OHIO STATEWIDE FILES - Lindsay Journal #4, 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 19, 1999 *************************************************************************** Continued Mr. Samuel Boid's case of Hydrocele. Operation on the 20th of Oct. 1840. This patient residing 13 miles distant. on the above day put him under my care in this place & submited to the operation in which I was kindly assisted by my friends Drs. Vale & Pretlow disease on left side, nothing unusual about the case operated by incision in the distended state about 3 or 4 inches long. but when contracted about 2 inches. water clear & in quantity about 6 oz. should suppose. I made the incision thro' the Tunica vaginalis not to exeed 1 inch. Patient bore the operation well did not exceed 20 seconds having finished with the 3d. stroke of the scalpel. Dressing first time used wheat flour in the wound, & over which applyed a light compress. & pouch over all. 1st. night rested pretty well-2d. day appetite pretty good. directed patient to make generous diet, but to stop short of satiety. at night applyed a light bread poultice. passed a restless & feverish night. 22d. being the 3d. day continued the pultice. gave salts, which did not operate until following morning. appetite not quite so good. patient complains much of pain in the small of the back, poultice continued. rested rather badly. 23d. appetite tolerably good. wound looks well. Testicle & general integuments swolen nearly as large as before the operation. has had little or no fever since the 2d. night. but is considerably restless & still has considerable pain in the back. poultice still continued. and occasionally warm Whiskey has been driped on the wound & surface of the part generally for the purpose of releiving pain of the back, & always for the time being. has a soothing effect. Friday 24th. Took salts last night at bed time, bowels moved in about an hour rested better than any night heretofore. This morning found the wound had bled a little, & shewed a little sign of supuration coming on. last night drew the wound together for the first time with adhesive plaster pain in the back very much abated. appetite continues, pretty good. and patient quite cheerful, poultice continued. Thirsday Oct 29th. my Patient returns home today, strength much restored, the incision healing up. and discharge from the scrotem nearly ceased. had been siting up since Sunday. he leaves in excellent spirits and says he would be willing to pay 3 times the amt. I charged him rather than have hydrocele again. My bill in this case $40. Peter Kepler's Little Daughter Fracture of the Humeris. Oct 27th. found the arm fractured a little above mid way. occasioned by waggon wheel running on it. 3 days ago. a Steam Doctor was first called on this day of this injury & pronounced it not fractured, I found the arm swolen inflamed & quite painful, application had been the Comfrey Poultice, I made the usual dressing by the many tailed bandage & stay case of splints. The case being about 4 miles west, or N. W. of Centreville, Dr. Pritchet of Centreville will take charge of the patient. operation Nov. 12 1840 Case of Fistula in anno Patient Alanson Dunham age about 35. I think understood him to say had been laboring under the disease 10 or 12 years, is by occupation a Taylor. after being some time at his trade and having made use of aloes & oloetic Pills to releive constipation, was affected with Piles and the first symptom he noticed of the fistulous affection. a small protuberence from the Anus of the Hemorrhoidal character commenced discharging. sometime aftwards a sinus formed towards the nates when this discharge from the Lit protuberence ceased. The sinus which now communicated with the bowel, had changed its course occasionally and as might be see from the Sycatrixes had had its exit at different points at difference times. at the time of my operation the sinus externally opened at about 1 or 1 1/2 inches from the anus in the nates. and in the rectum just above the Spinchter Muscle. In sounding it there was some difficulty. as the sinus in passing the director on reaching the bowel, the rectum at first seemed to act as a valve over the director though after a few attempts the director was passed into the bowel. The operaton was made by passing the probe pointed bistoury on the director & having introduced the fore finger of the left hand directed the point of the instrument with the finger and cut out at once which was done with little trouble. and was attended with less pain according the declaration of the patient than was experienced in sounding, & the introduction of the finger. The operation was attended by little hemorrhage. The dressing was finished by introducing lint into the incision & sinus. Nov. 29. The patient continued under my special care for 1 week after the operation at the termination