OHIO STATEWIDE FILES - Lindsay Journal #3, PART 6 *************************************************************************** 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, Frederick Daniels patient came in from west of Jacksonburg to be operated on. History of the case. about 3 weeks ago Mr. D. called on me to consult me on his case supposing it be rupture. The scrotum was much distended On examination I at once pronounced his case to be hydrocele. notwithstanding, the semitransparent appearence generly seen on darkening the room and examining with the candle was scarcely perciptible. On June 4th. 1839 the above patient came in and submited to an operation. before operating on measurement found the circumference to be about 19 Inches. and length (of the scrotum) to be about 20 In. quntity of turbid fluid drawn off about 3 pints. Nothing very peculiar. with the exception of the Tunica Vaginalis Testes on making the excision and examination appeared somewhat hydatid. The disease had been of between 3 and 4 years standing had not been attended by any peculiar pain. the size and weight made the organ very inconvenient. In the operation I was kindly assisted by my friend Dr. J. W. Salter. Operated by making an incision commencing pretty high up on the side affected (right side) near the insertion of the spermatic cord. and carrying it down about two thirds of the tumour towards its lower apex. Dressing, having inserted a tent of old muslin charged with simple cerate partially brought the incised wound together by means of 3 stiches and at the open angle one strip of adhesive, and over all applyed as suspensary bag. put patient to bed & enjoined quietude and light diet. during the operation patient lost not to exceed 4 or 5 oz. of blood had expected greater owing to the varicose state of the scrotem. patient stood the operation well June 10th. patient appears to be geting along tolerably well--on the 3d. day after the operation opened his bowels with salts reaction having brot up some fever & reslessness thirst &c. was relieved by the operation of the operient--tho every afternoon and evening some degree of Fever and an increase of reslessness & thirst. On yesterday again administered a small dose of salts. moved the bowels two or three times. tho' very sore & stiff was able to get up to the pot without assistence, To day the scotem is at least 2/3 as large as when operated on--about 1 ince (sic) of the upper part of the incision united by the first intention all above the upper ligature wound below contains the seaton-- and is discharging a fluid about of the same character <&?> appearance to that evacuated in the operation. dressing to day only lint in the wound moisture by Whiskey. appetite tolerably good -- Tongue moist and clean -- The spermatic cord but little swolen, has since the evening of the day of operation been attended by occasional shooting pains up the cord towards the kidney. Urinates without much pain -- urine higher colored than natural. June 11th. Not much difference since yesterday. Still discharging a similar fluid to that found in the scrotem on operating. and rather fearful inflamation is not coming up sufficiently. in dressing to day made use of Whiskey for injecting the scrotem, with a view of exciting more inflamation. appetite, Pulse, general strength, &c. about as yesterday. June 12th. general symptoms about as yesterday. and treatment the same. onlly (sic) in addition made an external application of to (sic) the lower part of the scrotem of the Mur. Amonia in the form of a cerate. last night administered E. Salts which produced two defecations. June 13th. Last night the part became quite painful, attented by an increase of heat in the organ. some thirst and fever with excitement. loss of appetite. fearing that inflamtion might run too high, removed the Seaton, & dressed the incision with a pledget of simple cerate. This morning found that the pain had much subsided, Am in hopes too that the inflamation has ran sufficiently high to induce adheshion & destruction of the vaginal coat and sack containing the secreted fluid constituting the Hydrocele. This morning on dressing. found that the watery fluid had ceased discharging during the night. shall soon expect soon to see supurative matter in its stead. Duressing this morning the same as last night. June 14th. patient somewhat restless last night, but less so than night before -- sleep much disturbed every night -- last night bled some at the nose, which has occurred every day or two since the operation. only dressing simple cerate on lint applyed to the incision. June 17. Today my patient has considerably improved is gaining strength is able to get up and dress himself & set up some time, the s(c)rotem is much less, continues still to run pretty freely. for the last two or three days have dressed him twice a day last night his nose again bled a little, and his sleep is still much interrupted, says he sleeps some in the latter part of the night. June 25th. To day my patient has so far recovered the operation that he has returned home. has for several days been able to walk out and about Town by way of amusement & recreation. The volume of the scrotum and swelling have considerably gone down. is not much painful. the incision has much contracted in its length and would soon be healed were it not for the supuration which still keeps up from the interior parts. bowels have become regular. sleeps well at night. appetite & strength returning. nov. 17th. at this lapse of time would remark in regard to the foregoing case that about 4 weeks ago I visited my patient at his residence. and on examination found him completely cured of Hydrcele. It should be mentioned tha the testicle appears rather larger than the other, but am inclined to think that the membranes or sack containing the secreted fluid, which will be recollected was voluminous, however much contracted, in the cure, now are so inveloped around the organ so as to give it the appearence of being a little enlarged. He is, and has been for a considerable time actively engaged in promiscuous work and labor on his Father in laws Farm. And when I saw him expressed thimself highly pleased with the result of the operation. That he is permanently cured. and the sack completely destroyed, I have not a remaining doubt. W. Lindsay Celular infiltration of the external organs of Generation. On the evening of the 24th. June 1839 was called to see Mrs M.