OHIO STATEWIDE FILES - Lindsay Journal #1, PART 4
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Continued

Hydrocele case 7.

     T. Johnson Esqr. now Prosecuting Aty. for one of the Judicial Districts of
thie state, consulted me during the summer of 1832 with regard to his case. 
He informed me that some 2 or 3 years previous he had been operated on by a
Physician of cincinnati. Dr. Judkins I think, a small incision, (having taken
no notes, of the preceeding history of the case this is given from
recollection only) had been made, with a view of inducing the adhesive
inflamation.  I think no fluid was injected.  Mr. J. informed me that the Dr.
assured him, or at least flattered him that he was cured, & so dismissed him,
How long it was before fluid was again collected have now forgotten what was
my information on the subject but think it was only a few weeks.  From my
supposed success in Moores case, the 5th. case before reported, (as will be
seen by refering to it was fallacious) and from Orthodox authority on the
subject: concluded to operate by simply drawing off the fluid & injecting.
explaining to my Patient its posable failure, but in case of which, My
confidence in the operation by way of incision which could be performed at
any future time, if necessary.  The anticipated adhesive inflamation did not
follow, consequently in the course of a few weeks the recollection of water
within the Scrotum was the result.  In the spring of 1833 Mr. J. came to
Richmond & again was operated on.  In operating this time I resorted to that
of incision by the knife.  The degree of inflamation which was anticipated
did not follow, & by artificial means. such as irritating & stimulating
dressings were resorted to, with a hope of inducing the state of things, wish
for. & indeed flattered myself that my efforts had been crowned with success.
but after a period of a few weeks the result shewed that my sucess was only
partial, having produced adhesion in about one half the extent of the sack. 
The following May or June my Patient put himself again under my care.  On
operating this time I was more successful. having made & more extensive
incision,   & thereby brot on a higher degree of adhesive inflamation.  It is
now more than 3 years since the last operation, and I think there has been no
return of Hydrocele.  The fact is, such was the degree of inflamation, that I
am induced to hope that the sack is completely obliterated.  In this case the
opinion some unnatural enlargements of the Testis also. if not schirrosity. 
Admitting this state of things to have been the fact. may this not account
for the unusual difficulty in the case? 2 or I suggested my opinion of this
matter to the patient of the unsound state of the organ, who admited that
such were his own fears. & suspicions. he admited that the Testis had at
times been somewhat painful, & that this unpleasent feeling extended up the
cord.

     The foregoing cases comprise about the amount that have been operated on
by me with the exception of one (Two) other, which, owing to the peculiar
situation of the testis, & its appendages, on making an extensive incision
for the purpose of drawing off the water, with a view to a permanent cure,
terminated in that of castrotomy; I will give it a place hereafter.

     It is remarked by Dorsey in his Surgery, that the method of operating by
incision, was so cruel, he would not describe it. beleiving that the
operation by the stylet & Trochar, with the injection of wine, or Brandy &
water, was much less painful & promised in the general, as much success. or
at least, the circumstance of having an opportunity of repeating the
operation of Taping at pleasure, in case success should not attend it, was
sufficient to give this method of operating in Hydrocele the preference & I
am inclined to believe that this is the opinion of Physicians generally, of
the present day.--The result of my practice has been such, as to give me but
little confidence of producing a permanent cure by it. puncture and when
successful, my experioence warrents me in saying, it is owing to the adhesive
inflamation induced (a fact of general admission).--That the inflamation
necessary to the obliteration of the sack containing the morbid accumulation
of fluid in Hydrocele, must run as high in the operation of puncyure, as that
of incision, is, to me, so evident, as not to require argument or proof.  Let
what operation may be performed, there is much judgment required of the
operaton to know (determine) how high it should be carried, & how to graduate
it, this requires a discrimination which can only be obtained by practice &
experience in operating.  The inflamation can, in my opinion, be more
judiciously & successfully graduated in operations by incision, than by
puncture.  That the operation of incision may be more painful, perhaps is
true, however, my experience will not allow me to admit that there is much
difference.--The sickness we are directed to induce by the injection of the
wine, or Brandy & water is distressing:--it is recomended to keep it up until
a disposition to fainting comes on.  In this the patient must suffer as much,
as from the operation of incision, besides, incision gives the surgeon an
advantage in another respect. viz, that of examination of the Testicle
itself.  this appears to me a consideration of much importance. it is highly
satisfactory to the operator to know that the organ is sound & healthy. & if
diseased, to know posatively of what character.  And if admited that the
organ may be so diseased as to require the extirpation of a portion, or
entirely, either from the disease of the testicle or the spermatic cord, the
operation of incision should undoubtedly have the preference.  that such has
been the case, as stated in the outset of these remarks, my own practice has
furnished me one case at least.  3 

     In further support of the doctrine, of giving the operation of incision
the preference, shall now advert to a case of Hydrocele in which I was consulted;
a case too, in which I might have operated, & should have operated, had not a
brother Esculpaius succeeded in geting it out of my hands.

