OHIO STATEWIDE FILES - Lindsay Journal #1, PART 5
***************************************************************************
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 8, 1999
***************************************************************************

Continued

Hydrocele case 8.

     John Clark aged about 45, was operated on by me Dec. 28. 1833. for the
disease of Hydrocele of the left side, He had been laboring under this
affection several years.  On examining his case, & describing the operation
of Incison & puncture, made choice of the latter.  The collection of fluid in
this case was considerabe. he was of the impression that the disease was
induced by hard lifting, The disease had been attended by pain in the small
of the back, left loin & side. weakness of the back was associated the pain
in the side, & sometimes accompanied with pain in the left Testis & spermatic
cord. but so far as could be ascertained by an external examination the organ
itself with its appendages had the appearence of being sound & healthy


     After drawing off the contained fluid, & in injecting a preperation of
water & proof spirits tolerably strong, not being much diluted, my assitant
unfortunately let the Trocar slip from its position, so as to cause a part of
the injection to be forced within the cellular tissue. or at least the result
was such, that this state of things were my suspicions-The patient spent a
very restless night, as he informed me the next morning when he called on me
at my office.  On examining his case found the scrotum in several points had
risen up with dark vesicles, containing a fluid, secreted immediately under
the cuticle.  And it was evident that gangrene had taken place which in a few
days run into mortification & sloughing of a portion of the scrotum in the
immediate neighborhood of the puncture.  Swelling of the testis & cord soon
followed attended by considerable pain & suffering, as might have been
expected.  However the patient under the influence of a false delicacy
continued to keep his situation and suffering from his Brotherinlaw and
friends with whom he had taken boarding for a week or two, & presisted in
coming to my office to be dressed, however at last I prevailed on him to make
his situation known to his brotherinlaw, when I visited him for the future
until he became better at his lodgings.  On discovering the situation of this
case the following morning after the operation, immediately made an
application of soothing applications & the light bread poultice. varied as
the symptons & indications seemed to point out from time to time, until the
sloughing process had thrown off so much of the scrotum as had taken on the
gangrenous vesication, described at the first dressing.  My patient with the
exception of his hydrocele & its effects as already mentioned, had been of a
robust & athletic constitution, had been accustomed to hard labor, at least
in his early life. being one of the early setlers of the country.  The result
of the gangrene and mortification, as might have been expected induced
considerable debility & prostration, altho he managed to keep up appearences
a while as if there had not been much the matter with him, as a means of
counteracting the gangrene & mortification, in a few days prescribed, nine,
Barks & the diluted Sulph. Acid. (Elix .vit .)  This unfortunate result was
unexpected as new to me. that such, or similar results are described by our
books was fully aware. but feel confident there have but few such results
been the fortune of surgeons in this country.  such a result should, & no
doubt would have been avoided, had the necessary precaution been used in
keeping the Trocar within the sack or Tunica vaginalis.  This I trust will
ever be a lesson to me in the future operations should I operate on this
plain.  And such a result will be carefully avoided.  My patient suffered
more, infinitely, than he would have done had he been operated on by
incision. and was much longer under treatment. being something like six weeks
before the swelling of the testis & cord had subsided, & the scrotem had so
far sicatrised as to discontinue my attentions. and when I review the rough
ground traveled over in his case, feel rejoiced that the result was no worse.
during a considerable period of the treatment of the case. the Testis was
bare, partly protruding between the ragged edges of the opening made in the
scrotum consequent on the sloughing. & the edges of the wound were very
difficult to approximate & sicatrise.

     However had the satisfaction of being successful in curing my patient
completely.  My patient was a widower at the time I operated on him.  But
soon after recovering, was married in pursuance of a previous espousal, & the
result has given favorable testimony of the power being unimpaired, in the
performance the animal functions as his wife in due time presented him with a
fine pledge, as the result of their weded, & mutual love.
Dec. 21. 1836
Richmond Ia.                                W. Lindsay