____K about 1 m . s. of Town. And as a history of her case learned that a few days previous, without much previous indisposition quite suddently the whole of the soft and external organ of generation began to infiltrated and soon became enormously distended with water in the celular membrane. Dr. Parmer having been called punctured the parts and gave exit to something between a Pint & qt. of water, of a clear limpid fluid. which gave an instantaneous relief to the patient. This collection of fluid continued to drip off perhaps some 12 hours before it entirely ceased. but in something like 48 hours it had again collected. and as my friend Dr. P. was from home I was called in. On my arrival I found the patient in excruciating suffering. And the celular infiltration of the Labia Pudenda and the whole of the external soft parts as greatly disten(d)ed, apparently, as nature would admit, the whole presenting a transparent glossy and shining appearence, in short the infiltration was now as great as it had been at the time Dr. P. visited her first and operated on her. And the punctures which I made with a Thumb Lancet through the course of the night carried off about the same quantity of fluid and as promply relieved her now as before. This to myself was a novel case having never witnessed any thing like it before. such was the enlargement of the parts and distention that the patient was compelled to lie on the back with her thighs thrown as widely open as could be admited. She was now about the 6th. or 7th. month of her first gestation, and as is not unfrequent there was some swelling of the lower extremities. but not more so nor indeed so much as I had often witnessed in other cases of pregnancy. What could have induced this infiltration of the celular membrans of this organ seems to be a matter of uncertainty. or difficult to be accounteded (sic) for. some few days previous to its taking place she had on account of some indisposition taken a cathartic of some kind of pill, which operated rather harshly. producing considerable griping and bearing down distress. What these pills were composed of, Dr. P. nor myself has not any knowledge, having been prescribed by some other physician. having punctured the parts in several points with a Thum Lancet. I applyed a dressing of simple cerate over the whole of the soft parts. Dr. P. had previously prescribed as an apperient & Hydrogogue Crem Tart. & Nit. Potash with which I made no change. June 27th. on yesterday & the day before she was visited by Dr. P. who informed me that she still continues quite relieved. without any appearence of return of infiltration. On yesterday she was said to be much relieved in every respect, the Edematous state of the Legs having much gone down. Dr. P. had on the day before yesterday prescribed a pill composed in part of calomel & Squill. from the time of the operation by Dr. P. of puncturing and the administration of the Crem Tart. & Nit. Patas. she had been much troubled with vomiting & gastric derangement, but on the Subsidence of the infiltraton, & the discontinuence of the Crem Tart. & Nitre & the exhibition of the Pills this derangement of the stomach ceased, and on yesterday the 26th was much improved generally. Nov. 17. In relation to the foregoing case at this lapse of time I have only to add that she was still attended by Dr. P. whether there was any return of the Labial infiltration or of any other part, am not informed. In due time she was attended in her accouchment by Dr. P. which I think was unaccompanied by an untoward symptom. And my understanding is that her health is again tolerably well established Mrs. Crocker's case of diseased breast. was called on 24th. June 1839 to wife of Mr. P. Crocker, found the left mamma much diseased. some 2 or 3 months previous had been confined with her 1st. child. in consequence of taking a severe cold as, was supposed, the Breast began to be painful, followed by swelling & inflamation and in the course of a week or two had supurated & was Lanced, or broke of itself have forgotten which, as I was called some weeks after this period and have now forgotten this particular in the history of her case as She gave it me on my being called in. the Breast was discharging from a ragged irrgular opening about midway between the nipple and the axilla. at the same time there was some knotty tumefaction in the axilla which was quite tender and painful on pressure. and the whole substance of the mamma was an irregular Knotty mass of Tumefaction. in a few days after I was called, a point of supuration had taken place a few inches above the nipple, on lancing it discharged a considerable quantity of an unhealthy supurative matter, mixed now & then with something like curd, and in part a purely Lacteal secretion. On examination of the breast with the probe at this opening, found it about one & a half inches deep -- which operation was unattended by much pain. While the introduction of the probe in the first described opening was quite painful and followed by some hemorrhage. The 2d. opening on the upper part of the breast was not surrounded