The President: As Dr. D. S. Fairchild, Jr., cannot be here to-morrow, we will now hear his paper, which is entitled, "Interesting Case of Traumatic Nephritis." This paper was discussed by Dr. D. C. Brockman, A. Babcock, C. H. Churchill, D. S. Fairchild, and by the author in closing.

Dr. H. G. Ristine then read a "Report of Anamalous Case of Chest Injury." The paper was discussed by Dr. Williams, and by the author.

"A Case in Practice" was reported by Dr. A. B. Bowen of Maquoketa. This was discussed by Dr. D. S. Fairchild.

The meeting then adjourned until 8 o'clock p. m.

EVENING SESSION.

The first paper was by Dr. D. C. Brockman of Ottumwa on "The Therapeutic Use of the X-Ray." The paper was discussed by Drs. I. K. Gardner, D. S. Fairchild, Ben Thompson, Scott, and closed by the essayist.

The meeting then adjourned until 9 o'clock Wednesday.

MORNING SESSION.

At the opening of the session, the Committee on Credentials made its report and upon motion the time for the election of officers was postponed until the close of the session.

The President: The first paper this morning is entitled, "Trauma as an Etiological Factor in Malignant Diseases," by Dr. D. S. Fairchild of Clinton. Prefatory to reading his paper, Dr. Fairchild said:

The subject of trauma is one that I have given a good deal of attention in times past, on account of its great importance in determining questions where damages are claimed. You know it is a common practice and a common habit among physicians and surgeons to attribute a large number of diseases that come under their observation to an injury, though the injury be very remote as to the time of the occurrence of the disease. For instance, in a surgical case, if a patient comes under our observation suffering from some growth or tubercular disease, and it can be discovered that some five, ten or twenty years ago he was injured, it is therefore presumed that the injury

was the cause of the disease. This does not seem to be a very logical position to take. On account of views of this kind which have been presented on the question of damages, I have for the last ten years perhaps devoted considerable time to the examination of the records of cases that have come up and have obtained views of physicians and surgeons who have had large experience. It can be readily seen, that if a person has received an injury, the question of damages must be determined by the immediate and remote results. An individual is entitled, if he is injured, to such damages as may come from the injury in its remote effects. If we find that a person who has received an injury to some part of the body, afterwards becomes afflicted with tuberculosis or cancer, or any other disease, then the individual has the right to base the sum which he is to receive upon the reasonable probability of the development of this disease; and I say that in consequence of this, I have looked up these matters very carefully. It has been my province, perhaps, to give opinions more frequently than most surgeons upon the subject of future conditions. These opinions will govern the claim

department in determining how much money shall be awarded an individual. In cases of tuberculosis, I think it has been a very common contention that the injury is a very important etiological factor, and it does not matter how remote the injury may be. I remember at the International Medical Congress in 1876, Dr. Gross and other very eminent surgeons held that hip-joint diseases were due to trauma which patients had received. In the works that have been written on tuberculosis of the bones and joints, for instance, Dr. Senn raises a serious question of doubt as to whether trauma creates tuberculosis. Dr. Bur who has made a number of investigations contends that trauma does not produce a focus for the development of tuberculosis, that on the contrary the reaction which takes place in injured tissues lessens the tendency to develop

ment of tuberculosis."

The paper which I have to read now has been read before, but I may be able to bring out some points in it of interest as bearing upon this particular subject. Now and then the question comes up-suppose you are asked what are the probable results of this injury, or what may be included in the probable results of this injury-if it is contended that cancer may be one of the probable results of the injury, it would increase very materially the patient's rights for damages.

Dr. Fairchild's paper was discussed by Drs. D. C. Brockman, J. C. Schrader and by the author in closing.

A paper on the "Treatment of Traumatic Gangrene" was then read by Dr. Van Buren Knott of Sioux City. The discussion was opened by Dr. Williams, continued by Drs. G. G. Cottam, C. H. Churchill, D. C. Brockman, the president, and closed by the essayist.

The next paper was by Dr. H. C. Eshbaugh of Albia, entitled "Compound Fractures." This was discussed by Drs. Ben Thompson, Saunders, Van Werden, the president and A. Babcock; the author replied.

Dr. J. C. Schrader of Iowa City then read his paper on "The Railway Surgeon as a Sanitarian," which was discussed by Drs. G. C. Stockman, Enos Mitchell, and the author.