     It was in the spring of 1834 a Mr. Johnson of the Society of Friends. who
resided about 25 miles beyond Indianapolis, came to our place, to consult
with me & others respecting his situation.  Previous to calling on me,
however, he had called on Drs. N. & D. of our Town who, on examining his case
pronounced it Hydrocele.  This I was not apprised of until having given my
opinion of his case, & not until he had learned what my Fee for the operation
would probably be. Having learned that the applicant was in moderately good
circumstances, on being asked by him what my charges would be, proposed to
operate on him for the Sum of $30. but in case success should not attend my
operation, proposed to operate until a cure was effected without further
charge.  He then informed me of having consulted with my Brother chips, &
that one or both of them proposed to operate on him for $5 or $10, At the
time giving the preference to the operation of puncture.  I gave him my
reasons for prefering the operation of incision.  As he was anxious to be
operated on in that way which would promise the greatest certainty of cure. 
He insisted on my operating for $25. which he prefered giving me rather than
be operated on by either of the others at their pitiful low fee. & observed
from what he had learned of me as an operator, he would pay me $25. "as
cheerfully as eat his dinner," making use of his own expression. but as my
feelings were excited, told him the sum proposed was the least cent I would
take, provided my operation should be successful.

     So the patient passed off from me, and was operated on by simple puncture
& injection.  But the result was unsuccessful. fluid soon collected again, & I
have had some intimations that the case may yet come under my care.--

     Perhaps I should not have indulged myself in some of the foregoing
remarks. but having been much persecuted on the score of liberal or high charging,
have concluded to indulge my feelings a little. and while on the subject
would remark further, that I have never refused to attend to an operation,
because the patient was unable to pay me a liberal bill.  On the contrary I
have operated in various cases several times gratuitously, where the
unfortunate patient was poor.  But in all cases where the circumstances of a
patient are such, as to justify being charged a liberal bill, I have always
practised onthe principle, that the dignity of the profession requires it. 

     When the foregoing remarks were commenced 4 most preferable by me, I
forgot that I had another case, of simply, HYdrocele, not yet repoarted. otherwise
this case now alluded to, would have been given first; which will now
commence on the 58th. page (see below, p. 32 of The Journals of William A.
Lindsay). and the complicated case of Hydrocele in which it was considered
avisable to perform the operation of castrotomy. will follow nest in course;
the same adverted to in page 45 & 46 (see above P. 27).
Richmond Ia.
Dec. 17. 1836                         W. Lindsay 

     Before closing my remarks on the subject of the most preferable method of
operating, intended to have said something on the subject of external
applications. among those which I have given a trial, have the most
confidence in the Iodine, & the Muriate of Amonia (Sal. Amoniac).  In cases
of infants & young children should have considerable confidence in these,
Since closing my remarks on the page, recollect a case of a child at the
breast laboring under Hydrocele which was cured by a saturated solution of
the Mur. Amon. in vinegar which was a case in which I was consulted.  I also
once treated the case of an adult, in which, as I supposed, there was a
collection of water within the scrotum, accompanied with some pain & swelling
of the testes & spermatic cords.  This man some years previous, had
constracted syphalis. for which he had been under treatment by two other
Physicians before calling on me.  He being a married man, his wife also
contracted the disease, which may in part account for the disease being very
obstinate to cure, both were under my care for a considerable time, before
their disesases yielded to medicine, various forms & combinations of
Mercurials, with adjuvants, were exhibited during the process of cure.  It
was some months after this man was dismissed, as was thought cured, he called
on me in the situation above described. whether it was from a sequele of the
disease still hanging (lingering) about the system, or from the circumstance
of his having taken pretty freely of the Mur. Hydrarg. during the treatment
of his syphalis which had not been completely  drained off, am at a loss to
say.  The reason I make this last suggestion, is, that in some work which I
have read, perhaps Matthias on the Murcuial disesase, similar effects are
mentioned, supposed to have been occasioned by this preparation of the
mineral being exhibited too freely, or too long continued.  The Iodine in
this case, as an external application in the form of ung I made use of after
some soothing applications had been resorted to, to relieve the pain &
inflamation accompanying.  In the course of a few weeks the Hydrocele
disappeared, the testes and appendages were reduced to their natural sise.
and up to this time being about 5 years since, no symptons of this affection
has again returned.  In confirmed cases of Hydrocele, or those of long
standing.  So far as my experience goes, have no confidence whatever in the
above foregoing Med. or any other of which I have knowledge, in the whole
Materia Medica


     In giving a description of the case of Hydrocele viz that of T. Johnson
esqr. I might have mentioned one or two other facts not there detailed, which
are the following.  The collection of fluid was inconsiderable, The operation
in cincinnati had I presume to some extent destroyed the sac containing the
secreted fluid. & the first two operations performed by myself it appeared to
me had a similar effect, the scrotum after the collection of fluid each time
seemed to be less in volume, & the water to occupy a dif(f)erent position. 
The first time I operated the fluid extended up the greater part before the
testis, along the Spermatic cord pretty high up, at the 2d. operation was
confined more to the lower part of the Testis, & at my 3d. & last operation
adhesions were such as to confine the fluid entirely in front, & only about
one half the volume as that of the preceeding operation.  My incisions were
not sufficiently extensive in either operation to allow me a view of the
testis, the volume of the fluid secreted was so inconsiderable at the 2d. &
3d. operations as to require only a small incision to traverse the whole
length of the sac.  I mentioned in another place that I suspected that the
testis & cord were somewhat enlarged, had my incisions been made of
sufficient length, this matter could have been determined with more
certainty. and had the incision the first time been thus extensive, beli(e)ve
a cure of Hydrocele would then have been effected.

     The result of this case has more confirmed me in the opinion than I was
previously, of the propriety of an extensive & bold incision in operating
with a view to a radical cure of Hydrocele
Dec. 20. 1836                      W. Lindsay
N.B. Dr. Thomas, formerly of Paddy's run either of Butler or Hamilton Co.
Ohio, As I am informed, operated by the extensive bold incision, and believe
him to have been a very successful operator.

To be continued

 
Helen, Sacramento
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