OHIO STATEWIDE FILES - Lindsay Journal #3, 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 8, 1999 *************************************************************************** John Jays son. Francture of the scull and Trephining Nov 8. 1831 I was called to see this Boy at this date, in Consultation with my old friend Dr. Ferguson. who had been called in first. Mr J. resides near Paris. This call being made in the night the operation was performed same night. During the day this young man who was probably about 15 years of age was Kicked by a horse, on the side of the Head, the whole force of the injury was recd. on the upper part of the Ear & in the Temporal Bone. The upper portion of the Ear was cut off, most the whole of the Os Tempora was fractured, besides a portion of it drove in on the rupturing bothe the Dura & pia Mater. The necessity of an operaton was of course apparent and imperatively called for. The patient was in a kind of comatose, mutering delerium, and during the operation of the Trephine and the subsequent use of the raspatory in removin several fragments & spicula of bone, was almost insensible, and quite unconscious of pain, or what was going on. The pulse was rather weak & slow, showing, or at leat corrisponding with other symptoms of cerebral oppression. After having operated depleted, & moved the bowels by degress the pulse rose, sensation & consciousness by degrees gradually returned, at the end of two or three weeks, symtoms of amendment & of recovery were quite flatering, however shortly after this, spongy granultions, or Fungus cerebri began to take place, and after all our prospects of recovery, our hopes proved to be fallacious. every effort was made to correct & suppress this morbid growth of the cerebral substence, by means of the compress & astringents, and when these failed the knife & escarotics were resorted to -- but in 24 hours we almost invariably found that a fresh portion of this mushroom production had sprung up. soon after this state of things had taken place our patient began to loose ground, and at the termination of 5 weeks he was relieved of all his sufferings by death. This was the 2d. case I had seen of Fungus cerebri, The other case was that of Moseby, whose case is repoarted in the 1st. Manuscript volume. In his case this spongy growth was stubburn, but at last yielded to compression, astringents, and at last to the application of the Red precipitate. In Moseby's case the os Frontis was the part in which the injury had been made. it will be recollected that Moseby recovered. That fractures of the Temporal bone are more fatal than of the Frontal, we are admonised in our works on surgury. But I have never seen a patient apparently mend faster than young Jay did until Fungus cerebri took place. and altho injuiries of this part are almost universally fatal according to some authors, In this case notwithstanding the depression & fracture was so very extensive, had the membranes not been ruptured, this young man would undoubtedly have recovered. I should here mention that Dr. Whiterage, & Dr. Knox (the latter then a student) both of New Paris also were present at the operation and rendered me all the assistence in their powers. Friend Charles Osburn's Case of fracture of sons Head. Injyry (sic) of the os frontis. operaton Nov. 9th. 1833. at Economy 20 miles distant from Richmond. HIstory of the Case, some days previous to the above date young Osburn with two or three others boys while in the woods, amusing themselves among the timber. one of the boys engaged with the axe by accident struck young Osburn in the forehead. the latter having inadvertently, and unobservingly of the danger, placed his head within the range of the stroke of the axe while the former was busily engaged in cutting at a stick of timber. The corner of the edge hiting on the forehead in the edge of the hair probably about one inch on the right side, from the central line of the top of the head. My friend Dr. T. T. Butler then of Economy being called, on examination of the case discovered that the cut had cut some distence thro' the bone & fractured the scull. And from the agrevated symptons of the case was of the opinion that an operaton was necessary. On the same day I received the call I set out for Economy & got there just before nightfall. In this case there was no want of consciousness. Nor did there appear to be as yet much cerebral derangement. However a high degree of fever, considerable degree of pain in the head attended by some derangement of the stomach. seemed to call for a critical examination of the injury -- on cutting down, and dissecting back the integuments it was evident that there was some portion of the scull depressed, and that there was some considerable fracture. Assisted by Dr. Butler I applyed the Trephine operating by candle light. The operation was attended by considerable pain, but the patient bore up under it with considerable fortitude. I left the case the next morning under charge of Docr. Butler. For several days inflamation and Fever (accompanied by extensive swelling of the forehead & face) continued to keep up with considerable severity. And it was considered that the patient during several days could not survive, however, by prompt & close attentions of Dr. Butler, during which he had the room darkened, and confined the patient to a strict antiphlogistic treatment, this unfortun(ate) youth in a few weeks time perfectly recovered and has ever since enjoyed good health. and is possessed with a promising intellect. Son of Danl. Pucket Trephining Dec. 31. 