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A History of American Law
 A History
of American Law
Fourth Edition

L AW R E N C E M . F R I E DM A N

1
 3
Oxford University Press is a department of the University of Oxford. It furthers the University’s
objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is
a registered trademark of Oxford University Press in the UK and certain other countries.

Published in the United States of America by Oxford University Press

198 Madison Avenue, New York, NY 10016, United States of America.

© Lawrence M. Friedman 1973, 1985, 2005, 2019

Renewed © Lawrence M. Friedman 2001

First Edition published in 1973 by Touchstone, an imprint of Simon & Schuster, Inc.
Second Edition published in 1985 by Touchstone, an imprint of Simon & Schuster, Inc.
Third Edition published in 2005 by Touchstone, an imprint of Simon & Schuster, Inc.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval
system, or transmitted, in any form or by any means, without the prior permission in writing of
Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the
appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of
the above should be sent to the Rights Department, Oxford University Press, at the address above.

You must not circulate this work in any other form

and you must impose this same condition on any acquirer.

Library of Congress Cataloging-​in-​Publication Data

Names: Friedman, Lawrence M. (Lawrence Meir), 1930– author.
Title: A history of American law / Lawrence M. Friedman.
Description: Fourth edition. | New York, New York : Oxford University Press, [2019] |
Includes bibliographical references and index.
Identifiers: LCCN 2019007416 | ISBN 9780190070885 ((hardback) : alk. paper) |
ISBN 9780190070892 ((pbk.) : alk. paper)
Subjects: LCSH: Law—United States—History.
Classification: LCC KF352 .F7 2019 | DDC 349.7309—dc23
LC record available at https://lccn.loc.gov/2019007416

1 3 5 7 9 8 6 4 2

Paperback printed by LSC Communications, United States of America

Hardback printed by Bridgeport National Bindery, Inc., United States of America

Note to Readers
This publication is designed to provide accurate and authoritative information in regard to
the subject matter covered. It is based upon sources believed to be accurate and reliable and
is intended to be current as of the time it was written. It is sold with the understanding that
the publisher is not engaged in rendering legal, accounting, or other professional services.
If legal advice or other expert assistance is required, the services of a competent professional
person should be sought. Also, to confirm that the information has not been affected or
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(Based on the Declaration of Principles jointly adopted by a Committee of the

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You may order this or any other Oxford University Press publication
by visiting the Oxford University Press website at www.oup.com.
To Leah, Jane, Amy, Sarah, David, Lucy, and Irene
 Contents

Preface to the Fourth Edition xv

Prologue xvii

I . T H E B E G I N N I N G S : A M E R IC A N L AW
I N T H E C O L O N IA L P E R IO D

I I . F R OM T H E R EVO LU T IO N T O T H E M I D D L E
O F T H E N I N E T E E N T H C E N T U RY: 1 7 7 6 – 1​ 8 5 0

1. The Republic of Bees 77

2. Outposts of the Law: The Frontier and the Civil-​Law Fringe 127
3. Law and the Economy: 1776–​1850 147
4. The Law of Personal Status: Wives, Paupers, and Slaves 173
5. An American Law of Property 213
6. The Law of Commerce and Trade 241
7. Crime and Punishment: And a Footnote on Tort 263
8. The Bar and Its Works 289

I I I . A M E R IC A N L AW T O T H E C L O SE
O F T H E N I N E T E E N T H C E N T U RY

1. Blood and Gold: Some Main Themes in the Law in the Last Half
of the Nineteenth Century 321
2. Judges and Courts: 1850–​1900 355
3. Procedure and Practice: An Age of Reform 373
4. The Land and Other Property 391
5. Administrative Law and Regulation of Business 417
6. Torts 443
7. The Underdogs: 1850–​1900 463
viii Contents

8. The Law of Corporations 495

9. Commerce, Labor, and Taxation 513
10. Crime and Punishment 551
11. The Legal Profession: The Training and Literature of Law 591
12. The Legal Profession: At Work 617

I V. T H E T W E N T I E T H C E N T U RY

1. Leviathan Comes of Age 643

2. The Growth of the Law 661
3. Internal Legal Culture in the Twentieth Century: Lawyers,
Judges, and Law Books 703
4. Regulation, Welfare, and the Rise of Environmental Law 729
5. Crime and Punishment in the Twentieth Century 749
6. Family Law in the Twentieth Century 769

Epilogue: A Final Word 779

Bibliographical Essay 783
Index 797
 Detailed Contents

Preface to the Fourth Edition xv

Prologue xvii

I . T H E B E G I N N I N G S : A M E R IC A N L AW
I N T H E C O L O N IA L P E R IO D
The Skeleton of Colonial Law: The Courts 6
Civil Procedure 24
Land Law 26
Succession at Death 32
Criminal Law 35
Government, Law, and the Economy 44
Commerce and Labor 48
Slavery 54
The Poor Laws 59
Statute and Common Law in the Colonial Period 60
The Legal Profession 63
The Literature of the Law 71

