OHIO STATEWIDE FILES - Lindsay Journal #4, PART 1 *************************************************************************** OHGENWEB NOTICE: All distribution rights to this electronic data are reserved by the submitter. Reproduction or re-presentation of copyrighted material will require the permission of the copyright owner. *************************************************************************** File contributed for use in USGenWeb Archives by Helen Silvey Helen_Silvey@macnexus.org http://jpaul.gwdi.com/silvey/ January 19, 1999 *************************************************************************** July 19. 1834 was called to see Edward Webster, Mill right, who had cut off the Anterior Tibeal Artery, or a branch of it, with the Foot Adze. I got to see him a few hours after the accident, distant from Town about 6 miles. the Hemorrhage had been considerable but not as great as might have anticipated. Applications of cloths by the aid of coagula had put a great check to it. which had been profuse at first and attended by syncope. On examination of the cut and the removal of the cloths and coagula I found the artery cut off deep anteriorly just where the artery made its exit between the Tibea & Gibula a few inches below the knee. The stroke of the Adze must have been made with the angle, judging from its depth, as the muscle Tibealis Anticus was cut through and entirely off. The stroke extended as deep as the Interoseous Ligament. and the artery was cut off so short anteriorly where it emerged thro' this Ligamentous membrane that I could not pass a Ligature neatly around it. And in order to take up the artery was under the necesity of passing the kneddle thro' the surrounding integuements and artery all together. The mode of operation succeeded well. was not attended by any secondery hemorrhage -- This wound healed up in about three weeks. Inflamation did not run very high having no doubt been prevented by the strict regimen and antiphlogistic mode of treatment enjoined in the case. The lameness consequent on the cuting off of the muscle was never fully removed. The foot droped down much at first, and after the patient recovered from the wound, the foot in raising and stepping forward of the Leg ever continued to be attended by a slight halting & dropping of the Toe. however after a period of some months my patient was enable to get along tolerably well without the use of his cane. and in due time was able to resume his ocupation. This young man now, while I make this record of his case, is no more his death was somewhat mysterious, but had nothing to do with the injury here recorded. Some 2 or 3 years after the accident which I have just described, on returning late from Town he was thrown, as is supposed, from his horse, being found dead the next day by the road side. So far as I had any knowledge of him, he was a young man of steady habits; was quite honarably connected, and his untimely loss much regretted. Richard Ia. Nov. 27th. 1839 W. L. Case of James Whiteman wen of the Hip. removed by operation on the 28th. Sept. 1839 -- As a history of the case I learned that this wen had been coming 10 years. The the patient is of the opinion that it originated from a small itchy lump. perhaps not much larger than a pin head when he first discovered it. And if I understood him correctly thinks it was produced by scratching the part with his nail. In this case I was called by my friend Dr. James Knox, had never seen the case until the day I operated. at this time the wen was probably about 6 inches long including the pedicle or stem by which it was connected to the hip. at the pedicle or base it was from an inch & half to 2 inches diamater -- at the fundis was between 4 & 5 and by compression could probably have been put within a Pint Tin Cup. And weighed after it was removed just 1 lb. Avoirdupois. This operation was simple. and consi(s)ted in excision near its attachment to the hip. by a circular incision, but little hemorrhage attended the operation. two small arteries had to be taken up. one of which by the assistence of Dr. Knox was taken up when the wen was about 1/3 removed, and the other after the wen was removed. This operation was rather painful. but the patient (by occupation a Blacksmith) stood it well, he was just recovering from an attack of fever. was just able to walk about. said he would have it over with and be done with it all at the same time. meaning the operation & the fever. On removel of the wen. I closed the would by drawing & approximating the edges so as to form a right line -- and with little force was enabled by means of 3 stiches & Adhesive Strips interveining to make a snug dressing of it. without much distention of the skin and integuments. In a few days after the operation I saw Dr. Knox, in whose charge the patient was left, by whom I was informed he was doing very well. & reported that the wound was healing finely by the first intention. That this patient is radically cured have not even a doubt. This wen in its formation was simply Adapose. being composed of pure fatty substance. This Tumor had been continually, according to the representations of the patient, on the increase. had not been of much inconvenience to him -- only from the size & weight and being in the way. his general health had been good. Jacob Shaw's case of fractured arm, broke in three places. Sep. 29th. 1839 This young man while driving a Hack in passing a 4 horse mail stage was precipitated from the seat and the coach ran over his left arm. In the course of an hour or two he was brot to Town and I was called to see him. At the time I set the Arm I was of the opinion that it was broke only in 2 plaecs a little above the Elbow -- and again a little below the shoulder. This arm proved to be very troublesome, swelled very much, attended by much pain & suffering, in a few days after the accident a high degree of inflamation took place at the Elbow Joint