1831. History of the Case This young man from an early age had been afflicted with something like Lunar Epileptic Fits which of late years had become very alarming, had considerably affected his intellect. These fits now lasted a week or more, and during the time probably would have from 20 or 30 spasms. when a period subsided he was left in a weakly debilitated situation and for something like another week generly lay in a comatose stupor, gradually getting over this and rousing up he would proabaly enjoy a few days somewhat rational, or at least was more so than at any other period. but at the end of another week about, he would commence a period of restlessness during which he became very talkative, irritable and quarrelsome, and so unmanageable that the Mother & sisters were in continual dread when his father was absent, requiring harsh treatment from his Father to keep him in subjection, This was something like the routine of his symptoms, being accompanied by a constant distress in the head. so very distressing that he at times would plead with his friends to bore his head with an augur in hopes that the operation would give exit to a collection of fluid or matter which would give him alleviation. From the success of an operation being performed on an acquaintence of the family, viz that of Trephining many years ago in the state of N. C. by a surgeon at Salem of the Moravian Society, which case was, as was represented, very similar to the case of this young man now under consideration. The Father and some of his friends brot this young man to me wishing me to operate on him, & I should think the operation would promise any reasonable prospect of a cure, or amendment. at the same time citing the N. C. case and to the individual himself an Elderly friend by the name of Kersey residing in the neighborhood of Milton this County. I gave the Father and friends no encouragement, as I had too little experience to form an opinion on the propriety of the operation. I knew & so informed them, that Dr. Dudley & perhaps some others had operated under certain circumstances, had been successful, and recommended the operation as being justifyable and correct, in cases in which Epilepsey could be pretty satisfactorily traced to a depression of the scull, which, in some cases, was said to have been from injuries of infancy, or young, inducing years subsequently, & continuing unabated for years, or for lifetimes. In others, operations had proved Epilepsey had, on operating, been cured and found to have been induced by spicula of bone, growing from the inner table of the cranium, & shooting downward or inward on the brain, being thus the cause of great irritation. On examination of his case I could see nothing like a depression from previous injury or any other cause, but that in the point he complained of such great distress, It might be posable that a spicula of bone was penetrating the cerebral substance. The young man was now taken home for the present, but after some time His Father and friends again brot the young man with them to consult me on the subject of an operation. I had taken it upon myself in the mean time to pay Friend Kersey a visit who had been operated on by the Salem Surgeon of N.C. And after a consultation concerning the case by a committee of the Society of friends, who concurred in the experiment of an operation, I very reluctently consented to operate. The point which the young man complained of, as being the seat of this distress, was in the right parietal, rather between the sagital suture & the organ of cautiousness as held, or located by Phrenologists. On removing the piece by the Trphine no spicula of bone existed there, neither was any morbid or unnatural appearence discoverable. The wound was dressed in the usual manner by bringing the scalp up, & approximating the edges, in juxta position by means of a few stiches assisted also in the interstises by the Emplas Adhesivum. The wound had united completely by the 5th day by the first intention, but The patient was soon after the operation manafesting symptoms of his reslessness, loquations, and ungovernable exacerbations approaching; & in a day or two was so frantic that he was with dificulty kept in bed, or from escaping from the room. Epalepsey in the course of 6 days came on--And a few convulsions terminated his sufferings. This turned out to be truly an unpleasant case for me, & I was indeed sorry that I consented to operate, however, it must