I I . F R OM T H E R EVO LU T IO N T O T H E M I D D L E
O F T H E N I N E T E E N T H C E N T U RY: 1 7 7 6 – 1​ 8 5 0

1. The Republic of Bees 77

Revolutionary Ardor 77
Constitutions: Federal and State 86
The Judges 96
The Organization of Courts 110
Civil Procedure 115
The Law of Evidence 123

2. Outposts of the Law: The Frontier and the Civil-​Law Fringe 127
The Civil-​Law Fringe 137

3. Law and the Economy: 1776–​1850 147

Laissez-​Faire and Its Limits 147
The Business Corporation 159
x Detailed Contents

4. The Law of Personal Status: Wives, Paupers, and Slaves 173

Marriage and Divorce 173
All in the Family: Women’s Rights and Property Rights 180
Adoption 183
Poor Laws and Social Welfare 184
Slavery and African Americans 190

5. An American Law of Property 213

The Land: A National Treasure 213
The Law of Private Land 218
A Cyclical World: The Law of Mortgages 227
Succession: Wills and Trusts 230
Intellectual Property: Patents and Copyrights 236

6. The Law of Commerce and Trade 241

A Federal Question: Admiralty and General Commerce 241
Sale of Goods 245
Bankruptcy and Insolvency 251
Contract 257

7. Crime and Punishment: And a Footnote on Tort 263

Penal Law and Penal Reform 263
Walking the Beat 269
The Substantive Law of Crimes 275
The Crime of Punishment: The American Prison 278
A Footnote on Tort 283

8. The Bar and Its Works 289

The Bar 289
Organization of the Bar 300
Legal Education 303
The Literature of the Law 308

I I I . A M E R IC A N L AW T O T H E C L O SE
O F T H E N I N E T E E N T H C E N T U RY

1. Blood and Gold: Some Main Themes in the Law in the Last Half
of the Nineteenth Century 321
The New Era 321
Organic Law 326
State Constitutions 330
The West 345

2. Judges and Courts: 1850–​1900 355

The Judges 355
Judicial Organization 367
 Detailed Contents xi

3. Procedure and Practice: An Age of Reform 373

Mr. Field’s Code 373
Appellate Courts 379
Codification and Reform 383

4. The Land and Other Property 391

The Transformation of Land Law 391
The Public Land 393
Property Law and the Dynasts 400
Landlord and Tenant 405
Mortgages 406
The Decline of Dower 408
A Tangle of Titles 409
Intellectual Property: Patents, Copyrights, and Trademarks 411

5. Administrative Law and Regulation of Business 417

The Coming of the Bureaucrats 417
Regulating the Infrastructure: Banks, Insurance, and Railroads 419
Occupational Licensing: And the Pull of Public Health 430
The Great Antitrust Act 437

6. Torts 443

7. The Underdogs: 1850–​1900 463

The Dependent Poor 463
Family Law and the Status of Women 471
The Races 482

8. The Law of Corporations 495

Corporation Law: Freedoms and Restraints 495
A Discordant Addendum: The Municipal Corporation 507

9. Commerce, Labor, and Taxation 513

Contract 513
Negotiable Instruments 517
The Law of Sales 520
Usury Laws 522
Insurance 524
Bankruptcy 527
Admiralty 529
Labor and Law 532
Federal Taxation 543
State and Local Tax 545
Death Taxes 548
xii Detailed Contents

10. Crime and Punishment 551

The Many Faces of Criminal Law 551
The Statute Law of Crimes 561
Victimless Crimes 564
Crime, Crime Rates, Insanity, the Guilty Mind 571
Punishment and Correction 576

11. The Legal Profession: The Training and Literature of Law 591
The Rise of the Law School 591
The Literature of the Law 605
Legal Periodicals and Casebooks 613

12. The Legal Profession: At Work 617

The Nimble Profession 617
Organization of the Bar 633
Admission to the Bar 637

I V. T H E T W E N T I E T H C E N T U RY

1. Leviathan Comes of Age 643

Center and Periphery 645

2. The Growth of the Law 661

Welfare 661
The Liability Explosion: Workers’ Compensation 663
More Explosions: Tort Law 667
Constitution, Rights, and Civil Liberties in the Twentieth Century 673
First Nations 687
Asian Americans 689
Hispanics 690
The Revolt of Otherness 692
Freedom of Speech 696
Religion and the Law 699

3. Internal Legal Culture in the Twentieth Century: Lawyers,

Judges, and Law Books 703
Legal Ethics 706
The Organized Bar 707
Legal Education 709
Legal Literature 711
The Twentieth-​Century Bench 718
 Detailed Contents xiii