by any unnatural appearences while the 1st. opening towards the axilla was of a blue or purplish appearence. which seemed to shoot up rather in the character of an unhealthy, irregular granulation around the margin of the sinus. while in the direction of the axilla for the distance of an inch or two the surface had the like ruguous purplish & Bluish aspect. Some 3 or 4 weeks after I was called in, the other axilla became diseased, and shortly afterwards tumifaction & supuration ensued. And in a week or two more at a point about 2 inches distant from the nipple, and on the right side of the body of the breast, matter began to point & in a few days more I lanced the part, which gave exit to supurative matter mixed as before with some secretion of milk. in a few days after opening this sinus by the introduction of the probe followed the sinus about 2 & 3/4 inches deep and upwards in the body of the breast. about this time the 1st. sinus was nearly healed. and the pain in the axilla and glandular swelling had nearly disappeared. Shortly after this period a 4th. sinus or point of supuration took place about 1 & 1/2 inch distance below the nipple, which on opening gave discharge to a quantity of matter much in character with the 2d. & 3d. sinuses above aluded to. at this time the 1st described opening had healed up completely, in a few days more the 3d. described opening was also closed. and probably in about a week or 10 days the 4th. sinus was healed. during all this time the 2d. sunus on the upper part of the mamma continued open and discharged supurative matter, more or less healthy in character, tho' sometimes than at other times cheesy or curdly, and every day a considerably quantity of a Lacteal character as pure to all appearence as that which continued to be discharged by the nipple. so it was evident that all the sinuses communicated with, and ran into the Lacteal glands at this time the general complexion of the breast was much improved and in about 1 week longer the 2d. and last sinus had healed. I have as yet said but little in regard to the treatment. Poultising with various preperations had been used previous to my being called in. by way of of poultice I made use of the oak bark oose thickened with light bread first. which I discontinued in about 3 weeks for the Flaxseed & it, in a few weeks more for the light bread & sweet Milk -- once a day I generally made an application of the Nit. of silver to the edges of the different sinuses -- and for a short time applyed a tent within the 2d. sinus. when all the sinuses were healed the breast still was knotty, (that it was Schirous am at a loss in deciding) but gradully (sic) these softened and became more natural, & occasionly (sic) on enquiry after her halth am informed that the breast is well. In receiving the early history of the foregoing case am deficient in recollection what I was informed in regard to the early swelling & inflamation. But at the time I took charge of her case & during my attentions of about 7 or 8 weeks it was at no period much of any larger than the sound breast from which She suckled her infant. During the time that supuration was in progress at the 3 several points described, I was surprised to find matter pointing toward the surface unaccompanied by so little swelling and inflamation. For some days previous to my suspicions, and any evidence that I could see of the fact. the patient would perhaps complain of some shooting pain in the part. which in a few days would be followed by a slight discoloration of the surface, and now a slight softness on pressure which became more and more developed, tho' without any increased heat, and but very slight swelling or tumefaction. perhaps the patient would sometimes speak of something like a burning sensation within in connection with the throbing shooting pains. during the progress of these points supuration, which would probably produce some restlessness during night. and all were surprised to see the quantity of matter that would be discharged on lancing one of these points, altho it was small compared with the quantity that is discharged from the breast in common cases of supuration. was called to see Mrs. C. (Note - a footnote in "The Journals of William A. Lindsay" states that Lindsay identifies this patient in his table of contents as a Mrs. Cheesman. - Helen Silvey, great-granddaughter) in April last (1839) who some 12 or 13 months after her first accouchment took cold in the breast which terminated in Phlegmonous supuration. the supuration being fully developed on my first seeing the patient & lanced the breast which gave exit to something between 1 & 1/2 pints of healthy puss. patient soon recovered without further attentions. was called to see Mrs. of Paris O. whose name I have not. patient of Dr. J. Knox in Sept. 1839. On examination found the breast had supurated, On Lancing by the Dr. a large quantity, perhaps a Quart or more was discharged during a few hours, I have no particular knowledge of the termination but was informed that she was doing well. In spring of 1827 at Germantown O. I treated a case of diseased breast. patient Mrs. whose case was in many respects similar to that of Mrs. C. found at Page 108 (page # in Lindsay's Journal) The inflamation finally setled down. and produced a schirrous knotty State of the Breast. I think it was only lanced in 2 places. it was 3 or 4 months in a slugish, ulcerated state sinuses dificult to heal, Finally succeed in healing it up by making use of arcenical injections which brought away a deep slough soon after which a healthy sanative supuration was induced, and the sinuses sicatrised in a short time. nov. 27. 1839 W. Lindsay End Journal #3 Helen, Sacramento ***********************************************************************