of which he returned home to Centreville. The dressings were introduced once a day and in a few days after the operation Poultices of light bread. on the third day I think it was the introduction of the lint gave much pain and was followed by a restless night. The next day the poultice had such a soothing effect the pain had much subsided & did not again recur to much extent. On yesterday I called at Centreville to see Mr. Dunham & found him at work on the board where he informed me he had been since Monday. I examined him & found tha the sinus had become oblitereated, granulations having sprung up from the bottom of it. and in short the discharge had ceased & the incision had the appearence of being nearly cicatrized. I should have mentioned that my friend Dr. Vaile assisted me in the operation. Nov. 28th. 1840 W. Lindsay Mr. Lewis James case of Strangulated Hernia operation on Tuesday night last week of Ap. 1841. History of the case. On the previous Saturday morning I saw Mr. James who had symptoms of violent Bilious cholic. And was treated as such. first with Anodines & secondly with cathartic medicines On Monday had so far recovered as to go to the mill but in the afternoon was again violently attacked with vomiting & severe distress of the bowels. however Mr. James did not call on medical aid until some time in the night my friend Dr. Steele of the immediate vicinity was called. who unsuspecting any strangulation of the bowels in the case gave Laudanum freely as an anodyne which gave temporary relief. during the forenoon of Tuesday Cathartics were freely administered. but did not operate. nor did the free use of enemata in conjuntion with the cathartics produce any effect. Some time during the day the patient made known to Dr. Steele that he had had rupture of the bowels of some two years previous. & from the pain now attending concentrating in the right Pubo-Iliac region it was suspected that the bowel had descended. & on examinaton Dr. S. found this to be the true state of the case & that the case was one of strangulated hernia The Dr. having made use of pressure with the hand & such other means as the case seemed to suggest without effect I was sent for late in the after noon. When the warm bath. & emoluent applications were in until midnight without any beneficial result. An operation was now resorted to as the only hope of relief was performed by Dr. Steele & myself between 2 & 3 oclk in the morning. On cutting down & exposing the bowel, the strangulated portion of 6 or 8 inches long was found to be in a highly congested state. The whole portion below the ring of a very dark colour & indeed quite black. The incision was made at first about 4 inches long. but in order to relieve the stricture, & return the bowel had to be continued up from one & a half to two inches higher. & such was the stricture at the ring. that the point of the finger could not be forced into it along side the bowel without very considerable exertion & the bowel could not yet be reduced, notwithstanding Dr. S. & myself made repeated efforts to effect this object, until the ring was freely enlargd. by means of the probe pointed bistoury. The bowel reduced the incision we closed by means of 3 sutures or stiches, carefully including in the needle the peritoneum, thus bringing the lips of the incision in juxta position, over which was applyed a dressing lint spread with Basilacon cerate, & over this the compress & bandage. The stiches were left in until the 6th. or 7th. day when a considerable portion of the incision found to have untied by the first intension. however a considerable discharge of supurative matter continued during the first 2 or 3 weeks, & up to this date on which this record is made, the 5th. week since the operation the incision is not yet completely cicatrised. I trust the patient will recover his health for some time he has been able to walk about the house on the farm. & about the end of the 4th. week rode out about 2 miles from home but he is yet far from being restored to good health. & has had two or three attacks of severe distress in the bowels, & twice has been accompanied by vomiting. The bowels have not yet been restored to a healthy tone. and the patient has been under the necessity of procuring their daily Alvine motion by means of some laxative or cathartic medicine. The patient at times has had a good appetite. and contrary to his instructions admits that he has indulged too freely at the table. & is willing to refer all the unpleasant symptoms enumerated to this cause. And it is to be hoped that he is correct; tho' I have my fears that he is laboring under partial structure of the bowels, probably at the point contained immediately within the ring during the period of strangulation. Perhaps it would be in place here to remark that the patient states that the bowel had at times been within the