At this point, the hour for the election of officers having arrived, Dr. I. K. Gardner of New Hampton was elected as president of the association by acclamation. Dr. B. Thompson of Tama was unanimously chosen as VicePresident. Dr. A. B. Deering of Boone was the unanimous choice for Secretary. For Treasurer, Dr. W. J. Williams of Adel was chosen by acclamation.

A Judicial Committee of three, composed of Drs. R. A. Patchin, D. S. Fairchild and A. A. Deering, was chosen. Des Moines was again selected as the place for the next meeting of the association.

The matter of the publication of papers that were read before the meeting and the discussions following, was discussed and referred to the Committee on Publication.

AFTERNOON SESSION.

The President: The first paper on the program is one by Dr. D. W. Finlayson of Des Moines, entitled, "Internal Injuries the Result of Severe Traumatism." This paper was discussed by Dr. I. K. Gardner.

"Compound Fractures of the Foot," was the title of at paper read by Dr. G. G. Cottam of Rock Rapids, and dis

cussed by Drs. A. Babcock, Van Buren Knott, and by Dr. Cottam in closing.

The President: The paper of Dr. W. T. Speaker of Manson is here, but the doctor is absent. What will you do with the paper on "Injuries to the Hand and Fingers in Railway Accidents ?"

On motion, the paper was read by Dr. R. A. Patchin, and referred to the Committee on Publication."

At the conclusion of the reading of Dr. Speaker's paper, President Wright expressed his thanks to the association for its kind indulgence in his shortcomings, and emphasized his appreciation of the honor that had been conferred on him.

Dr. Ira K. Gardner, the President elect, was introduced to the society and after thanking the members for his elevation and the honor conferred, dwelt briefly upon the benefits derived by the members on account of these meetings, after which the association adjourned sine die.

CARE OF MINOR SURGICAL CASES.*

BY W. J. WILLIAMS, M. D., OF ADEL, IA.

In the care of such cases of minor surgery as ordinarily come to the railway surgeon, no little importance attaches to the proper diagnosis. It is not always easy to determine in a particular case that it is of minor importance and a proper classification has much to do with the safety of the patient as well as the surgeon's reputation. The great majority of cases fall easily into their proper place; but the exceptions are the ones that give us trouble and oftentimes where we least expect it. Injuries of the extremities come easily as a rule in proper place, and full weight may be given them as far as any effect on the general system is concerned. A great number of minor injuries to the extremities, occurring coincidentally, however, may change the nature of a particular case to one of more import, to that degree that it entails shock from which reaction is slow, followed by an enfeebled condition of the general system, leading to impaired nutritional conditions and as a consequence a slow healing process..

Incised or contused wounds of the trunk or head may appear slight in extent or seem of trivial account, while, by reason of location or depth of impression on the system, they may assume serious importance in that the ultimate results are impaired function of important and useful organs. No rule can be laid down here, and the surroundings of excitement coincident with many accidents are such that the victims are slow to be convinced that anything more than a trivial accident has befallen them. Deep-seated, contused or bruised tissue, or even complete severance of continuity of tissue in deep seated organs may occur where black and blue marks are the only surface indications. Friable tissues as of the liver or lung may sustain rupture leading to concealed hemorrhage insidious in character, but more or less depressing. Contused or incised wounds of the abdomen not seemingly deep, may be the only outward index of blows that have ruptured the walls of tender blood vessels, or so injured

such walls as to lead to development of deep-seated aneurismal conditions.

*Read at the ninth annual meeting Iowa State Association of Railway Surgeons, Des Moines, Oct. 22-23, 1902.

Of importance is it then that he who undertakes the responsibility of the care of even such wounds should go to the depth of the meaning of every symptom, and expression of the patient, that he may know the full extent of the injury and not treat as trivial cases those of most serious nature.