Hydrocele & Castrotomy

     Saml. Woods aged 68 or 65 years had been laboring under Hydrocele a number
of years.  On the 21. Sept. 1831. was called in consultation with my friend
Dr. W. Mount, now of the vicinity of Cincinnati. to consult on the above
case. having previously examined his case had satisfyed myself that it was a
well marked one of Hydrocele. which was also the opinion of Dr. Mount on
examining the case.  The patient having made up his mind to submit to an
operation. we proceedid to operate by incision.  On cutting into the Tunica
vaginalis, which gave exit to a large collection of fluid, the testis exposed
to view, we found to us an unusual appearance. viz. that of a number of small
sacks which on cutting into them were found to contain a fluid similar in
appearance to that which was contained within the tunica vaginalis Testis,
these on an average probably contained one half oz. of fluid, which were
thickly clustered by bases or pedicles attached to the spermatic cord at its
connexion with the Testis. also some scattering sacks were on a more minute
examiniation of the case found attached some distance up the cord having made
up our minds, on finding this state of things that the removal of the testis
would be proper to a radical cure, our patient readily consented to its
removal which we proceeded immediately to do. having dressed our patient &
put him to bed. left him in moderately good spirits. in the hands of a nurse.
 On returning home in the afternoon Dr. Mount returned to Eaton, & I rode out
to see a patient 4 or 5 miles in a different direction from the place of the
operation above described.  On returning home in the dusk of the evening, a
messenger had just arrived from my patient, Woods, with the inteligence that
he was "bleeding to death."  The fact of the case was this.  Shortly after
leaving, Mr. W. regardless of our instructions to remain in bed & keep still,
he got up, walked out thro' the dining room into the kitchen, & sat
down.--Shortly after taking his seat at the kitchen fire, the ligature around
the Spermatic Artery gave way, & hemorrhage in a dripping stream was the
result.  Mr. W. being somewhat credulous, in the efficacy of the powwowings
of some self confident ignorant old women, who are found in every
neighborhood. & made loud pretentions to stopping blood and many other
things, equally ridiculous & extravagant, he sent one of his family to one of
these 5"Endors"  living not far distant.  The messenger having made known the
object of the embassey. was ordered to return & bring the exact age of my
patient. day. month. & year.  but behold after all this farrango, he
continued still to bleed on a pace.  It was then that a runner was next sent
after myself.  The hemorrhage had commenced probably about two oclock, & I
did not get there until after dark, the patient was 3 miles distant from
Richmond.  On removing the dressings found that the blood had coagulated. &
distended the scrotum to an enormous size, besides much blood had been lost
which had made the exit in a stream.  My patient was now weak and almost
exhausted from the loss of blood.  I found I had a difficult task to perform,
The coagula had become so moulded & impacted, that to remove it was indeed a
very difficult task, the more so in consequence of having to perform it by
candlelight. however at length I succeeded in finding the artery, & again
secured it firmly with the silk ligature.  To my patient, this second
operation of taking up the spermatic artery, was far more tedious & painful
than that of the operation of the removal of the testis; and to myself far
more perplexing. my patient now dressed, & in bed the 2d. time. was more
careful afterwards, in attending to instructions. and without any other
untoward circumstances was again on his feet in about three weeks, though not
restored to his former health & strength under 5 or 6 weeks.  Mr. W. has
since paid the debt of nature. but had no return of Hydrocele he lived 3 or 4
years after this operation.  Whether it was the most judicious course to
remove the Testis, there no doubt will be a difference of opinion.  I believe
my reading does not furnish a similar or a parallel case.  The removal seemed
to us to be the most preferable, to a radical cure of hydrocele in this case.
and after this lapse of time, & much reflection, beleive I have nothing to
regret, or to charge muself with, unless it be that of securing the Spermatic
Artery so badly. perhaps the ligature might have been in some way faulty, or
in its applicatio not well adjusted. as any one on the reading the foregoing,
must have learned the situation of things, which, in our opinion, called for
the removal of the testis, I scarcely deem it necessary to add here, that it
was owing to the Hydatis State or appearance of these sacks which clustered
around the cord as before described.  Our fears were, that they would serve
as a nucleus to reproduce, at no very distant period, a return of Hydrocele.
Dec. 21. 1836
Richmond Ia.                          W. Lindsay

