OHIO STATEWIDE FILES - Lindsay Journal #4, PART 2 *************************************************************************** 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 *************************************************************************** Continued 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. In cases where the child in this presentation is evidently large, where after removal of the arm, by a proper effort we fail in altering the position, or fail in bringing down a foot, would not the caesarian operation be justifiable? To turn, seems generally to result in failure; & so far as my experience goes, to succeed by dissection & removal of the child by piecemeal is, in my opinion, equally doubtful. hence it would seem that in many cases the caesarian section would be a justifiable practice before the removal of the arm. as it would seem to promise as much, if not more, to save the life of the mother, than the usual practice attended by the usual delay in these caes. and it would promise abundantly more so far as the life of the child is concerned. I must not take my leave of this case without paying a small tribute of respect to my friend Dr. Bugg, with whom. I am proud to acknowledge, I have been on terms of intamacy for several years. he has the advantage of many years experience in the profession; having had the advantage of attending Lectures at Philada. has practised many years in Tenn. and for the last six years been engaged in a respectable practice in this state (Ia.) and as a Gentleman of high noble & honorable feelings I know of no one, among my professional acquaintences, in possession of superior claims. The position of the child in the foregoing case in detail I have neglected to mention. The arm removed & which presented was the left one. The head as doubled back, with the uterus very strongly contracting on it. against the back (I mean the of the (sic) child,) the face laterally in the right side, and in this position passed thro' the superior strait, which in descending the inferior changd (sic). with the face in front, and the belly facing the sarum of the mother. This position necessarily gave the back of the head & portion of the posteriour Fontanelle a very flat shape as it was pressed with great force against the back & spine of the child's own body. The face & forehead was also moulded very flat. In this position the anteriod Fontanelle was the most projecting part of the head. This situation gave such a peculiar moald (sic), that all the portion posteriour to the Anteriour Fontanelle was in the the relation of a side or leg. Had this order of things been reversed the labor would have been much easior (sic). Richmond Ia. Nov. 30th. 1839 W. Lindsay Was called Sept. 10th. 1839 to Daughter of Nathanil Lewis (Friend) in case of Luxation of the Lower Jaw. The Female a married woman had visited at her Father's being fatigued and otherwise indisposed had taken a dose of salts as I learned on enquiry by way of history of her case. Owing to the nausea induced the salts vomited her and produced a Luxation of the Maxilla Inferiora my friend Dr. Bugg hapening (sic) to be at my house from Newport I prevailed with the Dr. to accompany me. This to me was a noval case never before having seen this dislocation But my success was quite satisfactory; having placed the Female on the edge of the Trunnel Bed (on which she had been reclining) in a siting (sic) position with her fore head leaning forward against the breast of her husband who sat facing the bed on a low seat. and placing myself behind him (according to the instructions of Lisfranc by coster) having armed my Thumbs with a Hndkf. in the usual way placed a thumb far back on the molar teeth of each jaw, pressing downwards, while with the hand & fingers placed under the jaw at the same time pressed the chin upwards, and thus succeeded in reducing the Luxation almost instantaneously. Altho' this is indeed a simple operation I must acknowledge that I somewhat dreaded it. being as above stated my first case. But simple as this operation is, I beleive (sic) physicians have sometimes been a little puzled (sic). A Physician of my acquaintance informed me that in a case which was dificult, & in which he was unsucessfull in his attempts in the usual way at first, succeeded by intoxicating his patient (a male) and thus overcoming the spasmodic contraction. Richmond Ia. Dec. 1st. 1839 W. Lindsay Case of Miss Wright. Febry. 