and the lower arm became enormously distended. At about the end of the 1st week I concluded to throw off the dressing of 4 splints which I had used and substituted a stay case of splints. I was induced to this change from the circumstances of some displacement in the fractured bone being now discovered, which required a reseting, With the effects of this stay case dressing I was much pleased, which consisted of 2 pieces of factory being first cut out of the proper length to extend from between the shoulder to the Elecranon, I ran together lengthwise at intervals of about 1 & 1/2 inches and adapted so when filled with splints to fit neatly around the arm. which I applyed over the many tailed bandage tieing on with 4 pairs of Tape Strings attached to the 2 edges of the stay case. the tapes in applying the the case of splints were interlocked by crossing & tieing on the oposite side of the arm. over this the bandage was applyed in the usual way, as inflamation ran high and the arm became a little chafed in places I diped the many tailed bandage into melted Beeswax softened with a little Tallow. This was a protracted case, the patient not being able to leave his bed until nearly 6 weeks. and at the end of 7 weeks was just able to walk about the house with the arm in sling. About this time he left town in a carriage on a visit to his mother, where he expects to remain until he is intirely recovered This has necessarily been a tedious case, and it will yet require a considerable time to get the use of the arm. and from the high degree of inflamation in the elbow at an early period, I had some fears that he would have an Anchalosed or stiff Elbow. but beleive (sic) now this will not be the case. Nov. 28. 1839 Richmond W. Lindsay Was called to see Mrs. Thornton on the night of the 14th. Nov. 1839 distant from this place (Richmond) 12 miles. being sent for by the request of my friend Dr. Joel Bugg with instructions to bring along with me the Forceps & other instruments belonging to the case of the Acouchier. On arriving at Friend Thornton's I learned that Dr. Bugg had been in attendance some 36 or 40 hours. And previous to my being sent for the membranes had been broken and a large quantity of water Discharged, if the women present were not mistaken in their report, something like a gallon and one half, & according to some nearly two gallons. after which it was ascertained by the Dr. that it was an arm presentation. which by any skill or effort could not be altered to that of any other. at least such proved to be the fact. had the presentation been suspected in time or previous to the evacuation of the waters it was hardly probable that the presentation might have been changed immediately. on the rupture of the membranes, and before the Liquor Amni had all passed off. However, Dr. Bugg seems to be of the opinion that even with this knowledge he could not have succeeded, owing to the want of sufficient dilation of the uterus. At all events after the removal of the arm at the shoulder I was unsucessful in turning or in geting holt of a foot. to effect which I made several attempts during a period of 3 hours. On consultation it was agreed that the exhibition of the Ergot should be tried. which was given in the form of a decoction. nothing could have succeeded better, by giving it in divided doses every 15 or 20 minutes the pains which had been quite inefficient became stronger and stronger every dose of the medicine given; and in about 2 hours from the time this medicine was commenced, she was delivered of the child. The Placenta produced some trouble, and detention of about half an hour longer, owing to some adhesion and retention at the fundus uteri. a circumstance attending this case requires particular mention. The child was born dead; and from the symptons of putrescency should judge it had been dead several days. It was rather smaller than the average size of newborn infants, but should think she had carried about the full period. This was the 6th. I think that had been "still born" had generally been hard labors some of them preternatural, but none previous to this had been an arm presentation, the one previous to this had been a breech, & was also still born. As was the child in the case above described, all, or nearly all the still born were in some respect or other deformed, this above which I attended was deformed in the feet & Legs. This woman is 40 or upwards years of age -- has only 2 or 3 living children. This was the only case which has ever occured in my practice in which a delivery was effected with this presentation, where turning was not effected. This indeed is the 3d. case of the presentation that I have witnessed during a period of 17 or 18 years practice. The 1st. case I witnessed was a colored woman slave of a Mr. Whitaker of Ky. which occurred during my practice at Laurenceburg this state some 15 years ago. A Female Midwife had first been called and I think had been in labor 48 hours or upwards. having spent some hours in fruitless attempts in endeovoring to turn the child, I had my friend Dr. Jabez Percival called, who was old in the practice. I well recollect with what self confidence he took his seat by the patient. but having spent 2 or 3 hours in extraordinary effort was as unsuccessful as I had been, and was very reluctently compelled to desist, for the present at least:-- but the event proved that it was the last. We concluded to put her in bed and enjoin rest, in hopes that nature would in a few hours produce some favorable change of position. So we left her to repose, and returned home distant about 5 miles. proposing to return in the afternoon (this being in the morning) when as a dernier resort it was our intention to perform the "caesarian" operation in case matters still remained as we left, but before we returned a messenger informed us that this poor woman's sufferings had terminated, in which she was releived by the hand of