    Joseph Smith, “Manuscript History of the Church,” Book A-1, Note C, p. 131, Church Archives.

  •   4.

    Le Roy S. Wirthlin, “Nathan Smith (1762–1828): Surgical Consultant to Joseph Smith,” Brigham Young University Studies 17 (Spring 1977) : 319–37.

  •   5.

    Nathan Smith, “Observations on the Pathology and Treatment of Necrosis,” Philadelphia Monthly Journal of Medicine and Surgery, 1827, pp. 11–19, 67–75; reprinted in Nathan Smith, Medical and Surgical Memoirs (Baltimore: William A. Francis, 1831).

  • Le Roy S. Wirthlin, a vascular surgeon, is priests quorum adviser in the Bloomfield Hills Ward, Bloomfield Hills Michigan Stake.

    Can You Read Deseret?

    This pioneering Mormon alphabet was more than an educational experiment.

    “How do you spell ‘through’?” your child asks.

    “T-H-R-O-U-G-H,” you tell her.

    And then she comes home from school with a C on her paper. One of the mistakes you find is this sentence: “John through the ball through the window.”

    Patiently you explain to her that when you mean threw you spell it differently from through. And just as patiently she says, “That’s silly. Why should you spell it two different ways when it sounds the same?”

    Good question! And in pioneer Utah, with new converts pouring in from many European nations, the early Latter-day Saint leaders decided something had to be done about the English spelling system.

    On 19 January 1854, the Deseret News carried an official announcement that explained that the “Board of Regents [of the University of Deseret], in company with the Governor and heads of departments, have adopted a new Alphabet, consisting of 38 characters.” At first, the board of regents had hoped to simply revise English spelling using the existing alphabet. But no amount of juggling, it seemed, could reach their goal: one letter for every sound, and only one sound for every letter.

    So an alphabet, largely devised by George D. Watt, a convert who had studied an earlier phonetic alphabet in England, was adopted by the Territory of Utah. “These characters are much more simple in their structure than the usual alphabetical characters; every superfluous mark supposable, is wholly excluded from them,” said the Deseret News article. But to those used to standard English writing, the Deseret Alphabet looks as if it should be held up to a mirror to be read!

    Spelling reform in the English language was not a new idea. Noah Webster, the creator of America’s pivotal dictionary, simplified some English spellings, changing colour to color, for instance; yet although his changes were adopted in the United States, they never spread back to Great Britain. Other reformers, such as English playwright George Bernard Shaw, have clamored for changes in English spelling.

    How did English spelling get like it is? The reason is basically that English, as a hodge-podge of Anglo-Saxon, Norman French, and smatterings of Gaelic, Danish, and other languages, has become a hopeless mixture of different types of spelling. Actually, though, English spelling was following a natural tendency to straighten itself out as people began to spell things the way they sounded until the great English lexicographer, Samuel Johnson, wrote his definitive dictionary of the English language. Some spelling changes have come since then, of course, but by and large Dr. Johnson froze English spellings the way they were in the eighteenth century—and even went so far as to make many English spellings more difficult by adding silent letters to show the word’s origin. For instance, det was given an extra b, becoming debt, to show its supposed origin in the word debit.

    The Deseret Alphabet was one of the earliest—and in some opinions, one of the best—full-scale efforts to make English spelling sensible. The designers of the alphabet broke down English speech into six long vowels, six short vowels, one aspirate (h sound), and twenty-one articulate sounds (consonants). One professor of linguistics has commented, “The designers of the Deseret Alphabet made a correct phonemic analysis of English on the whole. They were more successful in breaking down the antiquated traditional orthography than many more recent reformers who have attempted to respell English.” (J. M. Cowan, “The Deseret Alphabet,” paper presented to Linguistic Society of America, 27 July 1940.)

    And the Latter-day Saint spelling reformers were serious—they meant the alphabet to be used. Two elementary readers were produced in 1868; after all, one of the purposes of the Deseret Alphabet was to enable children to learn to spell more easily. Articles also appeared in the Deseret News printed in the new alphabet, and the entire Book of Mormon appeared in the Deseret Alphabet in 1869.

    Two lessons from Deseret Second Book

    Two lessons from Deseret Second Book; key to the alphabet.

    The alphabet was also adopted by a good number of individuals. Many pioneer diaries and records were written in the new orthography, and because of the shortened spelling—the word through, for instance, has only three letters in the Deseret Alphabet—many clerks used it for taking down speeches. For fifteen years the alphabet was sporadically used—but the alphabet was impractical for use unless the rest of the English-speaking world adopted it, and the majority of the Saints found it too difficult to learn, or too boring to the eye of the reader. Other more pressing issues and problems took precedence and the alphabet faded from use around 1870.

    The Deseret Alphabet, strange as it seems today, was right in keeping with the pioneer spirit. The Latter-day Saints in Utah Territory were trying to build something new—a new society, a new economy, a new system of governing—and a new alphabet went right along with that reforming mood. As Elder John A. Widtsoe of the Council of the Twelve said: “The Deseret Alphabet represents a noble experiment with a thoroughly worthwhile objective. Mormons have reason to be proud of this episode in the history of their people.” (Gospel Interpretations, Bookcraft, 1934, p. 265.)

    Glenn N. Rowe, assistant Church librarian, is bishop of the West Jordan Twenty-fifth Ward, West Jordan Utah Stake.