10th. 1840. was called after Dark to see this young woman, who early on the previous morning, had, in the act of splitting some kindling wood for the fire, by an awkard stroke of the axe struck it in the upper part of the foot. & woun(d)ed an artery. am not now certain what one but must have been either a branch of the Anteriour Tibeal or an Inosculating branch of the Plantaris Externa given off from the Fibular Artery During the day much blood had been lost at intervals. which had been treated by various applications. & wet cloths. It seems that she & her friends were not aware of the fact that the artery was cut but from the profuse hemorage & frequent recurrence of it were enduced at last to send for me; and it was only on my anouncement of the bleeding from an artery that she & her friends were awakend to the danger in her case. This was the 2d. time only agreeably to my present recollection that I had been called to take up an artery of the foot. I think the wound was between the flexer Tendons of the great Toe, & the one next it, on the Tarsal portion of the foot. The wound had extended quite thro' the integuments to the bone. and owing to the retraction of the artery or the depth of it by the aid of candle light found it a difficult operation to take up. and only succeeded by passing the kneedle deep into the cut & inclosing the surrounding integuments with the end of the artery. however the operation was successfull, & without any untoward occurence the ligature came away in 12 or 14 days & the wound healed in due time. It was some 6 or 7 weeks before she was able to walk on it; but by degrees acquired strength & complete normal action of the foot. July 8th. 1840 Was called on Apr. 24th. 1840 to see Shady Henderson in consultation with his attending Physician and my old friend Dr. Swain of Centreville this county. The history of the case was that 10 or 12 days previous Mr. H. had had his hand caught between two saw Logs at the mill. the flesh not much torn. and the injury was not thought to be very serious at the time. had until the day previous got along without much suffering, was not confined to his bed & for the most part was able to walk about the house. Dr. Swain had in consequence of the little pain & apparently good geting along of the patient only visited him 3 or 4 times during the period, who, I believe, had been called on the same day of the injury. It had been only for the last day or two, say 24 or 30 hours that there had been any distrust that the patient was not doing well. Day before my seeing him had had some rigors. & the previous night had been quite restless. I saw him about 11 oclk A.M. on opening & removing the dressings found the thumb black shriveled & in complete State of Phacelous almost seperated from the hand. which had spread to the whole hand to a considerable degree. there had been some swellig & inflamation of the hand & arm but now the swelling had subsided & the whole hand & greater portion of the arm at least to the Elbow was flabby & relaxed & from the back of the hand particularly discharging a very fotid dirty sanious fluid. The pain in the arm then was intense. and the whole body was covered with a dripping cold clammy sweat. much like that of the worst case of cholera. The countanance sunken & cadaverous. pulse still perceptible at the wrist, tho very weak & could scarcely be counted it was so frequent. The teeth were clinched & a Tea Spoonful of brandy & water in the effort made to swallow it was well nigh strangling the suffering patient tho' he could scarcely articulate a word so as to be understood. Yet he seemed to be anxious to swallow when water & brandy was offered him in the spoon, (tho' he could not) and apparently was still in the enjoyment of his reason & consciousness. What do you think of an operaton? was the interrogation propounded by the Dr. in (attendance on) consultation. As well as some of his friends, on returning again into his room. Too late, was my reply. And so the sequel proved. I left him 12 oclock & he died at 2. only two hours afterwards. This case if worth recording at all will go to show how insideouly Lock Jaw and I may say Gangrene & mortification sometimes stead on. The Physician & friends had all been deceived in this case. his age perhaps had something to do. & was evidently against him. he was about 70 years old tho' his constitution was good, & had been one of the earliest Pioneers of the Country. had been one of that class who had been subject to all the hardships privation & toil of clearing up the rugged western forest. However, advanced age, as we have abundant experience, has not much to do in seting limits to, or in determining who are most subject to this dreadful disease. In this case the result must be looked on only as the result. And the effect, of gangrene & mortification, as Locked Jaw did not assail until Gangrene & mortification had been fully established. The nervous temperament, would seem to me, to be more likely to favor this termination viz. Lock Jaw, tho' from my little acquaintence with this patient I have no evidence that such was the temperament. An early operation would in my opinion have saved the life of this patient. and the patient might probably have been saved by judicious treatment without an operation. Warm bathing of the hand & fore arm, with emoluent & soothing poultices would have been my treatment. I think the treatment by Dr. S. had been Lint & cerate, & perhaps Linament applyed to the hand. This I believe is the second (3d.) case only of Trismus or Lock Jaw that it falls my lot to have seen. Danl. Rue's son was the first (2d.) which had been detailed in the 1st. or 2nd. No. of this series. Richmond Ia. July 7th. 1840 W. Lindsay Continued Helen, Sacramento _*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*