R.L. Johnson Medical Journal

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    Clayton. Maiden Lane NY. David Wigton. Beaufort SC. RL Clark. R.L. Johnson. Prototype. R.L. Prototype. Prototype.
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    H. R.L. Johnson. Hamilton. R.L.J. Asst. Surg. P.A.C.S. R.L. Johnson. RLJ. RLJ. RLJ. RLJ. RLJ. R.L. Johnson. Private in Moultrie Guards of Charleston 1860-61. Served for a short time in Artillery Company at North Edisto in June 1861. Spent Summer of 1861 in Alms House Hospital as a volunteer nurse and student Richmond Va. Returned South in Fall graduated in Fall of 1861. Served a month in Moultrie Guards on Wadmalaw Island. Detached and assigned to duty as Hospital Steward at McPhersonville S.C. in winter of 61 and 62. Transferred to Georgetown S.C. in 1862 as Hospital Steward of the Post. Examined in May 1862 appointed Asst. Surgeon June 14th 1862 ordered to Va. Assigned to duty with Palmetto Sharp Shooters Col. M. Jenkins at Battle of Cold Harbor or Gains Mills and Frasier's Farm, 2nd Manassas, Boonsborough Sharpsburg, Fredericksburg. Transferred 1863 in winter to 15th S.C. Regt. at battles of Gettysburg, Chancellorsville 1863, Chicamauga, Knoxville. Left the enemy in charge of the wounded of Kirshaw's Brigade winter of 63 and 64 mar. Knoxville. Transferred to 60th Ala. Regt. in 1864. Married in 1864. At battle Drewry’s Bluff 16th May 1864. Transferred 1st Regt. Va. Reserves 1864. At battle of Staunton River Bridge. Transferred to hospital duty in city Richmond and served in Howard's Grove Hospital until a month after Richmond was occupied got home in May 1865.
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    List of Names of Nurses. J. Lewis Stoddard. Steward. 3rd G.C.U. Sent across the lines with asst. surgeon. C.C. Ferguson. Nurse. Sent to Knoxville Jan.21st 1864. Wm. Calvin Harman. Left him with Dr. Piggott Feb. 9th. Wm Saddler. 2nd Regt. S.C. Taken sick on Jan. 1st see case. Died Jan. 7th. Hemenis. Deserted about 13th and took oath of allegiance to U.S. Wm Hand. 3rd Batt. Sent to Knoxville Jan. 11th/64. Scott. 6th". J.F. Turner. 15th Regt. Left him with Dr. Piggott Feb. 9th.
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    [The writing on the top half of the page corresponds to the writing on the previous page (page 6).] Dos. Spinks, Cotton, and Boulware, and myself were detained on parole nominal in the hotel in Knoxville and entertained very comfortably by the U.S. medical officers for 10 days and sent across the lines where we joined the army near Dandridge.
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    [pages 8 and 9 read together as one chart] List of Names of Patients on Dec. 4th 63.
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    [pages 10 and 11 read together as one chart] List of Names of Patients continued. Sent to Knoxville. Died. Remarks. L.P. Hadden. Corporal Co. D. 7th S.C.V. Jan. 21st. J.H. Cantrell. Prvt. K. Elsmore. Dec. 31st. Abner Alexander. Private. M. 8th. Dec. 7th. H.C. Miller. G. J.R. Irwin. K. 15th. J.F. Koon. J. Jan. 6th. A.F. Hodge. Corporal. E. 11th. J.H. Kelly. B. 21st. J.H. Cheatham. Prvt. F. 2nd. W.J. Parks. J.T. Ragland. J. 51st Ala. Cav.
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    Case 1st. E.M. Hix. Sergeant Major. 3d Regt. S.C.V. Wounded on 17th of November. The ball entered about the middle of the 7th or 8th rib, passing upwards across several ribs, fracturing them, and coming out between the nipple and the axilla on the same right side. On the next day, he spat blood quite freely. After that, the patient tells me, he had pneumonia. I took charge of the case on the 4th of December, at which time he could sit up, after being raised in such a way as to avoid putting the intercostal muscles of the right side into action. Latter part of January he was going out on horseback nearly well.
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    Case 2nd. Wade Allen. Lieut. Co. D. 3d S.C.V. Wounded on the 17th of November. The ball entered about the middle of the 8th rib, fracturing the rib. It fell out of the wound on the next day. The patient tells me that he breathed freely out of the wound, and, that there was also haemoptisis. I took charge of the case on the 4th of December; at which time he was walking about his room. The wound was still discharging some, and necrosed bone could be detected by the probe on the 21st of January; when, at his own request, I sent him to Knoxville to be sent off with the prisoners. This patient was a physician.
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    Case 3d. J.F.M. Foster. Private. Co. I. 3d S.C.V. Wounded on the 17th of November. The ball entered the skin at the anterior fold of the left axilla, and came out at, or near the 9th or 10th rib, without fracturing any bones. The patient says, he spat immediately a great quantity of blood, and breathed freely through the wound. I took charge of the case on the 4th of December; but he was so near well at the time, as to require no treatment except cleansing. After doing hard work, as nurse, for about two weeks, he started to Knoxville, on the 11th of January.
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    Case 4th. C.P. Boozer. Co. C. 3d Regt. S.C.V. Wounded on the 18th of November. Left arm amputated a few hours after, on the same day, at about the middle of the humerus. The patient tells me, that some haemorhage[sic] took place on the next day, which caused the sutures to be cut. I took charge of the case on the 5th of December. At that time, there was a small abscess at the lower end of the stump; and a healthy granulating surface the whole length of the incision, and nearly two inches wide. All of the ligatures had come away. Nearly well on the 9th of February.
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    Case 5th. H.J. Harman. Co. B. 3d Regt. S.C.V. Wounded on the 18th of November. The ball entered at the upper edge of the patella of the left leg; and came out at the outer edge of the tendon of the biceps flexor cruris, on a level with the poplitial space. I took charge of the case on the 4th of December. A few days after, I noticed, that he spat a considerable quantity of yellow, tenacious sputa, and, had a severe cough. This, after a week or two, passed off, and was followed by typhoid symptoms. I then gave stimulants freely. About the 16th of December there was apparently fluid in the joint, but, after a few days, it disappeared. He was often annoyed by diarrhoea. On about the 10th of January the discharge had stopped entirely from the wound, and there was a swelling in the foot of the same side. No matter formed in it however, and on the 23d he got on crutches. On the 27th of Jan. his apetite good. The wound superated has decreasing a little today. Swelling of his foot decreasing diminishing.
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    Amputated the middle finger at request of Dr. H at McPhersonville in 1861. Performed operations on hand and fingers at 2nd Battle of Manassas. Amputated leg at thigh at Chicamauga in middle 3d. Died in a few hours. Amputated leg at junction of upper third and middle 3d of tibia at Chicamauga. Heard he did well. Sent to the rear. Amputated at lower 3d of tibia at Chickamauga. Heard he did well. Sent to the rear. Resected clavicle at Knoxville see case 7th. Amputated foot Hays operation modified by want of flap from sole. The flap being taken partly from dorsum see case 32 of this book for particulars. Tied temporal artery in a wound Feb. 1867. Negro man incised wound extending for 3 inches accross the Temporal bone cutting the artery and muscle. In 1864 Removed a fatty tumor from the back of soldier in 1st Va. Res. in Halifax Co. Va. Tumor the size of a goose egg.
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    Case 5th and 6th. Case 6th. Julius Zable. Co. E. 3d S.C. Regt. Wounded on the 18th of November. His thigh left was amputated, in lower third, on the morning of the 19th. On the the 16th of Dec. the ligature came away, and, a few days later, another the last. The next week he was walking all about on crutches quite well.
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    Upper part of the humerus, entering at and breaking the inferior edge of the cartilaginous surface, and coming out at the upper part of the attachment of the lat. dorsi and teres maj.. Came under my charge on the 4th Dec. at which time nothing was known of the position of the ball.
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    Case 7th. William. H. Husky. Corporal. Co. I. 3d S.C. Regt. Wounded on the 18th of November 1863. Left hand amputated about one inch above the wrist Nov. 19th. One half of the right clavicle resected Dec. 27th. History while in the act of shooting, a ball Enfield struck his left hand, injuring it so severely, that it was amputated on the 19th; and, after passing through many folds of blanket, struck the right clavicle about two inches from the sternal articulation, fracturing and comminuting the bone for the space of about two inches, and splitting the sternal end to within half an inch of the articulation. The ball lodged near or at the humeral attachment of the deltoid muscle. It then passed, as I afterwards learned, from a post mortem examination, through the head of the humerus, implicating the joint seriously, and I took charge of the case on the 4th of December; at which time I did not know where the ball was; nor did I know, that the head of the humerus had been perforated, and the joint involved, as I had not seen the case before, or had any history of it.
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    And there was no crepitus. This was unfortunate; for, had the head of the humerus been resected the patient would almost certainly have recovered.
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    Case 7th. The surgeon who first examined the case was necessarily must have been ignorant of the fact, that humerus was injured; for it was not broken in two, but shot through; which however caused some splintering. When the arm was moved, the head of the humerus worked freely in the socket. There was therefore good reason to conclude, that the bone was not broken. There was, when I first saw the case, a sinus leading from the wound of the clavicle towards the anteriour part of the corresponding shoulder; upon exerting pressure on which point the pus was discharged freely from the wound. December 5th I find the left wrist stump doing well. The right arm is very much swollen; probably on account of the great swelling of the shoulder in the front of which is an abscess that discharges through the wound at the clavicle. Bandaged the right arm to reduce and prevent the swelling caused probably by the pressure by the abscess on veins in the shoulder.
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    Case 7th. At the expiration of two weeks, the broken and necrosed end of the distal fragment showed itself through the skin at about half an inch from the wound, and, in two or three days more, projected; making an opening half an inch in extent, and half an inch from the wound. The clavicle distal protion was quite firm, and projected from its normal position only because of the weight of the shoulder which depressed the outer end, thereby raising the inner one. Dec. 16th Ligatures came away. Dec. 19th Ordered whisky, eggs, milk, and other nourishing diet which have just been obtained for the first time. Dec. 24th On examining the wound every day, I become more and more convinced, that the case is not a hopeless one, and, that he may be benefited by an operation. The discharge of pus is about a gill every twelve hours at the lowest suppositions calculation, estimate. The abscess, in the front of the shoulder, probably contains fragments of the clavicle, of clothing, and the ball itself. This pus can only escape by accumulating until it overflows at the wound.