4. Regulation, Welfare, and the Rise of Environmental Law 729

Land Use 729
Environmental Law and the Environmental Movement 732
Intellectual Property 735
The Welfare-​Regulatory State 737
Business Law and the Law of Business 743

5. Crime and Punishment in the Twentieth Century 749

Crimes of the Century 751
Decriminalizing Sex and Vice 753
Defendants’ Rights 761
The Death Penalty 764
Crime Waves and the National Response 767

6. Family Law in the Twentieth Century 769

The Law of Divorce 770

Epilogue: A Final Word 779

Bibliographical Essay 783
Index 797
 Preface to the Fourth Edition

More than ten years have gone by since I worked on the third edition. Law, like
life, never stands still. Not only have many things happened between then and
now, but the scholarship has continued to grow exponentially. I have tried to
take as much of the new scholarship into account as I could, and I have also
substantially rewritten the entire text, trying to improve phrasing, style, and
emphasis, and sometimes revising my train of thought.
The basic structure remains as it was; I think the structure continues to make
sense. In general, American legal history is a flourishing field. The amount of
work done, and being done, is astonishing. Nobody can really keep up with the
literature—​and it might be useless even to try. This flowering of scholarship is,
to be sure, a sign of progress; it shines new light into a lot of dark historical cor-
ners; it revises a lot of old, hasty, or obsolete notions. But all of this, alas, makes
a work of synthesis, like this one, all the more difficult. I have had to omit a lot.
American legal history is extraordinarily complex. There are fifty states, each
with its own legal history. There are native tribes; and the anomalous position
of Puerto Rico, Guam, and various smaller dependencies. And on top of all of
them, there is a federal system which has grown to monstrous size. The sheer
amount of “law,” even in the most primitive sense, is also of monstrous size,
and shows no signs of abating. We are a law-​ridden society, for good reasons
and bad. I hope I have been able to tell a coherent story, to find patterns in this
chaos of detail, despite the colossal bulk of material that is at least theoretically
available.
History is a moving target. Nothing really stands still. A book of this sort will
be behind the times the day it comes out, and probably even before. Nothing is
ever definitive. The very definitions change. I hope that what I have to say here
makes sense to the reader. Even so, it is necessarily linked to its time and place.
Each one of us is part of a particular society, and no matter how powerful our
imagination, we cannot escape the cage of the present.
The earlier editions have heavily emphasized the nineteenth century, or per-
haps more accurately, what some have called the long nineteenth century, or
perhaps more accurately still, the period from the Revolutionary era to the
1920s. The twentieth century has been relatively neglected. Since 2002, I have
had at least something of an excuse: I can cite my own book, American Law in
the 20th Century. In this fourth edition, I have expanded somewhat the treat-
ment of the twentieth century, but it is still, I must confess, something of a poor
xvi Preface to the Fourth Edition

relation. I could have done more, much more; but it would have made a long
book even longer, and I decided not to go into as detailed a treatment as I had
given the nineteenth century. I have also tried, in this edition as in the earlier
ones, to use as little legalese and jargon as possible, and to write in a way that
might be accessible to that mythical figure, the intelligent lay reader. I sincerely
hope she exists.
As before, I want to thank the marvelous staff of the Stanford Law Library,
now under the leadership of Beth Williams and Sergio Stone, for the magnif-
icent help they have given me. I could not have done these revisions without
their assistance. I also want to thank Vanessa de Mello Brito Arns, for her help
with stubborn issues of formatting. Special thanks to Stephanie Basso and Will
Setrakian for their tremendous help in preparation of the final text; and to Leah
Friedman, who saved me from many errors large and small.

Lawrence M. Friedman
Stanford, California,
Summer 2019
 Prologue

Modern communications and technology have made the world smaller. They
have leveled many variations in world culture. Yet, people still speak different
languages, wear different clothes, follow different religions, and hold different
values dear. They are also subject to very different laws. How different is not
easy to sum up. Clearly, legal systems do not differ from each other as much
as, say, languages do. The new world, the world we live in—​urban, indus-
trial, technological—​creates a certain kind of society; and this kind of society
depends on and welcomes certain kinds of laws. Developed countries have in-
come tax laws, they have laws about computer software, air traffic control, gene
splicing—​and, very likely, old-​age pensions and some form of health care for
some or all of the people.
The exact form that these take, in any particular country, is quite variable.
Much depends on the general legal culture (which in turn depends on the pol-
itics, culture, and economics of the country). Americans are naturally used to
American laws. Law is an integral part of American culture. Americans could
adjust to very alien laws and procedures about as easily as they could adjust to a
diet of roasted ants or a costume of togas. Judge and jury, wills and deeds, the fa-
miliar drama of a criminal trial, an elected assembly or council at work making
laws, licenses to get married, to keep dogs, to hunt deer—​these are all part of
common experience. They are also peculiar to the United States—​in some
ways. No other legal culture is quite like American legal culture. Presumably,
no other culture would fit, or suit, American society quite so well. Nonetheless,
American law is part of a large family of laws: the laws of rich, developed coun-
tries. And all of these have a lot in common.
Many people think that history and tradition are very strong in American
law. There is some basis for this belief. Some parts of the law can be traced
back very far—​the jury system, the mortgage, the trust; some aspects of land
law. But other parts of the law are not particularly old at all. The living law, the
law we use every day, the law that affects us every day, including tax law, traffic
codes, and social-​welfare laws, is comparatively recent, on the whole. While one
lawyer is advising his client how to react to a ruling from Washington, issued
that very day, another may be telling his client that some plausible course of
action is blocked by a statute well known to the lawyers of Henry VIII or by
a decision of some older judges whose names, language, and habits would be
unfathomable mysteries to both attorney and client. But the first situation is
xviii Prologue