General rules for treatment include a thorough preparation for such cases by emergency outfits liberally supplied with all needed modern conveniences for obtaining as nearly as possible asceptic conditions of open wounds, including gauze, antiseptic solutions (or materials for making them), ligature, suture and drainage material. In contused wounds, injuries of soft parts, connective tissues, muscles, arteries, veins and nerves, or of hones with overlying periosteum are the results of blows from blunt objects applied with great force. When the skin is not broken there is little danger of infection from the outside, but, they are subject to the additional risk of great collections of blood and serum amidst macerated tissue to a degree that interferes with circulation and leading to resultant destruction of tissue ending in abscess formation. Excess of tension relieved by the surgeon's knife under strict asepsis will here often serve us well. If the accident itself has produced only a small puncture it is often better to diligently search the depth of such a wound for infected tissues, even to laying wide open by the knife, and thus changing its condition to one of comparative safety.

Incised wounds caused by sharp-edged instruments, edges of broken glass, china or metal or the use of cutting instruments in the hands of the surgeon are characterized by great retraction of the edges of the wound, as well as deeper tissue where muscular fibres are crossed. Hemorrhage is usually free from sharply divided blood vessels and where density of tissue is present, as in scalp wounds, there is little tendency to collapse of these vessels and voluntary cessation of the bleeding. In treatment more care is needed in the ligation of blood vessels, suture of nerves and tendons, as well as in bringing muscular tissue and fascia together. Drainage is indicated in some cases, the deeper tissues held in apposition by deep seated sutures, as well as the superficial where muscular strain has a tendency to pull apart.

In all cases where indicated by the cause careful search should be made for foreign bodies in the deeper parts of the wound in the shape of points of broken glass or china, as it is surprising how often these are overlooked to give rise to trouble later on, and if we can save our patients a useful limb by suture of nerve or tendon we have rendered him the greatest possible service, while twisted silk,

gauze or rubber-tube drainage will be of material service

in the outcome of certain cases.

Lacerated wounds, the result of injuries by blunt bodies,

cogs, or edges or flanges of wheels do not usually bleed freely at first, but are particularly prone to give rise to troublesome secondary hemorrhage. Shock is common and of severe type, and sloughing apt to be extensive, the dirt and grease literally ground into the tissues. Comresult of impaired nutrition, but especially the result of plete disorganization of tissue with removal en masse of large areas of tissue make these cases very destructive of function even under the most favorable treatment. The

size of wound may be no measure of such injuries in the extremities where functions of limb are so easily disturbed by resultant scar tissue. Arrest of hemorrhage by the utmost care-taking is one of the essentials, lest, later on, a dislodged clot in a lacerated artery give rise to fatal hemorrhage or formation of clots deep-seated in the wound where by sloughing they give rise to trouble. In the cleansing of such wounds ordinary antiseptic solutions are often insufficient, as the grease ground into such wounds requires some solvent as the application of turpentine, scrubbing with soap and water, and often the careful use of forceps and scissors and even curette to remove the excess of infected dirt-permeated tissue. The best method of approximation is of importance; the widely separated margins of normal tissue precluding the bringing together of edges where excess of tension on tissues already prone to sloughing is to be avoided. Partly detached pieces of flesh and skin that give reasonable hope of sufficient circulation may be loosely stitched in place, supplemented by a compression of moist antiseptic dressings. Bony structures, especially of the limbs, even though thoroughly denuded of soft tissues, should be treated on the expectant plan and a chance given to save every inch in length of limb. Secondary amputation is much more conservative and safe. Scalp wounds, even of great extent, should thus be treated and the peeled off scalp lightly approximated by stitches, supplemented by compression from firm bandaging. Healing by granulation in wide-open wounds must be the rule, and while continuous irrigation has its advocates, dry dressings with antiseptic material in form of gauze, or powders and gauze, generally secures the best results.

Closely allied to this class is a series of injuries from friction of ropes in motion, rapid moving belts or moving timbers; the friction burns, resembling the burns from hot liquids, but often entailing loss of deep tissue. If superficial, the treatment should be by antiseptic washing and dressing in moist boric acid or acetate of aluminum gauze; when deeper, antiseptic oil emulsions as of olive oil, lime-water and carbolic acid have served the purpose well. Distinctly punctured wounds resulting from sharp pointed instruments, nails, splintered timbers or pieces of broken glass are common, and when no infectious material is carried in heal kindly. The danger of puncture of deep-seated organs or tissues leads to additional risk, and when infection is carried in the surgeon often has reason to wish his first treatment had been more thorough. When punctured wounds are the results of blunt objects, they are especially apt to be infected by pieces of clothing or other material being carried to the deep parts of the wound, there to start infection and deep seated suppuration so common in such cases. He will sleep best who sees deepest down in such wounds and knows that no hidden foe lurks to be the cause of later trouble. Hence the rule should be to go deep in search of any source of trouble, enlarging them under as nearly aseptic conditions as possible and treating most thoroughly, even resorting to anesthesia if necessary. The Esmarch bandage may render assistance by clearing the field of blood, while in a limited number of cases the X-ray may be of service.