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    The patient was consulted today and declared himself willing and anxious for the abscess in the front of the shoulder to be opened, in hope of finding the ball therein, or of getting some information of its position; and for any operation to be performed that might then be found expedient. 25th Asst. Surgeons Spinks of Humphrey's Brigade, and North of Anderson's were consulted and agreed, that an operation should be performed for the removal of all of the injured portions of the clavicle. 26th Through the kindness of the Federal Surgeons at Knoxville I procured a good and complete set of resecting instruments and on the 27th the following operation was made. Asst. Surgeons Spinks, Pygott and Cotten, and Dr. Allen being present. Nothing more was obtained by this step than knowledge of the exact position of the abscess.
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    An incision was then made about two inches long, at the anterior edge of the deltoid muscle, and paralel with it, reaching from opposite the head of the humerus to below it's neck. After cutting nearly an inch deep the knife entered the abscess. The finger was then introduced, and a large abscess was found with one sinus leading to the wound at the clavicle, and one leading round under the skin and fascia to another abscess which lay in the posterior part of the shoulder. The first or anterior abscess contained pus and a few small spiculae of bone. The second or posterior contained dark filthy pus and the ball. This was extracted through the anterior opening. It would have been better to have made an incision behind for that purpose as a counter opening was necessary at that point. The ball was much battered; but could be easily distinguished as an Enfield.
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    Case 7th. humerus was fractured, and as there was no crepitus, no displacement, and no impairment of the movement of the joint, it was decided that the humerus and S. joint were intact. I then made an incision about two and a half inches long, at the anterior edge of the deltoid muscle, and paralell with it, reaching from opposite the head of the humerus to below the neck. After cutting nearly an inch deep, my knife entered the abscess. I introduced my finger and found an abscess extending towards the wound, but to my surprise, there was no ball, wadding, or other foreign substance, except a few very small spiculae of bone. After considerable difficulty, I discovered the continuation of the abscess extending round to the posterior part of the shoulder. There I found the ball, and extracted it through the incision in front; though, it would have been better to have pushed it against the skin and cut down on it at the back. The ball was battered out of shape but I could easily tell that it was an enfield ball.
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    The clavicle was then resected. The existing orifice was enlarged by incisions one extending nearly to the articulation of the left clavicle and sternum, the other extending over the distal fragment for about 2 inchs distance. The sternal end was then disarticulated and carefully removed by dissection. Spiculae were carefully removed. One surface of each of those spiculae was generally furnished with periosteum by which it was attached to the tissues, while the other surfaces having no periosteum were exfoliating and forming small abscesses around each spicula.
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    Case 7th. I then proceeded to resect the clavicle. I commenced by enlarging the existing orifice by incisions; one extending to the articulation of the sternum and left clavicle; and the other extending over the distal fragment for nearly two inches distance. I then disarticulated the sternal end and removed it by careful dissection with a curved bistoury, leaving behind however a portion of periosteum which remained when I forced the bone away. Then I removed all of the spiculae except one about inch long which was from the posterior part of the clavicle; which was in its natural position; which had its anterior or broken surface hidden by healthy granulations, and which was firm in position, without any collection of pus about it. This was left by the advice of the others, as its removal would have increased the danger of the operation very much, with out any material advantage being gained. After making a post mortem examination,
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    A chain saw was passed under the distal fragment an inch from the broken end and the bone sawn in two. The fragment was then removed by dissection. Though no veins or arteries of any size were cut he lost over half a pint of blood. A few sutures were taken. Wet lint was laid over the wounds, the patient was put into bed and morphine and whisky were administered. 28th Rested well last night: very pale and languid today; without apetite and with some diarrhoea. Made a counter opening into the abscess from which the ball was extracted. Prescribed opium gr.j Ordered Eggs, whiskey etc.
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    Case 7th. I concluded that there really was none of the old bone left, and, that the solid place I felt and took for a spicula, was, in reality a new bony formation on the periosteum of the posterior part of the clavicle, which periosteum remained in its normal position. Then I passed the chain saw under the distal fragment and removed about an inch; the necrosis extending about one third of that distance only. as well as I could judge before sawing it off, for I could not find it afterwards. Though I cut no veins or arteries of any name or importance, he lost between half a pint and a pint of blood. I took a few sutures, put him back to bed, and gave him morphine and whisky. He rested well that night. Dec. 28th very pale and languid; without apetite and with some diarrhoea. Made counter opening. Prescribed Eggs, Whiskey, and Opium. Dec. 29th Has a little more colour in his cheeks than he had yesterday. Eat squirrel stew.
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    Case 7th. with great satisfaction. Bowels better. Gave him Milk, Eggs, Whiskey etc. Tr. Catechu. The openings in the shoulder are running freely today; the discharge from the wound being much diminished. On the 28th I had cut down to the abscess, at the back of the shoulder, that contained the ball, to let out the pus which had collected there, and to establish an outlet for it at the most dependent part of the shoulder. The swelling of the arm is so much reduced as to slacken the bandages on the arm for the first time since I applied them on the fifth of December. He also moved his fingers for the first. Indeed I had supposed them to be paralysid. Dec. 30th and 31st Doing well. Jan 1st/1864 Doing well. Appetite good. The wound and the incisions granulating. The discharge from the wound is much diminished; there not being enough to overflow the wound in twelve hours. The discharge from
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    Case 7th. the anteriour incision, in which I keep a tent, which is now the outlet from the abscess in the shoulder, is less, than the discharge was from the wound before the operation. Jan. 7th Granulating finely over the end of the bone, and indeed everywhere. Discharge, which is principally from the incisions in the shoulder, gradually decreasing. Several days since, I noticed, that the ends of the bones of the left forearm were protruding, though they were covered by granulations. This was caused by his lying on his back with the end of the stump pointed directly upwards, and the weight of his blankets resting on it. In order to draw the skin up over the ends of the bones, and, at the same time, support the weight of the covering from the stump; I applied the following apparatus. One splint on each side of the arm, extending from two inches above the elbow, to two inches beyond the end of the stump, fastened to the arm by adhesive straps
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    Case 7th. passed round the arm at right angles to the splints. While the elbow is bent, the lower ends of the splints rest on the bed, supporting the weight of the arm, suspended between the splints and the weight of the cover, which rests on the other end of the splints. Inner side of left arm. a. the cover and b. the bed. Dr. Johnson's apparatus Dr. Cotten. Has some diarrhoea this afternoon. Prescribed Rx Tr. opii et Tr. Catechu aa gtt. v. misee. dose ten drops after each operation. From Jan. 7th to Jan 14th whisky supplies out. Diarrhoea constant. Prescribed Tannin, Catechu, Tr. Opii etc. etc almost ad lib. with little or no effect. Jan. 20th In spite of all I can do, his diarrhoea continues. I procured a small quantity of whisky. Jan 26th for past six days I have had a good supply of stimulants; but the diarrhoea remains constant. He will not probably live till tomorrow. Jan 29th Died at one o'clock P.M.
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    Case 7th. Post Mortem. On making an incision from the wound, which had healed to a considerable extent to the incision in the front part of the shoulder, and from there round to the posterior incision, I found, as I had had reason to expect, the track of a large abscess, which also extended downwards in front and parallel with the pectoralis minor: at the bottom of this branch abscess, there was a spicula of bone half an inch long. The ball had passed through the head of the humerus, but had not broken it in two. It did not pass therefore in front of the shoulder, through the sinus by which I extracted it. Wherever any periosteum was left, bone was forming rapidly; resembling in its texture somewhat the cancellated part of the head of the tibia, or provisional callus in fact it was very little different, if at all so, from that structure. To a piece of this, which I cut out carelessly and roughly, I found a portion or section of an artery about the fifth of an inch in diameter, attached.
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    Case 8th and Case 9th. C.M. Franks. Prvt. Co. A. 3d S.C.Regt. Wounded Nov. 18th. Left arm amputated 4 inches from head of humerus on the 18th of November. I took charge of the case of the 5th of December. Dec. 20th By a little force I pulled away all three ligatures. Sent him off well on 21st of Jan. Case 9th. J. T. Waddle. Private. Co. G. 3d S.C.Regt. Wounded on the 18th of November. No bones were broken, the ball having passed under the skin from the shoulder to the elbow. Owing to the length of the sinus and to the filling up of the orifices by excessive granulations the pus became for a short time pent up thereby retarding the cure. Sent him off well on the 11th of January.
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    Stewart afterwards died in prison I think at camp Chase of pneumonia or typhoid fever Cheatham says that Stewart's arm was quite well long before he died. I met Cheatham and one or two others of my patients in the Ballard and Exchange Hotel in Richmond the following year. They had just been exchanged and were going home on furlough.
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    Case 10th and Case 11th. G.F. Long. Sergt.. Co. C. 3d S.C.Regt. Wounded on the 18th of November. Flesh wound over the stomach. The orifices of entrance and exit were on a level, and about one foot apart. I took charge of the case on the 5th. Dec. 16th Both wounds have stopped discharging. Patient walking about and doing hard work. Sent off on the 6th of January. Case 11th. J.P. Stewart. Private. Co. B. 3d S.C.Regt. Wounded on the 18th of November. Elbow resected on the same day. The patient tells me that the surgeon who operated told him that he had sawn off the ends of three bones. I took charge of the case on the 5th of December, at which time he had never sat up. On the 6th I set him up in bed. On the 7th put a splint shaped thus [sketch here] on the inside of his arm and attached it by adhesive straps to his arm. Dec. 12th walking all about. Jan 20th wound cicatrized completely. I keep his arm on the splint. Jan. 21st Sent off.
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    Case 12th. J.R. Dalrymple. Private. Co. B. 3d S.C.Regt. Wounded on the 18th of November. Operated on, on the same day. While in the act of shooting a ball struck his arm joint below the elbow fracturing the bones of the elbow, and lodging under the skin on the shoulder. The arm left was amputated about three inches above the elbow. The case was turned over to me on the 5th of December, as a case of gangrene, that is, it was in the house allotted to the gangrenous cases. I found the posterior flap which consisted of skin hanging dangling down; the bone projecting about half an inch beyond the muscles which seemed to have sloughed away. I find poultices on. Dec. 6th Cheeks with a hectic flush. Bone projecting about two thirds of an inch. Stopped the poulticing. Applied lint soaked with Tr. Feni Chloride and a thin wet cloth and bandaged lightly. Dec. 7th Same. Dec. 8th The tissues immediately around the bone granulating so much that one half inch scarcely protruded. Continued the Iron internally and externally. He was taking it internally when I first saw him.