much more likely than the second. Some parts of the law are like the layers of
geological formations. The new presses down on the old, displacing, changing,
altering, but not necessarily wiping out everything that has gone before. Law,
by and large, evolves; it changes in piecemeal fashion. Revolutions in essential
structure are few and far between. That, at least, is the Anglo-​American expe-
rience. (In some countries—​China, for example; or Russia—​the changes have
been more dramatic, more revolutionary, at times). Most of the legal system is
new, or fairly new, but some bits of the old get preserved among with the mass
of the new.
What is kept of the old is also highly selective. Society may be fast or slow as
it changes, but in either case, it is ruthless. Neither evolution nor revolution is
sentimental. Old rules of law and old legal institutions stay alive only when they
still make sense; when they serve a purpose today, rather than yesterday. They
have to have, in short, survival value. The trust, the mortgage, the jury are legal
institutions that can be traced back centuries. But they do not seem archaic—​
because they are not archaic. They have come down from medieval times, but
they are still with us because they serve twenty-​first-​century needs. They have
survived because they found a place in our society—​a society that does not
hesitate to pour old wine into new bottles and new wine into old bottles, or
throw both bottles and wine away. At any rate, the theory of this book is that
law moves with its times and is eternally new. From time to time, the theory
may not fit the facts. But more light can be shed on legal history if one asks why
does this survive than if one assumes that law, unlike the rest of social life, is a
museum of accidents and the mummified past.
In an important sense, law is always up to date. The legal system always
“works”; it always functions. Every society governs itself and settles disputes.
Every society has a working system of law. If the courts, for example, are hide-
bound and ineffective, that merely means some other agency has taken over
what courts might otherwise do. The system is like a blind, insensate machine.
It does the bidding of those whose hands are on the controls. The laws of China,
the United States, Saudi Arabia, France, North and South Korea, reflect the
goals and policies of those who call the tune in those societies. Often, when
we call law “archaic,” we mean that the power system of its society is (in our
opinion) morally out of tune. But change the power system, and the law too will
change. The basic premise of this book is this: despite a strong dash of history
and idiosyncrasy, the strongest ingredient in American law, at any given time, is
the present—​current emotions, real economic interests, and concrete political
forces. It may seem a curious beginning to a book of history to downgrade the
historical element in the law. But this is not really a paradox. The history of law
has meaning only if we assume that at any given time the vital portion is new
and changing, form following function, not function following form. History of
 Prologue xix