Contusions and injuries of joint tissues so apt to occur in cases of railway accidents are particularly troublesome

and correspondingly important. In the healthy they are bad enough, but the victims of accidents are not always of the healthy class; ultimate results it is true are ofttimes much more than could reasonably be expected, but the enfeebled anemic and tuberculous conditions add to the danger by impaired nutrition and slow reparative processes. Abscess formation, excess of joint tissue and ankylosis, are so much the rule that the order should be to give injured joint tissue, whether slight or severe, the utmost care and attention from the first. Rest by splints, plaster, or elastic pressure, moderate in amount, heat or cold continually applied by bag or irrigating apparatus with massage and passive motion at proper times and in proper cases will give best results, but require the exercise of much good judgment. When in spite of all care and effort, suppuration supervenes, prompt incision and drainage will be indicated. Such cases must be kept under constant watch for weeks, and even months, to obtain the full measure of recovery of function, and often they surprise us how well they get ultimately.

Sprains of joints, the result of violent twisting or wrenching of joint tissue, are apt to be followed by effusion of blood and serum into the joint and extra articular tissues, and often take on quite an important aspect when the ligaments are ruptured, or where these fail to separate and pull off the thin sheet of bone at the point of ligamentous attachment. Care in diagnosis even to the extent of complete anesthesia is often rendered necessary so' we may be certain of our exact position. Thorough replacement of tendons of tendinous attachments, and thorough application of functional rest by splints and plaster of paris are essential to good results. Heat, cold or anodyne applications, and often complete strapping by rubber adhesive, are indicated as soon as the excessive swelling will permit.

DISCUSSION.

Dr. A. B. Bowen: I think this is a very practical paper. These cases come under the care of every surgeon and it is something we are all interested in. The doctor referred to the wound caused by a rope moving rapidly through the hand, or a brush burn. Such injuries are quite common in farming communities, and we often meet with them. A child will follow up the rope of a hayfork and perhaps comes to a pulley, and gets its fingers ground or burnt. I think it is often by neglected treatment that we experience the results of deformity or contracture, which renders the fingers useless and often leads to quite delicate subsequent operations in order to bring about relief. I have met with two or three such cases within two or three months, which might have been prevented by radical treatment at the time, not only by disinfecting thoroughly, but by proper mechanical support,.. such as light splints, which would prevent cicatricial contraction.

Dr. D. C. Brockman: I have been unfortunate with children who have been burned by catching hold of ropes, and I have had as many as a half dozen children's hands caught in that way and brush-burning the palms of the fingers. The doctor speaks of putting on light splints to hold them from contracting. I wish he would tell us how it is done. In every case where I have had a bad brush burn they have lost the use of those fingers by contrac

tion. I have done every kind of an operation I could think of, but few of them were in any measure successful. If there is any kind of a light dressing the doctor or anyone else can suggest, I would like to know what it is. I want also to suggest, on this subject of burns, and especially fire burns, the use of picric acid.

Dr. Bowen: The light splint will certainly aid in the prevention of contractions, and I think, with persistent, careful treatment, contraction can be prevented. But if efforts at prevention are unsuccessful, I would divide or remove cicatricial tissue, and if practicable, cover the denuded surface with healthy tissue.

Dr. G. C. Stockman: I have a case in mind that I remember occurred early in the year; it was under the care of a doctor of our city, a most excellent surgeon. He called on me to administer the anesthetic, and I saw him dress it two or three times after that. In this case splints were used, and the work was done with all the care possible, I do not think anybody could work more carefully; yet the patient now has a hand with crooked and drawn-in fingers. The splints had been used until the hand was apparently thoroughly healed, but the final result was as I have indicated. I have had several cases in my practice, and like Dr. Brockman, I have crooked fingers, and I expect to have more if I live long enough and continue to practice surgery.