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    Case 12th. Dec. 16th The posterior flap adheres to the muscle ends, and no longer hangs down. Only the very end of the bone can be seen. It does not protrude. The orifice where the ball was cut out near the acromion process discharges very little pus now. I noticed a small abscess on his side just below the axilla, which emptied itself through the end of the stump. This could be ascertained plainly seen by pressing it. Applied half a dozen half inch wide adhesive straps over it with force. Dec. 17th Renewed the straps. Dec. 23d Continue treatment. A sinus remains which extends from the wound to the axilla. Dec. 24th Stump red and a little swollen. Dec. 25th Sloughing. Dec. 28th The slough extends now almost the whole length of the cicatrix. The lower or posterior flap in growing up to the other flap had become too much cup shaped and formed a bag which contained pus. 4th 5th and 6th the time this swelling was commencing he had a chill and fever for several days in succession. From the 28th to the 5th of Jan. I had no Tincture of Iron or Quinine. I had his wounds kept very clean. The bone is again in sight. The wound sloughing almost its entire length.
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    Case 12th Case 13th. Jan 5th For several days I have felt a foreign body in the arm about three inches above the wound of amputation and nearly on the course of the brachial artery, but somewhat posteriorly to it. It seemed to be in a small abscess. Today I cut it out. It was a piece of the ball about half an inch in diameter and one eighth in thickness. Jan. 7th Doing well. 14th Improving. 21st Doing very well, walking all about, which he did not do previously to the 7th. Feb. 9th Turned the case over to Dr. Piggott almost perfectly well. After getting up he had some swelling of the feet and legs, which passed off with the use of Tr. Ferric Chloride exercise etc. Case 13th. E. C. Longshore. Private. Co. B. 3d S.C.Regt. Wounded on the 18th of November. Right foot amputated about three inches above the ankle joint on the same day. I took charge of the case on the 5th of December. He was then in the room for the gangrenous cases but his wound was not then sloughing at all. Dec. 13th Two ligatures came away today. Feb. 9th Turned case over to Dr. Piggott perfectly well since about a month ago.
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    A.O. Wilson quite well in Spring of 65.
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    Case 14th and Case 15th. A.O. Wilson. Private. Co. H. 3d S.C. Regt. Wounded on the 18th of November. Right forearm amputated in the upper third on the same day. I found him on the 5th of December in the house where the gangrenous cases were kept; but there was no longer any appearance of it. Dec. 11th Ligature came away today. Jan. 21st Sent him to Knoxville, well. Case 15th. A.A. Ross. Private. Co. C. 3d Batt. S.C.V. Wounded on the 18th of November. The ball entered over the space between the cartilage of the first rib and the clavicle, passing backwards and outwards (on the left side). I probed the wound several times and detected broken bone about two inches from the orifice in large pieces. This I supposed from its firmness of position. It may possibly be the ball. It was probably a piece of the clavicle under which it lay. The wound was still running a little on the 21st of Jan. when I sent him off. He was annoyed with a severe cough all the time I treated him, which was much increased whenever he lay on his back.
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    Case 16th and Case 17th. A.R. Parks. Prvt.. Co. D. 3d S.C. Battalion. Wounded on the 18th of November in left side, was said to be a lung wound. I took the case on the 5th of Dec. Dec. 6th Dyentery Till the 11th he got worse the evacuations being bloody mixed with some of a light colour. I used camphor, Dover's Powders, Calomel etc. I did not keep a daily record of his case. Died Dec. 11th. Case 17th. J. Babb. Private. Co. D. 3d S.C. Batt. Wounded on the 18th of November. The ball entered at the front of the shoulder about three inches below the head of the humerus and passed out through the scapula just below the spine. I took the case on the 5th of Dec. In a week he was sitting up and soon after walking about. I do not think any spiculae ever came out of the orifice of entrance in the front of the shoulder. Jan. 7th I removed a spicula of bone about one fourth of an inch long today from the posterior wound that of exit. Jan. 21st Sent to Knoxville nearly well wound draining about 8 drops a day.
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    Case 18th. G.A. White. Sergt. Co. F. 3d Batt. S.C.V. Wounded on the 18th of November. He was sitting up in bed when I first saw him. The ball had passed I heard through the r lung and I supposed the statement correct judging from the situations positions of the orifices. Occasionally he had a little pain in the breast. Sent him to Knoxville on the 6th of January 64. Case 19th. A.C. McConnell. Sergt. Co. G. 3d Batt. S.C.V. Wounded on the 18th of November. The ball entered the skin over the surface of the glutius medius on the right side passing across under the skin and coming at or near the same point out the left side after striking and fracturing to some extent the crest of the right iliac bone near the posterior superior spinous process of the same, and probably the spinous process of the last lumbar vertebra; or it passed between that and the corresponding spine on the sacrum. I took charge of the case on the 5th of Dec. when I found him lying on his belly. He was at that time unable to hold his urine,
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    urine, which excoriated his penis, scrotum etc in spite of efforts to the contrary. The wounds ran freely till the 14th when the excessive granulations filled the orifice. (I had no kind of caustic. There was at the same time an abscess becoming apparent in the gluteal region of the right side. On the 17th I procured instruments and opened it about three inches from the middle of the sacrum. Before puncturing I applied a large bandage round the thighs and buttocks very tightly to prevent air from entering the abscess. There was about one third of a pint of matter mixed with blackish clotted blood. Emptying the abscess loosened the bandages; so I applied another over the first, and, besides, put compresses over the abscess, slipping them under the bandage. The gluteus medius was very much dissected up as I found when obliged to introduce my finger to remove clots in the orifice to let the contents of the abscess out freely. All day he has been very nervous starting, and jumping convulsively whenever touched or excited by the slamming of a door or even by a person walking over the floor. I much fear tetanus. Prescribed stimulants whisky four times a day. On the 20th I opened into the sinus at the inner edge
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    of the posterior sup. spinous process of the ilium and obtained a small quantity of matter. 28th This orifice was still open and discharging on the 28th. The opening over the gluteal region has ceased running. From the first the track of the ball could be pretty plainly felt from one orifice to the other. The twitching of the muscles and aberration of intellect continued for several days and then gradually wore off. Jan. 7th No longer any involuntary discharge of urine. It has ceased gradually. Some disposition to form an abscess up the back on the left side. Jan. 14th Apetite for the last few days very good, some diarrhoea. Discharge from wounds not very copious, about a gill a day from all. Jan. 21st About the same. Feb. 1st Some diarrhoea. He sat up an hour. Feb. 9th For the past two weeks he has sat up about half an hour morning and evening every day. Penis no longer excoriated. He has had a large bile on the upper part of the scrotum near the base root of the penis and a little to one side. Turned the case over to Dr. Piggott on the 9th of Feb. The sinus could still be traced from orifice to orifice and necrosed bone detected by probe in orifice of entrance at event of ilium.
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    Ligature retained 25 days.
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    Case 20. S.P. Hadden. Corpl. Co. D.. 7th S.C. Regt. Wounded on the 18th of November.Right hand amputated on the same day about three inches above the wrist joint. On the 5th of December I found him in the house with the cases of gangrene. The entrance of the wound had some slough in it at that time, the arm was swollen to halfway up at the humerus, very red, and as hard as cartilage. There was by the 9th an abscess near the bend of the elbow which I opened. There had been several before as I could see by the punctures. I found poultices with charcoal in them in use. Dec. 6th Discontinued the poultices. Gave Tr. Ferri Chlor. Internally and applied it to the surface of the wound also. Dec. 13th A ligature came away. On the 16th the ulnar side was doing very well, cicatrizing. Dec. 23d. 28. Jan. 7th. 14th Improving slowly but steadily and surely. Jan. 21st Scab over the whole surface of the wound. Arm still swollen and hard. It is however gradually becoming soft from above downwards. I found him in bed and it was with great difficulty I persuaded him to believe he could get up, or ever recover. Sent to Knoxville Jan. 21st.
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    Ligatures came away about 25 days.
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    Case 21. J.H. Cantrell. Private. Co. K. 7th S.C. Regt. Wounded several days previous to the 18th. He did not know the exact date. He said that he had been shot by some person concealed. There were several circumstances which led to a strong suspicion that he shot himself intentionally. This fact, I think, has bearing on the character of the wound, as, in case of his having shot himself, there would in all probability be a good deal of powder and possibly some paper in the wound. I found the case on the 5th in the house with the gangrene cases, with poultices of charcoal on the hand. The first finger and thumb were amputated respectively at the third and second joint from the extremity. I had his arm and hand, which was very hard and much swollen, poultice, and, on the 9th, I had no lancet, a good sized abscess opened itself in the forearm. Dec. 13th Ligature came away easily. On the 21st of January I sent him to Knoxville. The swelling of the arm had diminished a great deal. The abscess in the forearm had gotten quite well. Abscess in the hand still discharging some and very red and swollen.
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    Ligatures came away on 28th day.
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    Case 22. Elsmore. Private. Co. 7th Regt. S.C.V. Convalescing from an attach of Pneumonia. Sent to Knoxville Dec. 31st 1863. Case 23. Abner Alexander. Private. Co. M. 8th S.C. Regt. Wounded on the 18th of November. The ball entered the right lung. I happened to have seen this case on the field as the 8th and 15th regiments were on the right together. There was, on the 8th, when I first saw the case, erysipelas, the eruption being all over the thorax on the right side. Continued Tr. Ferri Chl. Tr. Iodin. etc. Died on the 7th of December. Case 24. H.C. Miller. Private. Co. G. 8th S.C. Regt. Wounded on the 18th of November. Leg amputated between the middle and upper third of the thigh on the same day. It had healed to a great extent by first intention. Last 2 ligatures came away on the 16th of December. Dec. 19th Sat up. Jan 5th on crutches. Feb. 9th I left him with Dr. Piggott quite well.
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    Case 25. J.R. Irwin. Private. Co. K.. 15th S.C. Regt. Wounded on the 18th of November 1863. The ball entered in the lower part of the popliteal space I think probably, through the external head of the gastrocnemius, and came out at the outer edge of the ligamentum patellae one or two inches above the head of the tibia. Dec. 3 Doing very well. Dec. 11th Spitting blood pretty freely, he tells me, though I did not see it. Good deal of fever in the afternoon. Pres. Dover’s powder gr. X. bedtime. Dec. 12 and 13th Inflamation in and below the anterior wound of exit. Dec. 16th Opened an abscess at the outer side of the anterior tuberosity of the tibia, on a line, therefore, vertically with the orifice of exit. There was much inflamation for two inches over around the abscess. The orifice of entrance well. Probed the orifice of exit and the wound I had just made by puncturing, but could detect no necrosed bone. Bandaged leg from toe to thigh. Opening the abscess relieved the pain which he has been suffering. Dec. 28th Still improving. Jan. 6th opened a small abscess at the anterior tuberosity of tibia. Left him on the 9th of Feb. with Dr. P. The skin over head of tibia swelled, red, with several sinuses, and every appearance of diseased bone.