law is not—​or should not be—​a search for fossils, but a study of social develop-
ment, unfolding through time.
Law and society both have a long and elaborate history in the United States.
Compared to some, the United States is a new country—​but Boston and
New York are more than three hundred years old, and the U.S. Constitution
may be the world’s oldest living organic law. In short, enough time has elapsed
for American law to be essentially American—​ the product of American
experience.
But American law is not an isolate. It has, and has had, close affinities to other
legal cultures. The most important immediate ancestor is easy to identify. The
basic substratum of American law, as of American speech, is English. Before
the Europeans came, the country belonged to the Native Americans. Europeans
came late, but they came in force. They settled first along the coast. The Spanish
settled Florida; the French built New Orleans. Swedes settled briefly on the
Delaware; the Dutch pushed them out. Then the English overwhelmed the
Dutch. The Hudson and Delaware settlements were added to a chain of tiny
colonies, all English-​speaking, along the Atlantic coast. Their populations grew.
More Englishmen came. And English speakers, as Englishmen or Americans,
ultimately pushed out the native peoples, often quite ruthlessly, and took over
their lands; they took over the lands of the French and the Spanish as well;
and they gobbled up a big chunk of Mexico. They established an empire that
stretched from sea to sea. And then they pushed out across the ocean to Hawaii,
Puerto Rico, and the Philippines.
Each culture group lived by its own legal norms. Of many of the systems of
law in effect in some of the native groups, it is fair to say, not a trace remains.
Others kept some of their vitality. There are Native American communities
today with their own court systems, and some bits and pieces of their tradi-
tion live on. Some scholars have claimed to find a speck or two surviving from
the Dutch legal tradition. The office of district attorney may be Dutch in or-
igin. French law gained a more or less lasting foothold in Louisiana, and there
(in translation) it stays. Spanish law sent down wider if not deeper roots; no
state can call its law Spanish, but some aspects of Spanish or Mexican law (for
example, the community-​property system), persist in California and in other
parts of the West. Everything else, if not strictly native, is English, or comes by
way of England, or is built on an English base.
But English law was complex and bewildering. It is not easy to say which
English law was the ancestor of American law. Colonial law—​the law of the col-
onies, up to Independence—​is, after all, an abstraction; there was no “colonial
law” any more than there is “American law,” common to all fifty states. There
were as many colonial systems as there were colonies. The original union was
made up of thirteen states; but this thirteen represents, if anything, only a head
Another random document with
no related content on Scribd:
order to more perfectly maintain that physiological rest which is so
necessary. This last is the so-called “Physick” splint, which has been
variously modified, while the method of traction has been usually
spoken of as Buck’s extension. It seems well thus to commemorate
the names of the American surgeons who showed the value of these
methods. When a long side splint cannot be borne, sandbags 15 in.
or 20 in. in length and 3 in. in diameter may be used to give support.
Any decided tendency to eversion of the limb should be corrected as
well as the shortening. When the long side splint is used the foot can
be held in place with it and thus the position of the shaft of the femur
controlled. At other times this may be done by flexing the knee and
thus preventing upward rotation. In all methods of traction it is
advisable to keep the heel free from the bed, in order that the effect
of the method may not be lost by the obstruction of the mattress.
 Fig. 315 Fig. 316 Fig. 317

Fracture of upper third of Shortening resulting from Overlapping fracture of

femur. Vicious union. overlapping. femur.
 Other methods of treatment of these fractures are common as well
to those of the shaft, and will be considered later. These include the
single and double inclined plane and the method by anterior
suspension. In general the first indication is efficient traction. This
should be made as efficiently as possible. When the patient cannot
tolerate any of the usual methods, then the double-inclined plane
may be used, the knee being hung over its apex, or anterior
suspension may be practised. In severe cases patients should be
simply made comfortable, with such local treatment as they can
bear. It may be even necessary to place them in the semi-upright
position in bed, in order to free the lungs, or to frequently change
their position to avoid the formation of pressure sores.
—Fractures of the shaft of the femur are usually oblique and
accompanied by considerable displacement, because of the
powerful thigh muscles which tend to shorten the limb. These
fractures are often compound, and occasionally the femoral fragment
causes serious damage to important vessels or nerve trunks. When
the fracture is just below the insertion of the psoas into the lesser
trochanter this muscle tends to not only pull up but to externally
rotate the upper fragment. Inasmuch as there is no way of controlling
this muscle or the fragment, the fractured limb should be dressed
upon an inclined plane, or in anterior suspension, in such a way as
to make the axis of the shaft fall into line with that of the fragment.
When the fracture is in the middle of the thigh, or lower, there is
sufficient length of the upper portion so that pressure can be made
upon it, or that psoas activity can be overcome. Fig. 315 illustrates
the tremendous deformity that may result from neglect of these
precautions. Fig. 316 illustrates a certain degree of overlapping
without conspicuous other deformity. Fig. 317 shows the shortening
which is often inevitable.
Muscle spasm should be overcome as an essential part of
successful treatment, the most important feature in making traction
being to use force sufficient to tire out and overcome the irritated
muscles.
—Fractures of the lower end of the femur are usually the result of
extreme violence, and may be classified as were those of the lower
end of the humerus. When there is a supracondyloid fracture the two
heads of the Fig. 318
gastrocnemius will
help to displace
backward the upper
end of the lower
fragment to an extent
permitting injury to
the bloodvessels,
while there is always
marked shortening.
Here the patella will
be made unduly
prominent, and there
will be depression
above it. Either
condyle may be
broken loose alone,
or there may be
intercondyloid or T-
fractures which are
serious because the
amount of force
required to produce
them may have
played serious havoc
with the soft tissues.
The joint capsule will
probably be filled with
blood, the ligaments
rent, and perhaps the
blood supply of the Fracture of lower end of femur, with great
limb compromised. In displacement of condyles.