Dr. Deering: This was a very good paper. I wish to emphasize the necessity of cleansing these wounds thoroughly before any operative procedure. In In cases where the wound is ground in with grease and dirt, I would give my patient an anesthetic and then use gasoline, which I have found better than anything that I have ever used for cleansing.

Dr. Williams: I want to add, that the discussion that has occurred here has simply emphasized one important feature, and that is, unceasing and unlimited attention; and even then the results of some of these cases are un

fortunate. I therefore desire to emphasize a thorough

preparation, even under complete anesthesia, as suggested in my paper. The day has gone by when we can leave infected material in a wound and not be responsible for

it, and if we can not secure a complete cleansing of the wound, we are justified in doing that. By making these thorough preparations and cutting out all infection, the first dressing secures the very best results to us in many wounds, and satisfies us that we have done the very best we could. These brush burns are of very great importance, and how best to handle them has been a very serious matter and will continue to be so, because of the frequent necessities of operation.

Always warn your elderly patients that a contusion. of the hip sometimes causes shortening, especially if the case be the subject of rheumatic arthritis.--Fenwick.

Remember the frequency with which hematomata and traumatic aneurisms have been mistaken for abscesses, and have been incised with untoward results.-Fenwick.

Do not forget that incisions for superficial abscesses in the neck and face should run parallel with the wrinkles

and folds.-Fenwick.

THE EXPERT WITNESS.*

BY HƠN. N. T. GUERNSEY OF DES MOINES, IA.

At the outset I wish to express my appreciation of the compliment which the invitation of your committee to address you implies. I should feel less embarrassment if

I were confident that I could either instruct or entertain you.

The suggestion of your chairman that I choose my own subject, intended, I am sure, as a kindness, has, in fact, added to my embarrassment. For me to attempt some subject pertaining to your profession would suggest the old comparison that a woman's preaching is like a dog's walking on its hindlegs-you do not expect him to do it well, and are surprised that he can do it at all, and I might not even be able to surprise you to that extent; while any subject of my own profession would, I am sure, be as dry as proverb makes it.

We have, however, a common ground in questions of expert testimony in personal injury cases. The difficulty and often impossibility of proving to the satisfaction of a jury

First, the cause of physical disabilities that are asserted as the basis of a claim for damages, and

Second, the extent of such disabilities have led to frequent discussions; and my excuse for further consideration of a matter that may be said to be worn threadbare is that no solution of the difficulty has been presented, and that until it is solved the importance of the question will make it a persistent subject for discussion.

At the outset permit me to suggest that, in my judgment, there are legal objections which render impossible any plan looking to a submission of such questions as these to an independent tribunal composed of impartial surgeons selected by the court, to decide and report to the court and jury their conclusion as to any disputed fact of such a nature that it should be, and, in fact, can only

be properly decided by an expert.

The right which the constitution of the United States and of each state guarantees to every person of trial by jury, and the further guaranty that he shall not be deprived of his property without due process of law, entitle the plaintiff in a personal injury case to have all disputed questions of fact determined by a common law jury, and any statutory enactments providing for their determination otherwise, would be invalid.

We must assume that cases are to be tried in accordance with present methods, and our inquiry is limited to what may be done along these lines to secure fairer verdicts upon controverted questions going to the causes, nature and extent of injuries in personal injury cases.

It has seemed to me that a clearer appreciation of the functions of the expert might lead to better expert testimony, and therefore to better results from this testimony.

The distinction between the expert witness and other witnesses is, that the former is allowed to state as a matter of evidence his opinions and conclusions, while the latter is not permitted to give such testimony but is required to confine his statements to matters of fact. A jury, in contemplation of law, is made up of persons of

*Read at the ninth annual meeting lowa State Association of Railway Surgeons, Des Moines, Oct. 22-23, 19.2.

ordinary knowledge and intelligence, and as to matters which do not require any special learning, but are matters of ordinary occurrence, the law does not permit the witness to state his conclusions, but limits him to a statement of the facts, and requires the jury, and permits no one else, to draw the conclusions from these facts.

To illustrate: Negligence is the absence of that care which an ordinarily careful and prudent person would exercise under the conditions presented. This is necessarily a conclusion to be deduced from all of the facts and circumstances surrounding the transaction. A witness is not permitted to testify whether or not these facts and circumstances constitute negligence, but is limited to a statement to the jury of these facts and circumstances; it is the sole province of the jury to draw the conclusion from these facts and circumstances as to the degree of care that has been exercised, and to determnie whether negligence in fact exists.