death.. In this case the arm was not taken off. what might have been gained by the operation cannot say. of course it would have been justifyable & should have been performed. But I was then inexperienced & young in practice, and I do not recollect that it was proposed by Dr. Percival. Who indeed justly stood high as a Surgeon and practitioner. he is, or was quite lately still living, and must be nearly 80 years old. and I understand that he continues still in the practice. when I located at Laurenceburg this state some 18 years ago he was then said to be upwards of 60 years of age (about 63 I think) and he then held the honorable station of President of the District Medical Society of which I had the honor of becoming a member But I have made a little digression & must return to my subject. The 2d. case of arm presentation, I was called to see about 11 years ago. In this, as the preceeding one, a female Accouchier had been first called. and should judge from circumstances which it would be unnecessary to particularise, that it was her (the midwife's) first case, of the kind. I think she had been about 36 hours in labour, and the arm had been presenting some hours previous to my being called in. Having spent some hours in fruitless attemps in endeavoring to alter the position. I had my friend Dr. Jesse Parmore than of Eaton Ohio called. (I then practised at West Alexandria East of Eaton 6 miles.) My friend Dr. P. was a physician of considerable reputation and experience even at that period and he still sustains himself well in the profession & continues to be a neighboring competitor. Dr. P. also, after some time spent in endeavoring to turn the child. gave up the attempt in despair. I now proceeded to take off the arm at the shoulder, which, with some difficulty, I succeeded in performing by means of the Probe pointed Bistoury. After which and after making some considerable exertion I succeeded in bringing down a foot. & without much difficulty succeeded in delivering. A few hours after this we left our patient. and for any thing I was able to discover tolerably comfortable. But the event disappointed our hopes, for she died I think in about 24 hours afterwards. I do not conclude that such cases must necessarily be fatal. but owing to the delay and the protraction that generly attends this presentation, particularly in country practice, it too often happens that a degree of prostration and inflamation follows which carries off the patient in the end. It is fortunate for humanity that this presentation is rare what proportion they in their occurrence bear, to natural labors, or to other preternatural cases, I do not recollect the report of authors, on the subject, but among a large circle of my professional acquaintences for many years, I recollect very few (indeed not any one) , had a single case of arm presentation. However, I would incidentally remark that only a few weeks ago, an unfortunate case of arm presentation occurred 6 or 7 miles South East of this place. in which the unfortunate female died without being delivered, I was not called in this case, but feel confident that I have correct information on the subject. She was first attended by an experienced female midwife. and first & last by 3 or 4 Physicians who, of the number, had a good Set of accouchery Instruments. Yet amidst all this array of skill and general experience she was not saved. Two of those in attendance are Graduates of the Philadelphia School. (If I mistake not, of the old school) one of whom has the advantage of age and much experience in general practice, & both are quite respectable in the profession. -- I do not wish to be understood as pointing to this case as one of "professional approbrium" but refer to it as being a case in point. & only too conclusively proves the position I have assumed above to be founded in truth and experience. In this case just refered to the arm as taken off at the shoulder as I am informed by Dr. Salter one of the PHysicians in attendance. but with all the advantage this gave, a foot could not be reached or the presentationed (sic) altered. MY success in Mrs. Thornton's case has not made me sanguine, or inspired me with much confidence that I should again succeed. -- had the child been large I doubt much that it would have been a successful case for to turn the child or alter the position seemed to be out of the question and altogether impracticable, And as labor pains were represented at any period of her labor; not to have been strong, and as her strength seemed not much exhausted, we concluded that in case this Ergot acted well, it was posable the child might be born in the position then so pertinaciously presenting. or, (as Denman or Burns, one or the other have forgotten which, hold out the encouraging idea,) that nature produce the change which we were unable to control by manipulation, or effort of the hand. -- So far as my recollection of Authority goes we have had little to build on, or found a hope from; that we should succeed in its then presentation. However, the arm being removed was breast was fairly presented, and the child doubled on itself and was delivered by the natural effort of labor pains, resussitated & strengthened by the exhibiton of the Ergot. and I have nothing to the contrary, that she is doing well. and recovering as usual after former accouchments. In conclusion I would remark that the result of my little experience would point out to me here after the necessity of guarding against the usual delay in such cases. The arm should be removed promply on failing by a proper and well directed effort to return it. To remove the arm safely & successfully of course will require a pretty free dilatation of the os uteri. This is the only delay that should prevent a prompt removal of the arm, when once satisfyed that to return it is impracticable. Continued Helen, Sacramento _*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*