Fractures of the Shaft of the Femur.such a case as this the joint

Fractures of the Lower End of the Femur.may be opened, the
contents turned out,
and the fragments readjusted and wired or fastened in place (Fig.
318). Epiphyseal separations, which may occur up to the twentieth
year, are not essentially different, although lateral displacement is
perhaps more common, while they are often compound.
Treatment.—Oblique fractures of the femoral shaft can be more
easily adjusted under the influence of powerful and continuous
traction than the transverse, where lateral displacement and
overlapping tend to occur. A more general application can be made
of the method described above when dealing with fractures at the
upper end of the shaft, i. e., when the upper fragment cannot be
controlled the balance of the limb must be adjusted to it in whatever
position it may be required to maintain. By the use of sufficient
traction, combined with molded or other splints, a fair result may
usually be obtained. In stout individuals it is by no means easy to
determine just how the fragments lie, save by the use of the x-rays. If
traction be so adjusted as to maintain the limb at equal length with
the other the surgeon may feel that, with certain coaptation splints,
he is doing the best he can. Application of the same rule given above
would lead him to place the limb on a double inclined plane, in case
of fracture near the knee-joint, in order that in this position the sural
muscles (the calf) may be relaxed and backward displacement of the
lower fragment be adjusted. If the apex of this plane be arranged
sufficiently high, so that the patient’s knee is practically hung over it,
and that the weight of the body makes sufficient countertraction, then
the use of weight and pulley may not be necessary. Here, however,
pressure which will be efficient may produce numbness, as will any
long-continued pressure in the popliteal space, and after a few days
it may be necessary to assume some other position. Fractures which
loosen the condyles will need lateral pressure, while the position of
each condyle may be controlled by the position of the leg, through
the medium of the corresponding lateral ligament.

Fig. 319

Extension band and foot-piece.

 Fig. 320

Same, folded and ready for use.

The standard “Buck’s extension” (for which latter word I prefer to

substitute the term “traction”), by weight and pulley, with the limb in
the extended position, is still the resort of the majority of surgeons,
but combined with other support by long side splints or coaptation
splints as may be needed. Fig. 321 illustrates the method of its use,
except that the ends of the adhesive strips should be extended
upward to a point nearly opposite the site of the fracture. The
amount of weight to be used should be graduated to the effect
produced. From ten to forty pounds, or even more, may be needed.
After the muscles are thoroughly tired the amount of weight may be
somewhat reduced[41] (Figs. 319, 320 and 321).
[41] Before applying the strips of adhesive, the best for the purpose
being that made of moleskin spread with material with which zinc oxide is
incorporated, the limb should be carefully washed and shaved and then
completely dried. A little cotton should be placed over each malleolus, in
order to avoid pressure-sores, while the strip of wood beneath the foot
should be sufficiently wide to prevent or minimize this pressure. The heel
should be kept off the mattress.
 Fig. 321

Mode of applying adhesive plaster. (When the dressings are completed the limb
should not be allowed to rest on the bed.)

Continuous and anterior traction was devised by Nathan R. Smith,

in the use of a so-called anterior splint, which was later modified and
improved in device by Hodgen. The method of its use is shown in
Fig. 322. Adhesive strips are used in this method as well, permitting
the leg and foot to be attached to the lower bar of the wire frame.
The position of the frame which contains the limb, swung within it
upon turns or strips of bandage, is then controlled by a suspension
apparatus, as shown, which tends to constantly pull the frame and its
attached lower part of the limb away from the patient, the effect
being to make a constant but gentle traction. If the point of
suspension were placed directly above the limb there would be no
traction whatever. The essential feature of the method, then, consists
in arranging it as shown, so that the pull shall be oblique, and that,
according to the obliquity of the suspension cords, the amount of
traction shall be regulated.
 Fig. 322

The Hodgen suspension splint.

In this method of treatment there is no violent attempt made at

reduction or overcoming displacement, but dependence is placed, at
least for two or three days, on the effect of the constant pull and its
overcoming muscular activity. After this such added splints or
expedients may be adopted as the case may require. The knee is
usually flexed at a comfortable angle, the intent being not to lift the
foot too high, so as to avoid being compelled to overcome this added
weight, but to regulate the tension by the obliquity of the suspending
cord.
Fig. 323
 Fracture of the femur in a child treated by vertical
extension. (Bryant.)