Castrotomy -- Sol. Harris --

     Sept. 23. 1831. was called on to see the above.  Found him laboring under
extreme pain, enlargement of the right testis. aaccompanied by a high degree
of inflamation.  On making enquiry into the history of his case learned that
some 2 or 3 years previous had had syphalis, (or perhaps only Gonorrhoea).
and, as was supposed, had never been completely cured.  From the information
recd. by my patient, was at a loss in determining satisfactorily, whether he
had during all this time been laboring under a sequele of his former disease,
or Gleet.  But be this as it may, this my patient had been under the care of
an empiric who was treating his case as a case of Syphalis.  What the
treatment was, had no opportunity of knowing. as his cure all of a Quack made
pretentions to the knowledge of a specific, unknown to the less fortunate
regular faculty.  My opinion as, that the bad state in which I found the
fellow, was induced by improper treatment, by the exhibition of highly
stimulating Diuretics, & heating injections thrown up the urethra.  With a
view of counteracting the high degree of swelling & inflamation, of the
Testis, made use of the Lancet, cooling aperients, and as an external
application the most soothing emoluents; such as the Slippery Elm in
combination with Bread & Milk poultises, This plan was pursured until the 27.
or 28th. of the month, without any abatement of the swelling, or the pain
attending.   The agony of my patient was such, at times, as induced him
earnestly to request me to operate on him by the removal of the organ.  This
was his determination on sending for me. which he continued still to urge
every day until the date above mentioned, when I (somewhat reluctently)
consented to gratify him in his earnest intreaties.  There was nothing
difficult in the operation more than might be expected in any other case
attended by as high degree of enlargement of the testis & Spermatic Cord.
accompanied, as this was, by a very high strung sensibility, & great
exaltation of the excitability of the system, & of the organ itself.  It was
with the hope of countervailing this high toned exaltation, that my treatment
was mainly directed, fearing that this state of the nervous system, might
defeat the benifits, of an operation, in hastening that fatal termination of
the case to which it appeared to be portending.--Perhaps it would be in place
here to make a remark or two on the subject of determining the proper time to
operate (operations, generally, is meant,), in cases which the propriety of
an operaton is admited, sooner or later to be imperatively called for; To the
novitiate in surgery this must be an important consideration, involving much
responsibility.  That there have been many cases, in which an illtimed
operation has been entirely unavailing, is undoubtedly true. 6 operations may
be illtimed, in being performed too soon, as well as too late.  A
discriminating judgment, associated with experience is indispensible in order
to arrive at a proper knowledge of this matter.  It is difficult to learn, or
to acquire it from books. of course for ourself to undertake to record
anything like special or correct principles on this difficult subject might
be considered presumptuous.  Without reference to what my reading has been,
would say, we must draw our decision, from all the circumstances of the case.
 For instance if an extremity be mangled. badly lacerated & broken, & in
short so injured that an amputation is plainly, & inevitably called for, I
would say operate immediately, if you are then called. but in cases where the
surgeon cannot be had until the system shall have taken on a high degree of
excitement. nervous irritation, & perhaps great febrile action, my experience
would say, first try and tranqualise the nerves. wait until the febrile
diathesis shall have in some degree spent itself, watch nature closely, see
if She (vis Madicatrix natura), is making any attempt towards drawing a line
of demarcation between the living and the dead, or in other words between the
mutilated part of the Limb, & the sound part, wait until the stomach shall
have shewn symptoms of resuming its orderly action, the illimination of
nutrition from proper nourishment, not forced on it, but now called for, & in
addition to this state of things, until the general system shall have begun
to acknowledge the debility. & ask the assistence of Tonics, manifested by
the powers of life shewing a disposition to come up.  Now is a favorable time
to operate. thus assisted by nature, amputate with out further delay.  Should
this favorable opportunity be neglected until the system begin to sink under
her long & heavy weight of infirmity, and great violence done her, ten
chances to one you are too late; an operation now would be almost certain to
hasten the awful catastrophe, & approaching dissolution!  It would be cruel
to operate now under such circumstances, you must now relax the sternness of
the operator & surgeon, and act the part of a tender affectionate friend, let
your treatment now be directed to the object of soothing, & palliating the
sufferings of the patient. during the little time of existence now left.

     I might instance, or suppose many cases, other than that of the foregoing,
which perhaps may not unaptly apply to amputation in general. but must
decline the task here, not having time nor room.--As regards the foregoing
case of Castrotomy would just add. that I was not assured as well as I should
like to have been, that the operation might not have been dispensed with. (In
the text, the following was crossed out:  "not having much  Suppuration,
Mortification, seemed or was thought to be threatened. which <might?>
exaltation of the organ was still kept up. portending as was feared, to this
result after the general irritation. Phlogistic (consequent) fever had in a
good degree yielded to the treatment, or had exhausted itself in the system."
 I have only to say as a matter of encouragement, that my patient in a few
weeks recovered from the operation. has since enjoyed much better health than
he had done for several years previous.  Having conversed with him frequently
since, expresses his opinion unequivocally that the operation saved his life.
 For 4 or 5 years he continued to reside in this place, during which time his
wife had 2 or 3 children.  Perhaps the interogatory est femina chasta? might
arise, her husband so far as I have had an opportunity of knowing was
unsuspicious of her in this matter.  What our Physiological writers say on
the procreative powers of man thus circumstanced, have forgotten what has
been my reading on the subject.  My patient resided, the last I knew of him,
at Connorsville this state, in an adjoining County.  In blood has been a
little amalgamated, & by occupation, for the last few years, a barber.
Dec. 24. 1836
Richmond Ia.                     W. Lindsay 

     On reviewing the foregoing remarks on the subject of determining the
proper time to operate, I mean in operations generally, and particularly in that of
amputation, I should have remarked that the indication & symptoms as
distinctly & strongly laid down, will perhaps rarely occur. however I expect
(design) hereafter to record a case of Amputation, performed by me some years
ago in which the situation of the patient, run very nearly parallel to the
symptoms which I detailed in the foregoing, as indicating the proper time to
operate.  And it was this case which was, (more particularly than any case
furnished by my reading) portrayed in my mind's eye, & from which the
symptoms & indications of the proper time to operate were drawn up. 

To be continued


Helen, Sacramento
***********************************************************************