be recollected that all hopes of curing the young man by the usual or any other medical treatment was hopeless he was a source of great distress & dread to his Family. his suffereings beyond description, & now almost entirely an idiot. It must likewise be recollected that his Father & relatives now submited the propriety of an operation to the church, which, had been under the deliberations of a special committee; which committe had repoarted favorable & recommended an operation. I would willingly have left this case unrepoarted, but considering it a duty to repoart my unsuccessful. as well as successful cases, could not consistantly omit giving it a place. The reason here made I know to be substantially correct, & is as faithfully recorded as my successful ones. Case of Joseph Edgarton's Son, Fracture of scull and loss of Brain, Operation Sept 5. 1835, History of the case. This boy was about 10 years old. was run over by a horse in the door yard. The injury was in the right temporal Muscle. The Physican first called was Dr. Trout of Germantown this County 14 or 15 miles west of Richmond near where Dr. J. Edgarton then resided. On the 9th day after the injury I was called with instructions to take my case of Trephining Instruments along with me. In arriving there I found that the fracture was considerably extensive, And was informed that a considerable quantity of Brain had been discharged from the wound during the time that was elapsed since the injury. I took my friend Dr. Swain with me as I passed thro' Centerville and Met Dr. Trout the attending Physician at the place. Having cut down & dissected back the scalp & Temporal Muscle. it was evident that the fracture was extensive, and that a portion of the scull somewhat more extensive than the cork of the shoe, which it was believed had knocked down the scull, was buried in the Brain. as it was evident that some portion of the cerebral substence was anteriour, and which filled up the fisure, I proceeded to remove a circular piece of the scull of the Os frontis, from the opening thus made, and was enabled by means of the raspatory & forceps to remove the depressed portions of the scull, which consisted of several pieces, During the removal of which, a quantie (sic) of Brain was removed also, probably amounting to a Table spoonfull or thereabouts. Notwithstanding the great delay & the number of days that had elapsed, the boy had not shown any delerium or stupor, I think he had complained of some Gastric derangement. as well as some fever. The boy was a sensable of his situation as any boy could have been expected to be of his age & inteligence. and by the by he was a smart little fellow. Having made known to him my views of his case & the necesity of an operation, I shall never forget the earnestness with which he emplored me not to operate on him. and he so far worked on my feelings & sympathies that it was with much dificulty that I could man myself up to the operating point. I had a son at home near his size & age, and I could not help anticipating what my feelings would have been, had this unfortunate boy been my own son thus emploringly pleading with me not to operate on him. His feeling Mother left the house unable to see the operation her son so much dreaded. while his Father lay sick with the Fever in another bed in the same room. But I was much encouraged in the operaton which I so reluctently commenced, by the manly resignation & fortitude of my patient., when he found the operaton was commenced & would be performed. Having operated and finished the dressing I left the boy in the care of Dr. Trout who had subsequently charge of the case. In a few weeks he had recovered, I have never seen a case get over an injury & an operation of the kind so well. & in so short a time, and Dr. Trout is undoubtedly entitled to much credit for the u(n)remitting attentions which the patient received from him during his recovery subsequent to the operation. The loss of brain did not seem to be attended by any bad consequences either in retarding his recovery. or injury of faculties after recovering. I cannot discover that his intellect has suffered in the least. The boy is now (more than 3 years since the operation) in the immediate neighborhood of Richmond. I have seen him several times since the operation. The quantity of scull removed by the operation was considerable, & of necessity has left an extensive surface unprotected by the natural bony coving, I must not omit here to mention that my friend Dr. Swain as well as Dr. Trout rendered me importent servises in the operation. The extent of scull removed in the operation were I to be more precise or definite would say it would have equaled some thing more than a Twenty five cent piece had the irregular extent been brot into a circle. In the operation the Temporal artery had to be taken up being cut in dissecting up the integuments. Mr. 10th. 1839 Richmond. Ia. TO BE CONTINUED Helen, Sacramento ***********************************************************************