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    Case 26. J.F. Koon. Private. Co. I. 15th S.C. Regt. Convalescing from Typhoid Fever. Sent to Knoxville on the 6th of January 64. Case 27. A.F. Hodge. Corpl. Co. E. 15th S.C. Regt. Pneumonia middle anterior lobe of right lung only affected. This went regularly through the course of phenomena attending inflamation of the lung. I did not keep a regular account of this case from the first. Dec. 16th getting better decidedly. I a week or two more he was quite well and on the 11th of Jan. I sent him off to Knoxville after having had him as a nurse for awhile. I used Calomel, Dover’s Powders, Blisters etc. Case 28. J.H. Kelly. Corpl. Co. B. 15th S.C. Regt. Dec. 5th This patient was wounded at the battle of Chancellorsville by a ball which struck him on the back about two inches from the spine, of about the last dorsal vertebra, in a lateral direction on the left side.
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    It then passed across to the other side of the vertebral spines as was indicated by the pain on that side and the course the ball was known at the time to take. The first time that I remember seeing the case was on the march from London to Knoxville, when I had found him on the road side unable to travel any farther. He complained of pain in the back. As there was firing of artillery ahead at the time and I was unacquainted with the man I doubted the statement, told him however to drop out and keep up as well as he could, that the ambulances were full. The next time I saw him was here, today. The whole surface of the cicatrix which is about the size of a 25ct piece piece is soft and evidently has a liquid under it. Opened it on the 7th making an incision large enough to introduce my little finger. I could follow the abscess obliquely forwards and inwards until I came to the space between the spines of the vertabrae[sic] which was not sufficient for the passage of the end of my finger. I could detect no necrosis with either finger or probe which I passed a little farther. Atrophy of the left leg to about 2/3 two thirds the size of the right. Abscess soon closed almost entirely. He never lay down. Sent him off no better as regards left leg Jan. 21st.
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    Feb. 28th 1865. Met Cheatham today. He has just been exchanged and has arrived here in Richmond. The depression of his shoulder was discernable through his jacket. He had excellent use of his hand, could write, grasp firmly and indeed suffered by little inconvenience. Could not make motions requiring deltoid, to any great extent. The resection was made with a Y shaped incision, which injured the deltoid of course.
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    Case 29th. J.H. Cheatham. Private. Co. F.. 2nd S.C. Regt. Wounded on the 17th of November. Right shoulder resection on the 18th of same month. Dec. 5th I find him in bed. He does not think he could try even to sit up. Dec. 7th I insisted on his sitting up a little. There is a sinus merely a granulating surface which is, in some places, higher than the surface of the skin, used caustic etc. Continued the adhesive strips to bring the edges together and to compress the granulations. For some time I was obliged to repress by various means, as caustic, sticky plaster etc. the exuberant granulations. Sent to Knoxville Jan. 21st. Case 30th. W.G. Parks. Private. Co. F. 2nd S.C. Regt. Wounded on the 23d of November by a ball which struck the trochanter major of the right femur. The ball entered in front and was out at a point diametrically opposed to it behind. Took charge of the case on the 5th of December.
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    Dec. 12th I notice and abscess forming in the thigh, " 13th There is an spontaneous opening through the skin to the abscess at a point over the bastus extremus. The whole leg was then bandaged. 17th Did not remove the bandages; but dressed the wounds without doing so. The large anterior one is filling up by granulations. From 13th to 23d giving stimulants. The anterior wounds still filling up with granulations. Dec. 28th Discharge from the opening over the vastus extremus about two gills per diem. The abscess can now be distinctly traced under the skin along the outer side of the knee downwards and forwards over the tibialis antieus. Renew the stimulants which have been out for the past two days. Bandage the leg again from toe to hip, putting a compress over the track of the abscess over the tibialis antieus. Jan 14th No change has taken place since the 28th ult. I made him sit up today for half an hour. Jan. 28th Sits up a little while every day. Moved him to another room. Discharge diminishing somewhat. The abscess does not now extend below the knee.
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    Feb. 9th I do not think I can perceive any change whatever, since the 20th ult., except, a little more diarrhoea. I give up the case today to Dr. Piggott. Case 31st. Wm[William] Saddler. Private. Co. F. 2nd S.C. Regt. This was a man about 55 years years of age, who had entered service as a substitute about two months ago. He is a small man, apparently in bad health, as he is very sallow in complexion. He was left as a nurse, but declared his inability to do anything. After about a week he became much more lively and active, and nursed very well in one of the rooms until about the 28th of December, when he became pale and weak again, had diarrhoea; and on the night of the 1st of January I found him with a hysterical attack, shivering etc but not cold. Complains of pain in leg. The posterior part of lower end of the thigh is oedematons; the anterior part of the leg is red and much swollen. He says the leg does not hurt today but did yesterday. The
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    thigh hurts today. Next day he said he felt better; but he was weak. The swelling remained to all appearances, just the same, and on the 7th he died. I supposed it be a case of erysipelul and gave Tr. Ferri Chloride, whiskey etc. His pulse was weak all the time, and there was much aberration of intellect low muttering delirium. Died on the 7th. Case 32nd. Ragland. Private. 41st Ala. Cavalry. Wounded on the of November by a rifle ball which entered the skin at the internal and inferiour border of the patella and came out at the external and superiour border. It passed therefore under the skin for the distance of about two inches. I first saw the case on the 5th of December. He said he did not think the ball had struck the bone, that a Surgeon who examined him said that it did not. On closely questioning him, he said that the Surgeon who
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    examined his wounds probed them with a silver probe one I showed him like mine, and, that neither he nor any one else had ever probed it with the finger. It seems excusable in a man not to probe a wound apparently so simple, espescially the ball went out so near the orifice of entrance, and the tissues over the track of the ball were so thin, that any foreign substances might have been felt between them and the bone; but it seems very strange that he should have used a silver probe to obtain information under these circumstances. Judging from the results of the wounds, I think it probably that the ball split on the edge of the patella, one piece entering the joint, and the other following the course described, and coming out at the upper and external border of the patella. Dec. 16th Until the last few days the wounds have discharged about half a gill daily of thin ichorous pus. The wound looking very red and swollen. He suffers a great deal of pain. Dec. 17th Seems a little better.
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    Dec. 20th I probed his wounds today and found an abscess extending up under the skin three or four inches, lying between the skin and the interior surface of the rectus femoris measuring from the superior edge of the patella. The leg and foot were a little swollen. Applied a roller bandage from the toe upward to above the abscess, to the middle of the thigh. This caused it to discharge quite freely for two days. Dec. 22nd The region over the abscess seems quite firm and the discharge of pus is diminished. 28th An abscess has formed on the outside of the thigh. I opened it anteriorly to the tendon of the biceps flexor cruris. It discharged about one pint of healthy pus. Jan. 1st Discharged freely from the opening I had made. From this date to the 10th the wound looked badly, the abscess not discharging running much, and there is pain on pressure at the inner edge of the head of the tibia. Jan. 10th to 13 Typhoid symptoms. 14th Dry tongue-blind wandering. Today I opened a large abscess at
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    the inner edge of the anterior border of the upper third of the tibia. Jan 23d Better-especially as regards typhoid symptoms. Moved him to another room today. In moving him his leg knee was flexed and extended a very little which caused it to bleed a good deal. Jan. 27th I notice at the orifice of entrance, and just under the skin near the wound a hard substance like bone. After a few days this projected through the skin at the edge of the wound and I found on examining it, that it was cancellated or spongy bone and that it could be easily broken down with the end of the probe and that it bled freely. When I left on the 9th of Feb. I scarcely expected him to live from day to day. Four days later he was scarcely alive, Dr. Piggott informed me. I asked Dr. Piggott, who remained in charge of the wounded, to make a post mortem examination, which he promised to do. Feb. 1867 I have never heard of Dr. P. or the patient since.
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    While stationed with the 1st Va. Reserves under Col. Farinholt at Stanton River Bridge on Richmond and Danville Rail Road. Before day was called down to the bridge to one of the privates over whose food the locomotive had run. He was attempting to crawl accross the track but before he got his foot entirely over, the wheel caught it. The top of the foot was to the rail and the sole to the wheel. I had him taken up by my tent and had a tent pitched over him. There being no physician near, and not wishing to loose the opportunity for a primary operation, I determined to operate alone and to get one of the officers present to administer the Chloroform under my direction. As soon as the patient became sufficiently as I thought under the influence of the anaesthetic I
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    gave the Lieutenant the sponge and I made an examination of the foot which revealed the fact that the toes were crushed and the flesh about the anterior ends of the metatarsal bones was mashed into a clotted pulp. By the time I had finished my examination the patient was partly awake and as I determined to operate I directed the sponge to be applied again to the patient’s nose, and I commenced with the incision accross the dorsum. No sooner had I done so than my volunteer assistants all took to flight and my patient at the same time began to breath in a suspicious manner. I succeeded in inducing my assistants back to their posts and in restoring my patient to a state of semi-consciousness and to a natural respiration and I then determined to operate
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    without the further exhibition of chloroform. The assistants now nerved themselves to their task and the struggles of my patient and his cries entertained them sufficiently to prevent their being shocked at any further steps of my operation which I performed as follows. The ordinary first incision of Hays’ operation, from the articulation of the great toe and inner cuneiform bone to the outside of the tuberosity of the fifth metatarsal bone was made; but in completing the operation as directed by Druitt I was obliged to modify it by making a small flap from the sole of the foot as the tissues covering the anterior end of the metatarsal bones was destroyed. I should have stated that I made the first incision with a greater convexity forward so as to obtain a flap from the dorsum of foot instead of entering from the sole.
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    In the efforts which my patient made before I had finished and while he was recovering his consciousness, as I had no assistant to manage the foot or hold the leg even, my knife point perforated the skin on the outer surface of the foot. This however was a fortunate circumstance for the perforation was an outlet for the pus which would otherwise have accumulated; as the edges healed by first intention. See Gedding's Lectures page 261.
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    This case resulted well. The wounds healed (except at the corners) by first intention and he was furlough’d and sent home in a boat up the river. Unfortunately his brother who had been wounded in the Army of Northern Va. Was furloughed and arrived at the same time from a Richmond hospital with enpipelas. My patient contracted the disease and had a good deal of trouble but finally recovered entirely. I never saw him afterwards. My thanks are due to Lieut. Jas. D. Hunter and M.T. Hewitt for their able assistance. Two worthy members of the Engineers Bureau who could draught and build handsome fortifications if they could not administer Chloroform.
