"I do not. I think there is as great a chance for the boy to live with the limb on as off—that the bones may be set, and the limb saved as good as ever."
"Will you give me your reasons, and tell me what Dr. Slaughter meant by a compound fracture, and why doctors always amputate in that case; and do it in language that his father and I can understand?"
"A simple fracture is where the bones are broken, but there is no external wound, and when the bones are set they heal for the most part readily. But a compound fracture is one in which the bone pushes through the skin, the muscles are lacerated, or, by the agent that breaks the bone, an external wound made, and air admitted. The laceration of the muscles and the admission of air, especially the presence of air, causes inflammation, the wound suppurates, sloughs, instead of healing, and ulceration is produced; it then becomes necessary to amputate, and the patient, being reduced, often dies. The old physicians thought less of saving the limb than the modern ones, and in case of compound fracture always amputated."
"Is not this a compound fracture?"
"It must be defined as such technically. But the muscles are not lacerated; and though the bone protrudes, I have not the least doubt that it was done by the sharp point of the bone pricking through in consequence of the foot's falling back when they took him up, and that it was not forced through by the violence of the blow. It is therefore so near to a simple fracture that it may be considered and treated as one, with a fair chance of success, especially considering the patient's age, health, and the time of year (for the weather is not hot as yet), and that he is at home, where he will have the best of nursing."
"Mr. Richardson," said the father, "I know in these matters the state of a patient's mind has much to do with the final results. The boy will not submit to amputation except by compulsion. That we cannot think of. But he loves you, and has the most perfect confidence in your ability. Will you set the bones, and do as you think best?"
"Mr. Merrill, I am a young man, without experience to guide me. I have no guide other than what I have gathered from books, a few weeks' instruction, and practice of dissection at Brunswick, and my own unmatured judgment; but I also know that before you can get a physician here from another town, swelling will take place, and the chance of recovery be greatly diminished. I will do it on condition that you take upon yourselves all the responsibility. If a regular physician should amputate the limb, and the result be unfavorable, it would be said he took the regular steps; he would have the authority of precedent, and the approval of other physicians; and the ill success would be attributed to the providence of God; whereas in my case it would be said, 'He is a rash, ignorant upstart and pretender, puffed up with conceit to trifle with human life.' It would destroy confidence in me for the future, and prove a poor introduction to practice."
"We will do that, and, moreover, make it public, let the event be what it may."
Rich now manifested as much despatch as he had previously displayed reluctance.
"Frank," he said, "I shall be obliged to give you some pain, but I will not do it unnecessarily, nor to any great extent."