If you will pardon a digression here for a moment, while I do not know that the question has been considered by any court of last resort, and I am sure that none of your members should have cause for any personal interest in the matter, it has seemed to me that suits for malpractice present an exception to this rule. There the question is whether a physician or surgeon has exercised the skill that is usually shown in the practice of his profession in the community where he resides; and where this question arises, the surrounding facts and circumstances from which the conclusion must be deduced are of such a character that their force cannot be appreciated by a non-expert, or what we call a man of ordinary intelligence, not skilled in this particular profession, and, therefore, it has seemed to me that in cases of this character, a witness who is qualified as an expert should be permitted to testify to the conclusion that the facts shown do or do not constitute malpractice, and that the jury should be required to determine whether or not the defendant had been negligent from testimony of this character, rather than from the general appearance of the patient and from their own speculation' as to what might have caused it. To return from this digression, while the general rule is that a witness may not testify to his conclusions, but must confine his testimony to the facts from which the conclusions are to be deduced by the jury, this rule has no application whatever to the matter of expert testimony. The expert is called for the very purpose of giving his opinion. He is denominated an expert because of the special knowledge which he is deemed to have and which in, order to qualify himself to testify he must show that he has, with reference to the special subject under investigation. Having this special knowledge, the expert, as to matters which cannot be understood without such special knowledge, is permitted to give to the court and jury his opinion, so as to afford an intelligent basis for their conclusion. To put this matter in another way: Ordinary testimony is exclusively as to facts, while expert testimony is almost exclusively as to matters of opinion.

In my judgment, many witnesses called as experts in cases of the character to which I have referred, have failed to appreciate this distinction, and by this lack of appreciation have distinctly weakened the legitimate and proper effect of their testimony. The expert witness should

clearly apprehend that he is called as a witness for the sole purpose of expressing his opinion upon the facts as he may have observed them, or as they may be detailed to him. This means that he should not hesitate about giving his opinion because it is an opinion and not a matter of positive knowledge, and, further, that he should not be embarrassed in stating his opinion by the possibility that sometimes exists that there may be room for two opinions.

Very frequently a surgeon when asked what, in his opinion, is the cause of a certain condition, replies that he does not know. This evidences a clear misapprehension of the scope of such testimony. Whether he knows what the cause is, is wholly immaterial. The material question is whether, under the circumstances as they are disclosed to him, he has an opinion, and what that opinion is; and, if he has an opinion, he should state it positively and unequivocally. He is not responsible for the absolute correctness of his opinion. He is responsible for his disinterestedness and good faith in the exercise of his judgment, and should not attempt to go beyond his knowledge, but there his responsibility ends. The honest witness who recognizes the possibilities that his opinion may be erroneous is the one who is most embarrassed by the failure to recognize this distinction. If he clearly apprehends that what he is testifying to is merely his opinion, and that his obligation is to frankly and fairly state this opinion, he will make a much better witness.

To put the matter in another way: From my observation what has most tended to weaken the testimony of some expert witnesses is their apparent feeling that they should not express an opinion unless the circumstances were such as to demonstrate with mathematical certainty the correctness of this opinion; and this has been especially true of those witnesses who have had the highest regard for their obligation to speak the truth. This has made the witnesses hesitating and uncertain, where, if they had correctly understood the situation they would have been prompt and positive in their statements. More than once a surgeon has said to me: "I have no doubt whatever about the question, but I do not know." Let the witness bear in mind that he is not summoned to testify as to what he knows, but as to what he believes, and bearing this in mind, let him, if he has faith in his own judgment, confidently and positively assert his belief. If he do this he will make himself a good witness, because he will impress the jury, and it is finally from the weight of the testimony presented to the jury that we must expect to secure our results.

Cross-examination will not destroy the weight of such testimony. When we keep in mind that what the witness is testifying to is merely his opinion, he will have no hesitancy in admitting that it is possible for this opinion to be erroneous, nor will this admission, if accompanied by the statement of the confidence of the witness himself in the correctness of it, militate against the weight of his testimony.

It goes without saying that the class of experts whom we are considering are those who are worthy of the name. I have left out of account those witnesses whose principal care is to avoid a display of their own ignorance. To add weight to their testimony the first thing to be