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    Case 34th. In Spring of 1867. Ligated the temporal artery. The artery had been cut in the course of an incision which had been made with a knife, which extended from near the sagital suture down nearly to the zygomatic arch. Of course compression was impracticable under the circumstances. Some four or five sutures were taken, an outlet left at the lower end for draining. The patient had lost a large quantity of blood which none of the assistants could suppress. He was unconscious when I saw him, and though he revived he fainted when I attempted to put him to bed after dressing his wounds. Recovered rapidly, healing by first intention. Case 35th. While attached to Col. Farinholts command of Va. Reserves at S.R. Bridge, removed a fatty tumor from back of patient. Tumor size of a goose egg.
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    Case 36. At Chickamauga amputated leg at middle third of femur. An unpromising case. The consulting surgeons hesitated as to whether it was worth while to amputate or not. Died in a day or two. Case 37th. At Chickamauga amputated leg at upper third of tibia. Successful. Case 38th. At Chickamauga, amputated leg at lower third of tibia. Successful. Never saw either this or the two preceding cases after operating as they returned to their homes and 0 to my regiment. Numbers of operations upon the hand at McPhersonville S.C. and Richmond Va. 2nd Manassas etc. etc. Sharpsburg, Fredericksburg Chancellorsville Chickamauga Knoxville, Drury's Bluff, Stanton River Bridge.
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    Edisto Island February 20th 1867. Brockington's wife who delivered of a still born. It had probably been dead some time as the cuticle was easily detached, and the woman said she had not felt the motion of the child for two weeks. On the evening of the 22nd I first saw the case. The patient complained of great pain in lower part of abdomen. On pressing the lower part of the abdomen the womb was felt to be much enlarged. When sufficient pressure was exerted to feel the uterus the pain was great. Prescribed Rx Dover's Powder gr. Viij Pulv. Camphor: gr. 1v to be given at bed time. The pulse was but little accelerated...the skin not very hot bowel's constipated. Morning of 23d In much pain on hands and knees says that she can get no ease. Pain still felt upon pressing the apparently distended uterus. Pulse nearly normal. Prescribed Rx Oly ricini zj Ol. Tenebinth. Zj Tr. Opii gtt.x at once. On the morning of 24th found patient much better, quite cheerful and comfortable said she was better from the time the medicine operated. Soon got well.
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    See "Dewee’s System of Midwifery" (Lea and Blanchard 1847) 11th Edit. Pp. 104, 105 eeq. et a."This has led to the supposition of certain cases being examples of imperforate uterus." Churchill in diseases of Females. Lea and Blanchard 1847. For a case of imperforate uterus see Western Journal Medicine 1868. This was the first case of labor that I had ever had charge of and one of the first that I ever saw. I had met the woman some time before and she told me she thought she had the dropsy as she
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    Feb. 1868 Gaby Fowler's wife. in labor with her third child. Had been in labor nearly all night. When I arrived she was upon her knees with her breast resting on the top of a bunk, the natis being turned to a large fire. I had the patient placed in bed and made an examination per vaginam. The os uteri was well dilated or perfectly soft and dilatable but was so far up in the hollow of the sacrum as to be difficult to reach. During a pain the anterior part of the uterus presented the feeling of there being no os uteri a large round hard ball. During interval, upon passing the finger far up into the hollow of the sacrum to the prominence the os could be hooked down. This was done and the finger held there during several pains. The os was very soft and yielding during back intervals but contracted hard during the pains and should a strong inclination to mount up the sacrum. By this process and by pushing up the fundus with the other hand over the abdomen the anteversion was corrected the head engaged and labor progressed rapidly to a successful termination. The prone position the woman had assumed over the bunk evidently increased, if indeed did not cause the version.
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    March 31st 1868. Was called at daylight to W32 in labor with 4th or 5th child. First stage rather protracted until about 11 a.m. when the pains changed their character. The child was born about 1 oclock P.M. The presentation was the 4th of Dewees, The ant. fontanelle at the left acetabulum. The presentation was not reduced artificially, nor did it reduce itself to the 2nd presentation of Dewees, The post fontanelle to the right acetabulum. The child was born with face towards the pubes. Mother and child both upon the back. The bag did not seem to contain a large amount of water. During the interval the head could be easily felt through the membranes. The anterior fontanelle could be distinctly distinguished through them and the coronal suture by the lapping of the parietal and frontal bones. After birth the diagnosis was confirmed by the considerable ridge and lapping at that suture. The post fontanelle could be reached more easily than the ant., but was not as distinct to the finger. The sagital suture could scarcely be distinguished through the membranes. The membranes were not ruptured as the head continued to advance through very slowly. The bag finally gave way and then labor progressed rapidly, or comparatively so, the child was born I think in about 15 or 20 minutes after.
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    The child was large and robust but was not crying as strongly as I desired. Mucus in the mouth which I wiped out. Cord pulsating, the child breathing freely but did not seem inclined to cry much. I held the cord before tying it and the pulsations became weaker the child still breathing freely and occasionally crying. I wished to cut the cord as the friends were asking what I was waiting for and as it seemed to be a very long time pulsating. I held it firmly and cut of communication with placenta at first. Just then I made an examination with my other hand and finding large clots of blood in the bed and the uterus entirely uncontracted I left the child for the mother. I passed the right hand into the vagina and with the left grasped the uterus through the abdominal parietes and was happy to find it contracted readily. The contractions and the grasping the uterus or rather pressure on it and rubbing caused much pain. I then returned to the child. It was still breathing well but was indisposed to cry much. The cord had ceased to pulsate and was a good deal diminished in size and was flabby and empty tied it and cut it. 3d Stage The placenta not coming away and the pains being very feeble after a quarter or half hour I made some Traction on the cord which caused complaint of painful soreness but did not cause the expulsion. When the traction was made with the right hand the uterus
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    could be plainly felt by the other hand over abdomen to be moved, yielding to the traction on the cord to a slight extent and springing back when it was relaxed. The traction on the cord was cautiously made. As the patient was extremely drowsy I let her sleep hoping the placenta would be expelled after a little rest. At the end of half an hour more and an hour or more after the birth of the child I gave a teaspoonful of wine of ergot. A dose had been given when the child was born to insure contraction and prevent flooding, which accident had occurred her last labor. Pain came on again quite strong but though I made traction the placenta remained in the uterus. Then holding the cord and keeping it tight with the left hand I passed right hand into the uterus and without any difficulty inserted my fingers between the uterus and the placenta in a mass of coagulated blood which was between them. The back of my fingers and hand were against the fundus and the placenta was in my hand. A pain coming on now brought the placenta down opposite my wrist i.e. into the vagina. I then withdrew my hand with the placenta which was much the largest one I had ever seen though my experience is comparatively limited. This operation caused the most intense agony and the patient fainted completely her countenance as
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    If the placenta has not come with the child and if the pains do not bring it by the time I have finished with the attentions to the child say ten minutes, I introduce my hand into the uterus and remove it in the usual manner. When this is done soon after the expulsion of the child before the pains have contracted it is not noticed near so much and is not much complained of. Of course I try the usual mode of extracting the placenta i.e. rotating it entering the finger into the os etc. It is not very improbable that arresting the circulation in the cord caused the derangement of circulations, cyanosis.
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    suming the most ghastly and death like appearance. By using camphor, cold water in face, pillows from under the head and she slowly recovered consciousness and in the course of half an hour reaction had taken place quite thoroughly. The patient said again and again that the pain was far greater than that of the birth of the child, which were quite severe, and far greater than any she had ever conceived of. I do not wish ever to have it to do again and if compelled to will use chloroform. The lady did well enough after that with an attack 8 or 9 days after of fever and indigestion which were removed by castor oil and turpentine. The child in half an hour or so had symptoms of cyanosis which were repeated at intervals of an hour or two. The hands and anus would become a bluish purple up to the shoulders and the lower limbs to the thighs. The lips and arms were a purplish red. The cheeks had some symptoms of the same disease but not in so marked a degree. Decubitus on right side recommended. Next day it had had several attack during the previous night and day. Decubitus on right side positively insisted on. The attacks became milder and milder and finally ceased after a day or two. Decubitus on r. side kept
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    See the "Western Journal of Medicine" for August 1868. Art. 1st Brief hints about the diet of puerperal women and the management of new born xxxxxxxx and a lengthy consideration of the propriety of ligating the funis of the neonatus xxxx by Jas. F. Hibberd M.D. During a slight sickness while I was lying down in the afternoon I heard a peculiar groan which I immediately guessed was made by a cat which I had noticed as about to have kittens; creeping to the door I looked into the next room and saw the cat lying stretched on the floor on a piece of carpet in a brightly lighted room. There was no apparent attempt at concealment. I crept up close to
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    up for several days longer. September 1868 very hearty and a most vigorous and robust child. where she was lying and finally lay down beside her and noted with paper and pencil each phenomenon in the act of partuation as it took place as follows. RS Johnson. Sept 13th 1868. A cat which had had one or more litters of kittens was taken in labor about 12 o'clock m. In fifteen or twenty minutes after I first found her she was delivered of the first kitten. He moved about a good deal and seemed uneasy and restless. When the pains became very severe she kept still. The bag of waters began to protrude from the vulva and remained so one or two minutes during which time it would advance and retract each time gaining a little until the head was born. The mother immediately began to lick up the liquor amnii from the floor, to lick the kitten and to eat the membrane. These she would eat or chew upon up to the vulva but owing to the nature of the tissue and to the mastication peculiar to the carnivora she
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    was unable to cut it off close and clean but left the ragged string an inch long hanging. She carefully avoided the funis except to lick it. She returned at intervals to the small string of membrane and chewed at the end of it every now and then leaving it to lick the kitten and the funis but not offering to sever it. After an interval of fifteen or twenty minutes pains came on again and another kitten was born in the same way i.e. a bag of water forming and protruding beyond and distending the vulva, the progress of the head being checked when it came to the other and then being suddenly expelled followed quickly by the body. It lay a moment quite still while the mother licked it. It then raised its fore paws and with one bold stroke tore the membrane through in which it was completely enveloped. The mother then carefully eat them in exactly the same manner as the first. After a few minutes the placentas came away. They came in one mass so I could not distinguish one from the other. She took one and eat it up to the funis, this was the placenta of the second born. She then eat that of the first born after which she licked herself and the
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    kittens quite clean, got into a clean place on the cloth and took a short nap. After some time 20 or 30 minutes she had pains at intervals of several minutes accompanied by discharge of small quantities of dark blood. I thought possibly they were after pains as she had licked herself off so nicely. However after a short time the pains became hard and fast and a third kitten was born. It was not near so robust as the second one and failed after repeated efforts to tear the membrane which was all over his head besides the old lady was very much exhausted by this time and lay quite indifferent to its fate. The hind legs were still in the vulva and the tail of the mother lay heavily across the body of the offspring which made occasional efforts to free itself from its perilous position of suffocation. I think one cause of its failures to rupture the membrane was that its nails might not have been sharp enough. 3 of them as I found by examination an hour after had much more perfect nails than the other one which had a small pad of soft horny substance under the nail so that it would not catch the nails into my hand as the others did this was
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    or it is more probably that the life was maintained by communication with the placenta which was not yet expelled and was probably still attached and that foetal circulation was still taking place the respiration being merely mechanical RLJ 1875
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    the smallest kitten in the litter. After this third one there came an afterbirth but it was not until some 15 minutes had elapsed indeed it was that time by my watch. During this whole time, 15 minutes, the kitten lay with his head and anterior half of body enveloped in the membranes. It had however some air to breathe for the membrane was broken at the posterior part and the tail was out and the liquor had escaped. I do not know however how the air got in at the head of the kitten for they were plastered wet against the sides of the kitten to the tail, but it had a small amount of air which it breathed in and out the membrane expanding and contracting around its nose and face. I suppose that its nails had pierced the membrane, letting in a little air and that in his subsequent efforts he had rolled upon the pierced places so that when he expired he made the membrane "bladder up" around his face. At last after 15 minutes the placenta came away and the cat immediately ate it and them membranes off the kitten. It was thus relieved for the little air that it had had kept it alive and when it got a fresh supply it soon revived. In about 20 minutes more she gave birth to the fourth kitten. The membranes broke
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    at the time of its expulsion. The mother did not eat the placenta until a quarter or half hour. In no case did the mother interfere with its funis as long as the placenta was retained. In the first a long time elapsed but yet it was suffered to remain attached until after the birth of the second. All circulation had evidently ceased in the case of the first for some time previous to the birth of the second for it the cord was part of the time twisted round the kittens foot and some time round the mother's tail. The kittens pulled and worked hard to get loose but they could not break the funis and the mother would not chew them. In the case of the first kitten it scratched and pulled so and got his feet so strongly fastened into the funis and against the vulva I thought that must be the natural way for cats to tear the funis through but this was not the case with the 2nd or 3d ones though it was repeated by the fourth as the mother would not eat the placenta until sometime after its expulsion.