scrotum. & that the rupture had been induced by over straining while engaged in clearing up some grounds in the act of rolling logs. And that he had had occasional distress from the discent of the bowel but had always previous to the attack which was followed by the operation succeeded himself in returning the bowel. In this case it must be mentioned that it ws the province of Dr. Steele to use the knife. as I was called in the sequel only in consultation. And in justice must say that he acquitted himself well but in the spirit of candour would just remark that if the incision at first had been made sufficiently extensive, so as at once to have exposed the ring of the stricture, the operation would have occupied much less time, & would have saved the patient much suffering. Here I would remark that during my long peri(o)d of practice this was the first operation of the kind that has occurred. and it is fortunate for humanity that this operation is the fewest number of strnagulated cases necessary. & owing to the success which has attended me hitherto I was slow in consenting to the operation, hoping the stricture would finally yield to the usual treatment, but on cutting down & finding the situation of the bowel I was well satisfyed that the operation had not been gone into prematurely. but as is frequently the case no doubt in unsuccessful operations had been delayed almost too long. Saturday May 29th. Clark Co. Ohio 1841 W. Lindsay The case on next page of Traumatic Tetanus. is the 4th. of this character that I now recollect having met with in my practice. Clemmer's son on the Eaton & Dayton Pike, Toms Run, Montgomery County 1829, being the 1st. and Mr. Rue's son 3 mile south of Richmond Ia. being the 2d. cse & Shady Henderson 3d. The 1st. from running a heated wheel spindle thro' the hand in preparing sugar spiles of the Box Elder--. The 2d. from jumping off a high fence & alighting barefooted on a dry Elder snag penetrating the Instep of the foot & a portion remaining in the foot. See cases as on record in manuscript. Wm. Young during the first week of March run with his foot against a splinter in the night which penetrated through his shoe & wounded slightly the foot penetrating near the flexor Tendons of the two little or least toes & near the articulation of their Metatrarsal (sic) with their corrisponding Tarsal bones. I was called in April about 4 weeks after the injury to see Mr. Y. and learned that his sufferings had been great having had for several days occasional severe spasms apparently approaching nearly to lock jaw. On examination of the foot. found it but little swolen and unaccompanied by any external inflamation. the fisure or sinus made by the snag on the upper part & rather inside of the foot was still open which could readily be traced by the introduction of the probe but not attended by any supurative discharge. Being at a loss to determine whether the pain & the unfavorable symptoms were to be refered to a portion of foreign or extraneous substance a portion of the splinter broken off, or to Tendenous inflamation, I introdu(c)ed the director & freely laid the Sinus open with the Bistourie. and as a soothing remedial application, directed him to frequently bathe the foot in weak lye as hot as could be bourne, & to make use of the light bread poultice. & until suppuration could be induced at each dressing, to apply a few drops of hot spirits Turpentine. With the exception of an injury sustained some two weeks subsequently after laying the wound open by falling off his feet which hurt the foot considerably, he had but barely one attack of the spasms which he had previously suffered so much from & which as before remarked seemed to threaten Tetanus However he has had a very bad foot of it, & two months & upwards have elapsed since the injury, he is yet unable to walk without his crutches or cain, & could not a week ago bear more than one half his weight upon the foot. This case I have concluded to regard as a case of wounded tendon believing the slow & insiduous & deep situated inflamation, attending at the same time taking the extreme sufferings of the patient into the account, warrent me in forming this diagnosis of the case. Those who have had cases of inflamed Tendon will recollect that the inflamation not only comes on slowly, but that it takes place seldom at the point of injury, but higher up at the point of its origin. so in this case the most pain was deeply seated under the fascia, & as described by the patient in the ancle among the ancle bones, & when the integuments had swolen by means of the warm bathing & poulticing, (or I would say distended) supurative matter was thrown up from some point an inch & half below the depth of the incision which I made in dilating the wound. May 29. 1841 W. Lindsay Continued Helen, Sacramento _*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*_*