This method has found favor in the West under the enduring
influence of Hodgen’s teaching. In the East it is not so generally
practised. It has, however, several advantages, as follows: (1)
Equably perfect and comfortable extension; (2) easy adjustment; (3)
easy exposure for inspection; (4) when a fracture is compound it
permits of easy application of dressings; (5) adaptability to nearly all
fractures of the femur. It is peculiarly serviceable for feeble and aged
patients who chafe at restraint. If it be desirable to flex the knee to a
considerable degree this can be done, e. g., in fractures near the
lesser trochanter.
In fractures of the thigh, patients are frequently disturbed by
muscle spasms occurring during sleep. This can usually be obviated
or minimized by suitable doses of sulphonal, given early in the
evening.
Fractures of the femur in children are not uncommon. In those who
still wear diapers, and perhaps in those a little older, these injuries
may be best treated by vertical suspension, with sufficient weight to
overcome all shortening. Here the adhesive strips and the
suspending cords should be attached to both limbs alike, in order to
have sufficient access to the perineum, and in order to judge of the
effect which we are obtaining. Figs. 323 and 324 illustrate this
method.
Plaster-of-Paris dressings for fractures of the thigh appeal
especially to those who are most familiar with the use of the material.
Some patients with fracture of the neck of the femur may be early
put in the erect posture, upon an elevated surface, allowing the
injured limb to hang down while the patient rests upon crutches. In
this upright position, with the down-hanging leg, to which traction can
be made by an assistant, a plaster-of-Paris spica may be applied,
extending from the waist-line down to or below the knee. As a limb is
thus dressed so it will heal, and it is of importance that complete
reduction be effected as a part of the procedure.
 Fig. 324

Fracture of the thigh; vertical suspension. The fracture is compound in the patient
on the right. (Stimson).

FRACTURES OF THE PATELLA.

During the active period of middle life the patella is the bone most
frequently broken by muscular violence. In many cases it is
practically cracked over the condyles, as one would crack a piece of
wood over the knee. If direct force be applied, as by a fall, in
connection with the above, the effect is even more marked. In such
cases the fracture is sometimes comminuted (Fig. 325), or the line of
fracture may run more or less perpendicularly rather than
horizontally. Ordinarily, however, these fractures are transverse,
while the upper fragment is pulled upward, sometimes to a
considerable distance, by the powerful extensors of the leg. When
the fracture runs vertically the displacement is very slight.
Occasionally these fractures are compound, a most undesirable
complication, since the knee-joint is thus exposed to infection, from
which it suffers unless first attention be prompt and scientific. There
is usually sufficient hemorrhage to distend the joint cavity, and it may
at first be quite impossible to bring the fragments near enough to
each other to get crepitus, but the loss of the power of extension and
the evident gap between the fragments will serve to make diagnosis
positive, at least in all transverse fractures. A vertical fracture without
much separation is a milder form of injury which may be regarded in
a much more favorable light (Figs. 326, 327 and 328).
In these transverse fractures it is rare that bony union can be
secured by non-operative methods. This is not only because of the
difficulty in maintaining parts in apposition, but because it is notably
the case that fragments of periosteum or other tissue drop in
between bony surfaces and tend to prevent their actual contact, no
matter how firmly they may be pressed toward each other. Osseous
union then may occur without operation, but is rare. The best that
can be expected is fibrous union, the intervening fibrous band being
short or long, according to the success met with in treatment and to
the amount of strain later put upon it by too early use of the limb.
Even with two inches of fibrous tissue intervening patients are not
completely disabled. The usefulness of a limb under these
conditions, however, is seriously impaired. Something will depend,
also, on the extent to which the joint capsule and the aponeurosis
terminating the vasti muscles may have suffered.
Treatment.—The non-operative treatment consists in placing such
a limb upon a single inclined plane, for the purpose of
relaxing the quadriceps extensor group. In this position the limb
should be maintained for at least from ten to fourteen days. Some
expedient should be added, so soon as swelling has subsided, by
which the upper fragment can be coaxed downward toward its fellow.
A neatly molded splint, formed out of gutta-percha or of plaster of
Paris, may be fitted to the thigh above the fragment, held in position,
and then drawn downward by elastic traction on either side of the
leg, the principle of traction being thus given a special application.
Something of this kind should be done if the fragments are to be
approximated to each other.
 Fig. 325 Fig. 326 Fig. 327 Fig. 328

Comminuted Stellate fracture of Fracture of patella, Side view of same.

fracture. the patella. united by
(Erichsen.) ligamentous tissue.
(Erichsen.)