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    Nancy Gayle at Wright's Seaside Plantation. Far gone in pregnancy as remittent fever simple and bilious and intermittent fever of all grades from slight sun pains or headaches up to fatal congestive were very prevalent I gave quinine in doses of a few gs a day to prevent fever. In spite of the quinine, which she may not have taken, she had remittent fever at the time of her confinement having a hot febrile paroxysm during labor. I was not with her during labor but saw her before and after and take statement of herself and friends. Used quinine freely all the time no bad results Fever left day after confinement. Note: this baby died in the course of a month or two I think rather suddenly. was attending upon E. Hutchinsons wife with severe case of remittent fever in latter months of pregnancy, did not know her time. Quinine freely. Labor came on and she was delivered during my absence. Fever soon left. She did well. Child died in a few hours after birth and about an hour after I left. When I saw it, it was groaning and its scalp was bloody. I could find no wound on the head but
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    the father and nurse both assured me it had been well washed and that the blood was from the infant. It was not bleeding at the time and what was there was coagulated over nearly the whole scalp so I could not find out where it came from. The child died in an hour or two after I left and was nailed down in coffin when I went back so that I never learned the source of the blood. Smith's wife at Wright's Seaside Plantation a mulatto in latter months of pregnancy. Had fever remittent or int. quotidian but not to an alarming extent. Gave quinine and left it to be continued after the violence of attack had passed to prevent return of fever as I was anxious to ward it off as she was far advanced. She hid the mixture of quinine under her bed and when taken to task said she would not take any more as it "made her head buzz so bad." She was at that time having either remittent or quotidian intermittent with very long paroxysms. She was confined and I saw her next day. She seemed to be doing very well and had no fever. On the 3d day after her confinement I was called in great haste and in less than an hour probably from the time at which her husband started for me I arrived at his house and found her dead. I could gather nothing from her friends as to the meaning of her death they were frightened ignorant and excited black people. A horse had died on the same plantation a day or two before of congestive fever and I suppose it was the cause of her death also.
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    Oct. 27th was called in the morning to see Mrs. 7185. The patient had moved into a malarious atmosphere contrary to advice on the first of the month, consequently some time before frost. She had been taking small doses of quinine daily as a preventative. She supposed herself to be eight months gone in pregnancy but was not certain. She had had shivering and vomiting of bile just before my arrival with pain in back which she thought to be labor it was her second confinement. Had it not been for the nausea and vomiting I would have given Dover's powder but as it was I gave a dose of morphine and the pains were relieved. The pulse increased in frequency and the face became flushed. In the afternoon the pains revived but they were irregular and not very severe. Not being certain whether she had fever or whether the shivering, pains etc were the effects of labor I made a vaginal examination and found the as uteri partly dilated and the head presenting but as the pains wore off in the night I thought she might go longer and concluded that the pains were brought on by the fever which I knew would cause contractions of
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    the uterus which I could feel with the hand over the abdomen and probably miscarriage if they were sufficiently prolonged. Next morning before breakfast she was quite quiet and I intended leaving but just after breakfast the pains returned and I remained all day. The pains returned at the same time as on the preceding day. I was undecided whether the labor pains were caused by the recurrence of a febrile paroxysm at that hour or not. I was in doubt whether the patient had arrived at her full time or not. She did not have a regular chill but chilly feelings etc. The as uteri was soft but not fully dilated the membranes did not protrude at all and did not seem to be separated from the os internum uterus. The head of the child however generally lay in contact with the circumference of the as uteri. I now thought that the pains had been enough off and on and that they were harassing and fatiguing the patient and that as the os was soft it would be well to assist a little. I did not suppose that the inertia procured from over distension of the uterus with liquor amnii partly because the membranes did not protrude through
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    B. This baby was robust and healthy though not very large. I saw it when visiting the mother for about a week but never had occasion to prescribe for it when the child was five weeks old I saw it accidentally and was struck by its cadaverous pallid countenance. Before seeing the child I hear that it was recovering from jaundice and that the stools had not been white or clay colored etc. When I saw the child however I was struck by its being very anaemic also. The resemblance of the child to some chill and fever babies which I had recently attended and the reflection that the mother was having severe chill and fever attacks just before at the time of this childs birth made me suspect that it has chills and I asked if they ever noticed whether it got cold. The answer was that they did not know but that it broke out into profuse sweats at times. I volunteered the advice that something ought to be done and proposed for the mother the following prescript which she took she says. Quinine 5gr Tr. Ferri mur. gtt. x7 Fowler's Solution gtt. V. during the day. I dropped on business in a few 5 days after and saw the baby again. It was still anaemic, The mother rosy and hearty but it looked a little brighter. I told the parents I thought it
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    the os at all and partly because the patients belly had not been large. I did not therefore therefore attempt to rupture the membranes it was not desirable I thought and it would have been difficult to do so as they lay in immediate contact with the head of the child. I gave two small doses of 30 drops tinct. Ergot. at intervals of half an hour. This was at that period between the chill and the fever when the pulse and skin were natural. Soon however the fever came on and I felt convinced, from its recurrence at the same time of day, that the disturbance was owing to the fever that the patient as she thought herself had not come quite to her full term that the chills fevers caused irregular distribution of blood through the system congesting the uterus and bringing on contractions. I therefore as the time had almost arrived at which the fever began to decline the day before. I gave a large dose of Dover's Powder and she soon began to sweat off the fever. As the pains had all left her I prescribed Quinine in 5 gr doses every two hrs till morning etc. and then decrease doses but not to disturb the patient later in the night to carry out the prescription. She went to sleep at bed time and slept soundly until three o'clock next morning
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    by no means in a thriving condition but that it looked better. They said it had had some attacks which I could not get a description of which the mother was alarmed about but which the grandmother said was nothing at all. Were they chills or fevers? I could find out nothing but I came home and determined to go back in a day or two and give quinine, directly to the baby, and iron or mercury if necessary. The next day I learned to my great surprise that it had died suddenly in the night. Perhaps in a chill of a congestive fever. For account of the baby turn back two pages, marked B. The mother and husband both had chills the day after and the husband for several days increased their quinine they had been taking it as a preventative in several doses. I think that their having taken it as a preventative modified their fever into intermittent instead of bilious remittent, which later I had found would be the result of their move to the country.
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    when she woke up and had a baby a fine healthy bow about half an hour or hour, and fully an hour before I could get back to her. When I did arrive at day light, she was doing perfectly well and the womb had contracted small and hard. After staying two or three hours and getting breakfast I left. I had been gone about an hour and a half and had gone about five miles when her servant came for me and said his orders were not to spare his horse and that I must not spare mine; for, that his mistress had been taken suddenly much worse. I thought of hemorhage for one thing and I was soon by her bedside. I found him by no means in an alarming condition she had some fever and headache. Her mother said she had had an attack of rush of blood to the head etc which she did not give a very lucid account of. However my patient had fever and headache and the attack had occurred about an hour after the accession of the paroxysm of the day before and two hours after that of two days before. The fever sweated off that afternoon and I unhesitatingly gave large dose of Quinine for several days. No further difference. Patient soon quite well.
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    cicatrix such however was not the case and it got well with scarcely a perceptible scar and no contraction of the lid and eversion or any other trouble.
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    Nov. 13th removed a fatty tumor from the lower eyelid of a mule. The tumor was nearly as large as a walnut and had pressed upwards and against the eyeball protruding the conjunction in front of it and turning the lower lid to some extant wrong side outwards. There were other tumors of small size in the same lid and one had become exconated. I turned out the contents of two small ones in the course of the long incision which was parallel with the eyes and about an inch below it and about as long as the opening of the eye. I made also a T incision i.e. I made an incision at right angles to the first extending upwards almost to the eyelashes of the lower lid. This case promised badly in a few days as the mule got his head loose and rubbed the sore until he broke all the stitches loose. The sutures were all made of too fine thread used sulphate of copper solution for a dressing owing to the supposition I supposed it would heal by granulation and leave a large. See last page preceding this.
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    1868. Sandy Chapman at Wright's Seaside had his hand crushed in between two cogwheels on the 11th or about it of November 1868. The first cog mashed the thumbnail. The second broke the second phalanx of the thumb, the third lacerated and contused the tissues and cut into the metacarpo-phalangial articulation, breaking the bones and laying open the joint. He being a laborer a stiff thumb would be preferable to none, as even a stiff one can help to hold a plough or hoe. Took out a very small piece of bone the wound was free of all foreign matters. I used cold water dressings. After he got well which was in good time his thumb was so stiff and the power of flexion so entirely lost that I almost regret not having amputated. I however urged him to use it as much as possible in order to restore the use to the muscle. Told him to carry a stick all the time. Six months after the thumb still stiff and standing off and back from the hand. Jan. 1870 Meet him lately. He has regained the use of his thumb to a surprising degree. It gives no inconvenience and he uses it for all purposes.
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    Nov. 16th 1868. Gilbert [blank space] child a colored girl about ten years old. Was shot through the elbow whole lower end of the humerus being torn away. With Dr. Cooks assistance I amputated at or a little below the middle third of that bone. I used a scalpel and the blade of a broken meat saw. Had a great deal of difficulty with the saw which was not set rank enough and it was pinched fast by the bone after it had gone half way. I was obliged to remove it and saw from the lower surface of the bone by little loss of blood. Dr. C. administered the chloroform and held the artery. But one artery the Barachial jetted. It was easily drawn out and tied. Nov. 22nd All the sutures loose, the wound open but quite healthy granulating and contracting. 1870 see her often. The muscles have of course become atrophied and the bone sticks up hard against the cicatrix. She has never had any serious trouble with it only a few falls upon the end of it.
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    November 15th Sunday morning was called to see wife of 2525994725254 at Maxcy's. The husband stated when he called that the patient had not passed any urine since the preceeding[sic] Wednesday afternoon. I thought it likely the bladder had given way and that she was suffering from the effects but such proved not to be the case. I found the patient to be a well made hearty laboring black woman apparently about twenty eight years old. The history of the case collected then and at subsequent visits was as follows. About twelve days before Sunday she had been engaged carrying heavy bundles of cotton up stairs. She knew she had exerted herself at the time but felt nothing peculiar. On the following Friday 3 or 4 days after she dug potatoes and at night had considerable pain in lower part of abdomen. Saturday she did not work on account of the pain, but the following Monday she worked hard hoeing and carrying potatoes. She lifted baskets of them and carried them as usual on her head. The pain prevented her working on Tuesday when she suffered considerably. On Wednesday the pain continued and afternoon of that day there was no further passage of urine. From then until Sunday no urine passed at all
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    A. "In retroversion of the fundus of the uterus, enlarged by gestation or other causes, the cervix may be driven so firmly against the symphisis pubis as to close the urethra." Barnes on Diseases of Women p.36. Henry C. Lea 1874.
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    During this period of four nights and three days she took teas but, as one of the nurses who was with her said, she could not get any sweet spirits of nitre. Before passing the catheter an examination was made of the vagina which led to one of the rectum. On attempting to introduce the finger into the vagina a mass composed of the corrugated posterior wall was found slightly protruding or at least blocking up the entrance of the vulva. The os tineae had mounted up so high that it could scarcely be touched by the end of the finger. It was close to the upper part of the symphysis pubis and was a was soft and seemed rather large from side to side. I think I was unable to touch the os until after emptying the bladder. Then and at subsequent examinations the posterior lip of the os tineae seemed softer and more relaxed than the anterior which seemed hard and on the stretch. Upon returning the prolapsed post wall of the vagina upon the end of the finger a smooth tumor could be felt lying accross the normal direction of the vagina. Upon introducing a finger into the rectum the same tumor could be felt. It did not however press back against the sacrum so as to interfere at all with the introduction of the finger.
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    Upon arriving at the house of the patient I found her standing by the bed with her feet stretched apart and her hands on the bed. She said she had tried every way and had strained etc. She was laid on the bed and after the examination as on the last page a female catheter the only one I had with me was introduced. The bladder had mounted up so high that the catheter could scarcely reach, indeed it was necessary to hold the end of the catheter between the fore finger and thumb and press them between the labia and push up the soft parts as much as possible and press down the bladder over the abdomen in order to keep up a flow. The neck of the bladder was so much to the front that the mouth of the catheter pointed backwards and downwards. Owing to the positions of things it was necessary to discharge the urine in the bed. It is not known what the quantity was, but it went through the mattress and I heard it for a long time piddling on the floor where it rand through a crack out of doors. I then attempted to restore the uterus to its proper position. I tried to push up the tumor by pushing up the posterior wall of vagina against it with two finger in the vagina. I could not
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    I made a blunt hook out of a female catheter by bending the closed end or bladder end and [illegible] the outeer end to the handle of a pewter spoon which I cut off for the purpose. This blunt hook I succeeded in introducing into the os so as to draw down the os if possible. I found in my various maneuvers to push up the fundus that the os went up at the same time. I tried therefore 1st to push up the fundus 2nd to pull down the os, and 3 to do both at the same time.
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    any hold on the os uteri as I could only touch it with the tip end of my finger. I then tried different positions first I put the patient on her knees with her face and breast on the bed and tried with two fingers in the vagina, then two in the rectum. Then I tried putting her with her hands on the floor and her thighs on the bed. This however put the abdominal muscles into action and the tumor was decidedly more unmovable. While the patient was on her knees and face I knelt down on the bed at her left side and in that position could introduce the thumb of the right hand into the rectum up to the tumor and two fingers of the same hand into the vagina up to the tumor and exert pressure on it, which shows how low the tumor was. It could be pushed up some, but did not stay, nor did it drop back suddenly either. After giving each plan a fair trial I abandoned the attempt for the day and prescribed salts in purgative doses and ipecac in slightly nauseating doses and the prone position. On the 16th I visited her and drew off the urine none of which had passed naturally. A slight examination per vaginum showed the parts to be in the same state. On the 17th Saw her again and again drew off the urine with a catheter. Parts in same state.
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    On the 18th Drs. Mikell and Sams saw the patient with me and agreed with me as to the diagnosis. The patient repeated to us the same statement as regards the work etc. and stated that she had not borne a child for several years and that her catamenial periods had been regular and that they had appeared only two weeks before she was taken sick, this she assured me of then again and again, and at previous and subsequent visits. We urged her to tell the truth as we suspected from their being no fever and no constitutional disturbance except pain that the displacement might have been of long standing and that pregnancy had just occurred and that the increase in the length of the womb and probably some slight displacement further had caused compression on the neck of bladder in urethra at the symphysis pubis. The vaginal examinations for several days showed blood on the finger. We now tried each of the plans to restore the parts which I had tried before, but we took time enough. Dr. Mikell passed two fingers into the vagina and I two into the rectum, the patient being on the knees and breast and
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    xB. The hook I made by bending my female silver catheter at the holes at the bladder end, and then cutting off a pewter spoon, which had an iron wire in the shaft, an inch from the ladle end shaving down the shaft until I could drive it into the catheter at the outlet end thus increasing its length three or four inches. This made my hook perfect.
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    we exerted a long slow pressure without success. Dr. S. then tried the position over the side of the bed, Dr. M. and myself holding her by the shoulders so as not to put the muscles of the abdomen upon the stretch. We then placed her upon the back feet in chair in position for turning and Dr. M. administered chloroform to remove pain and to prevent bearing down, which took place when the patient became partially from under the influence of it, and I introduced the hand with the back of the hand towards the sacrum, I could thus push the womb back or rather upwards to a slight extent but the general direction of the vagina was forwards and upwards. At the same time I had xB a hook in the mouth of the uterus and was exerting as much force as I deemed prudent to draw it downwards. The hook slipped out once and I replaced it. The introduction of this hook required a little manipulation as the os uteri was up to the upper edge of the symphysis pubis and could scarcely be reached with the tip of the finger. However nothing would do and we were obliged to abandon any attempts for the time. The next day she said a small quantity of water had passed but
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    that it had ceased. I drew off the urine and attempted to instruct her how to use the catheter. She was not suffering much pain nor had she any fever which I had feared might result from so much handling. On the 21st I succeeded in teaching her how to introduce the catheter, on which day the vagina was still directed forwards and the post wall of it was pushed down. Four days afterwards she informed me that she passed her water freely without the catheter and after that she had not further use for it but she had some company and could not conveniently submit to an examination which I would have been glad to make. The same was the case two or three days later and it was not until the 5th of Dec. that I got an opportunity to examine into the state of affairs. When I did so I found the os uteri in the axis of the pelvis and, with the exception of procedentia in the normal position. The finger could be introduced 'ad infinitum' in the normal direction of the vagina upwards and backwards. The walls of the vagina were very much relaxed but not forced down into a hard mass as the posterior wall had been before. The whole cervix was large, tolerably hard and apparently oedematous. The os was open and large enough to move the end of the finger about
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    in from side to side its great diameter. I prescribed for her to continue to use the recumbent posture as much as possible, to take gentle exercise and then lie down to rest. I think that the procedentia was caused by her sitting up too soon. Probably the uterus righted itself the same day that that urine came unassisted. She then thinking herself much better could see no reason for not sitting up all day. The ligaments were probably relaxed and procedentia resulted. The uterus seems quite fixed in its position and would not go up upon pressure. I leave the case for further developments. In January and February of 1869 reports menstruation regular; at hard labor, washing, hoeing etc. Feb. 2nd 1870 Reports herself regular in menstruation and very well. She has worked hard with hoe etc for the past year.