The more completely mechanical method, partaking of the

operative, is afforded by the use of certain hooks, whose points are
permitted to pass through the skin above and below the fragments
and to engage in the bone. By a screw mechanism these points are
drawn toward each other, and thus approximation is effected. This
method was first devised by Malgaigne and is usually known under
his name, although his device has been much improved. This is far
from ideal, and yet has given good results in some cases. The
surgeon should constantly guard against infection through the
punctures.
By far the most ideal method, when it can be suitably carried out,
is the open operation, a transverse incision being made across the
front of the joint, which is completely opened; this affords an
opportunity to empty out clots and to thoroughly cleanse it, which of
itself is a great advantage, since these clots often produce
subsequent adhesions. The exposed surfaces may now be freed
from clot and all soft tissue, or they may be neatly sawed as near to
the fractured surfaces as possible, the intent being to permit them to
come into absolute and complete contact, and to hold them there by
wire or other sutures, for a length of time sufficient for absolute bony
union. When properly performed this operation gives ideal results; it,
of course, exposes to great danger if improperly done.
Treatment by non-operative method rarely affords a useful
member under an average period of from thirteen to fourteen weeks,
while the operative method permits a reduction of this time to less
than half. It, therefore, has obvious advantages for those (e. g.,
laboring men) to whom time is of great importance. The operation,
however, is not to be practised as a rude emergency affair, but only
when we may be absolutely certain of everything pertaining to
aseptic technique. After operation it is rarely necessary to use a
drain, and such a limb can usually be dressed in a plaster-of-Paris
splint. Compound fractures, however, will probably need drainage at
least for a day or two, and because of this need may as well be
operated at once. In comminuted fractures the method is desirable,
since by a loop or by some other expedient fragments can be held
together as in no other way (Figs. 329 and 330).
 Fig. 329 Fig. 330

Wiring patella. (Lejars.)

Injuries to the patellar region, equivalent to fractures, are

separations, either of the tendon from the bone, or of the bone from
the ligament which holds it to the tibia. Such injuries can be
recognized by the fact that the contour of the bone itself is
preserved; in the former case it is not drawn up, although the
extensor muscles have lost their power while in the latter it is drawn
up, leaving a well-marked gap below it.
Remarks concerning the treatment of fractures apply equally here.
Choice can be made between the operative and the non-operative
treatment. In well-selected cases the former seems much the more
desirable, the fibrous end of the tendon or ligament being held to the
bone by strong sutures of silk or wire.

THE LEG; FRACTURES OF THE TIBIA.

The head of the tibia is occasionally broken as the result of
extreme violence, the fragment being usually held reasonably in
place by one or other of the lateral ligaments. Hemorrhage into the
joint will be profuse, with swelling extreme, while disability will be
complete. Not a few of these cases justify operation, directed toward
opening the joint, removing all clot, and fastening the fragment in
place with suitable sutures (Figs. 331 and 332).
Transverse fracture below the tubercle is less rare. The insertion
of the terminal ligament of the quadriceps extensor group will, in all
of these injuries to the upper portion of the tibia, tend to pull up the
upper fragment and make it project beneath, even protrude through
the skin. Fractures of the lower part of the tibia are freer from such
distorting influences. Fig. 333 illustrates the distortion produced as
above, while Fig. 335 shows one of the tendencies in fracture of the
lower end of the tibial shaft, which has to be overcome by correct
emplacement of the foot within the dressing. Fig. 334 illustrates
synostosis as the result of fracture of both bones at about the same
level. Torsion is a factor of no small importance in the production of
most of the fractures of the leg, to such an extent as sometimes to
make a completely spiral fracture, a condition generally held to be
more serious than fracture of the ordinary type. The line of fracture
often extends in such a direction as to leave a sharp spicule of bone
close beneath the skin; here rough handling, or carelessly made
pressure in the dressing, may cause a perforation within a few hours
or days after the injury, by which a simple is converted into a
compound fracture. Such a complication should always be avoided.
Fig. 331

Fig. 332
 Wiring tibia. (Lejars.)

FRACTURES OF THE FIBULA.

The lower end of this bone is much more often fractured than the
upper, although it may be broken at any point. Into its upper
termination is inserted the external lateral ligament, and this insertion
may be torn off from the bone in cases of violent sprain of the knee,
damage occurring which is similar to that which happens in injuries
about the ankle. The upper portion of the bone lies well buried
beneath muscles, and fractures here are not so easily recognized. A
good maneuver for their recognition is to seize the bones at the
lower portion of the leg and press them together; if such pressure
gives severe pain above, or if it be shown that the fibula is more
movable than natural, fracture may be practically diagnosticated,
even though crepitus be not detected. A skiagram would, of course,
clear up such a diagnosis.
 Fractures of both bones of the leg occur almost as frequently as of
either alone, usually as the result of direct violence, with or without
more or less torsion; as, for instance, when the foot is more or less
entangled, and, at the same time, twisted at the time of injury. These
double fractures are by no means necessarily placed upon the same
level; thus the tibia may be broken low down and the fibula high up,
so high indeed that the latter fracture may escape observation. With
fracture of both bones disability becomes complete, while shortening
is very likely to occur, all the muscles passing from the leg to the foot
conspiring to this effect. These fractures, moreover, are often
comminuted and compound, sometimes to an extent necessitating
exsection of fragments or of an inch or more from the shaft of each
bone. In exsection of the tibia an equivalent amount should for
obvious reasons be taken from the fibula. Displacements are
extremely likely to occur, and in every compound fracture the
presence of the opening may be utilized for the emplacement of
sutures or suitable means for enforcing approximation. Indeed, other
means failing, resort may be had to this measure in order to secure
an ultimately good result.