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    Jane Washington at Wrights Seaside Plantation: This woman had often during the Summer of 1868 fever remittent or daily intermittent. In the latter part of Sept. I accidentally saw her with fever and apparently in labor. I supposed that the fever was a cause of the labor as she said that her full time had not come. The pains at the time I saw her were rapid but there was no show and she was not certain whether she was in labor or not. She had no grease or vile of any kind in the house and as I had none with me I did not wish to make a vaginal examination more especially as I was not called to the case. As she had fever and no show I advised her to take a dose of Dover's Powder to try and stop the pains which I thought might not be at their true time. Though I could feel the uterus contracting strongly at each pain. She however positively refused to take anything to arrest the pains but said she wished I would give her something to increase them as she wished to go through with it. I did neither as she objected to one and I to the other course. In a few days after I saw her and found that the whole affair had passed off that night and
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    she was still carrying her burden. Just about one month after I was sent for to deliver her. I found her in labor: the bearing down pains just coming on. She requested me to make an examination as there was something partly come from her. She stated that about an hour before she had got up to pass water and that she felt it come down and supposed that the baby was partly born but that upon feeling it she found her mistake. She was uneasy and anxious to know what it could be. I found protruding between the labia a bag holding a gill or more of fluid. The membrane of which it was composed was gathered together in the vagina into a twisted rope as large as my finger. This rope of membrane could be traced by the finger into the open mouth of the womb where it was found to expand over the head of the child which was presenting. The protruding object therefore was the membranes protruding through the vulva before the head of the child had engaged at the superior straight or passed the os uteri. The bed was dry, there was a little urine in the pot and she said there had been no discharge of fluid or waters
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    There was no subsequent discharge of water during the labor. The waters had therefore I suppose been absorbed excepting the small amount which was in the protruding membrane, about a gill. Upon squeezing the bag I could force the fluid up the cord of membrane to the uterus again. The head presented the labor was very slow and tedious. The bag was ruptured with the discharge of the contained fluid but no more from the uterus. The bones of the cranium overlapped one another and the child was dead; the cuticle peeling off. Woman did well. Feb. 19th 1869 was called to see Cato Smalls' wife Martha at Chemplins Garden. She was, as near as she could tell, in the ninth month of pregnancy. She had been suddenly taken with a profuse discharge of blood from the vagina in the morning before day. She stated that a smaller discharge of blood had taken place a week or two before but not to near so great an extent. She represented that the bed pot was nearly filled on this occasion by blood. The nurse
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    testified to the same. Made a vaginal examination and found what I supposed to be the edge of the placenta presenting at the partially open mouth of the uterus. Was not prepared with instruments and was not convinced of the necessity of operating at once. Prescribed sugar lead etc internally and left with the nurse sponges soaked in alum water with directions to force them into the vagina if heamorrhage should take place to great extent during my absence. Was sent for on the 21st, found that heamorrhage had taken place to a considerable extent. The patient and nurse saying that the chamber pot could not hold it all. When I arrived it had ceased. On making a vaginal examination I felt through the posterior walls masses of hardened faeces in the rectum and learned on inquiring that the bowels were very torpid. Injections of warm water brought away large quantities of faeces, scyhala etc. On the 23d I was again called to my patient as haemorrhage had occurred, as on the preceeding[sic] days, before day in the morning. The nurse declared that when she attempted to push in the sponge she could not at one time do so on ac
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    count of the gush of blood. This, if true, could only have been at the moment of uterine contraction. As the parts were quite relaxed, as the patient was near full time and as she was in danger of loosing life at any time from haemorrhage I determined to turn and deliver. Everything having been got in readiness that afternoon, I proceeded to make a thorough examination by introducing the whole hand in order to ascertain the position of the placenta and child. I had not done so before, fearing to break up any coagula which had formed at the mouth of the womb. I now introduced my whole left hand to explore and as soon as it was up to the uterus I suppose its presence caused violent contraction of the uterus, for partly coagulated blood in a large quantity began forcing itself past my arm which, though large, did not fill the vagina. I doubled my fist and held it against the mouth of the uterus for ten or fifteen minutes. When the parts had become more quiet I examined farther and was puzzled by the quantity of coagula at and around the os uteri. I could not make out exactly the limit of the placenta and of the coagula. At first when I examined with the finger I supposed that the placenta was planted against the posterior part of the uterus and
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    After the feet were drawn down and had been brought in sight there was no advance at first though traction on them to some extent was made. Ergot was given and when the child was born to the knees progress was equally slow though the calves of its legs were wrapped in a towel and traction continued ergot and friction over abdomen. The length of time which elapsed was I think the cause of the childs death the funis being compressed.
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    afterward when I examined with the whole hand I thought it was on the anterior part, but in truth the coagula obscured the information on that point. The facts were however that the woman was in the ninth month, haemorrhage had taken place four or five times alarming in quantity, the vagina and os uteri were perfectly relaxed, and the woman and friends anxious to have the case relieved by any means. I found that I had the wrong hand in The presentation was head: the position with the vertix to the right posterior part of the pelvis. I had my right oiled and withdrew the left and instantly introduced the right on acct of the discharge of blood which took place when it was withdrawn. I passed my hand high up found the feet broke the membranes and brought the feet down. There was a perfect gush of blood and water when the membranes were ruptured until the feet were got into the vagina. The labour lasted for some 15 to 30 minutes after version and the child was born dead though it was alive an hour before. The patient was so much prostrated that I would not have her moved up in bed that night. She had no pulse at the wrist for some time, her nose and limbs were very cold, the shock and prostration of both nervous and circulating systems was extreme. I was obliged to use whisky and other stimulants. I used ergot
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    after the foetus was turned to assist in its expulsion and to ensure contraction of the uterus after it. Reaction took place after a few hours and she recovered in a reasonable time under the use of iron quinine and other tonics. She was very anaemic for a while. Jan. 17th 1869 Mrs. 533 was sent for early in the labor in the fore noon. Pains were not strong but no the patient was at full time I waited. In the evening they increased, by supper time she was in the second stage. Patient was strong, 2nd labor her age 27, and in good health, the second stage was marked by good regular hard pains and the child was born in about two hours. Presentation head. Position either 1st or 2nd I suppose the occiput being to the front of the mother as it emerged. At the time of the expulsion of the foetus a small quantity of the ergot was administered to ensure contraction of the uterus. The uterus contracted but the placenta did not come away and after repeating the ergot and using frictions, slight tractions on cord and passing of the finger into the uterus I determined to pass the hand in and remove it. The back of the hand was to the back of the vagina and entered the uterus with
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    out difficulty but the whole uterus contracted on its contents so as to interfere slightly with its free movement the lower part contracting as much as the fundus and thus preventing the exit of the placenta. There seemed moreover an attachment of the placenta to the anterior portion of the uterus for I found it difficult to turn out the placenta although the hand went over the top of it, and the whole anterior position was rough after the final expulsion of the secundines while the posterior surface was smothe. There was also, which was one of the causes of the retention of the placenta, an evident hour glass contraction of the uterus through the upper chamber did not contain either all or part of the placenta but part of the membranes. On passing my hand up to what I supposed to be the fundus I found a hole with a portion of the flaccid membrane hanging out of it into the lower chamber of the uterus. As my arm was in fully up to the elbow at the time I was rather startled at finding a passage leading any further and I would have been very much alarmed if I had not remembered Bedford's caution in his work on Obstetrics not to mistake this for a rupture of the uterus. I do not suppose
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    this was an hour glass contraction such as the engravings in books represent with two equal or nearly equal rigid chambers but it was a contraction of the same sort taking place in a circle of fibres high up towards the fundus. As all of the placenta was removed entire and as the portion of membrane came out of the constricted place in the uterus without any difficulty I did not intrude my hand any higher up. The patient recovered very well the only deviation from a normal convalescence being in a rather protracted continuation of the lochial discharge. I returned home at midnight eat my supper went to bed and in less than two hours was called to see. Case Mrs. 546. Act. 23 yrs in labor with 2nd child. The patient like the last was large and healthy. The pains were those of the first stage. They were quite regular and were very severe calling forth cries of distress. Dilation of the os was not complete but was progressing. By breakfast time the 2nd stage was fairly in and the parts being in good condition the labor was soon completed. Presentation head. Position 1st or 2nd I suppose the occiput being to the front or under the arch of the pubis
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    Ergot was administered to ensure contraction of the uterus as usual. The placenta was retained, Tr Ergot, frictions etc were used and after two hours time as the pains were ineffectual I introduced my hand into the uterus and removed the placenta. There was no adhesion to the uterus and there seemed to be a uniform contraction of the organ but the contraction at the neck was too strong in proportion to that of the body of the uterus. She recovered rapidly. Case March 2nd/69 Mrs. 059 Act about 30 yrs. 5th confinement. Patient very robust. Did not know her time, thought it was the 8th month. As I arrived late i.e. after pain had continued off and on all day and it was then dark and as they were tolerably brisk at the time I thought it improbably that it could be put off. On making an examination, per vaginam, I found the os dilated and the pains good and regular and the head presenting. Finding that the labor could not be put off the patient desired to make some arrangements in the room and I left the room. At the end of about 20 minutes while I was in the next room
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    For many years I have felt around the neck as soon as the head was born for the cord which I often find wrapped around it once or twice and in case of Mrs. Major O. when Warren was born three times. The case on the opposite page showes the importance of examining the cord after the birth of the child to see that it is not wrapped around a limb or knotted. 1883 J.
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    the baby was suddenly born it was quite small. It was apparently lifeless. I tried several means of reviving it; sprinkled it with whisky and water blew it, cleared out the mucus from its mouth, used a warm bath, which was ready held it head and face downward shook it etc. etc. Had not severed the funis up to this time blew into its lungs by placing my mouth over its mouth. The last succeeded in procuring a movement and an inspiration which was repeated when the inflation was repeated. I found how ever upon slipping my fingers along the cord that there was a knot in it. As soon as I loosened this the child revived. It cried, circulation was established and I severed the funis. It did well. The mother got on a pot and so parted with the placenta. This was against my wishes but it was her customary way.
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    Turn forward 8 pages to Joe Bryans wife. Compare this case with that of Gaby Fowler's wife turn back 39 pages
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    Diana C. Joe Bryant see 8 pages forward were both cases of abortion in the early months I suppose although the foetus was not seen. It might have been easily overlooked however in the large quantity of coagula. I attempted in both to extract the coagulum which I could feel in the os uteri, but failed. The cases both terminated favorably however and they were neither of them aware of passing the coagulum which I felt in both cases protruding in the form of a cone from the os. 1869 Peter Doctor's wife at Wright's Sea Side. In labor: abdominal walls relaxed. Patient on knees with thorax on a trunk, belly unsupported fundus of uterus of course thrown forward. Put her to bed on her back the head soon engaged and the child was born in good time. Mother and child did well. In this case the anterior lip of the os uteri protruded at the vulva i.e. it could be felt at the outlet. I held it back some but ineffectually but at the last it slipped back past the head.
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    May 1869 Mrs. 3.2. Turn back 38 leaves for listing of former labor of same person. The labor was so natural that after an interval of a few months I am unable to recall any circumstance of interest connected with it. The posterior part of the head was to the front of the mother at the time of birth. The child had during the first week some biles on the belly around the umbilicus which caused the parents much solicitude as a former child had been afflicted similarly and had died in convulsions. The doctor who attended it never expressed any definite opinion of the case. Child and mother both did well. 1869 Mrs. 8.2.0. In labor with 3d child. As the patient had suffered a great deal during the latter months of pregnancy with bedema of labia with pain and pruritus I feared the labor might be complicated. The latter part of the labor was slower than natural the pain severe. The baby was born well and mother soon rallied.
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    Dropsy of the cord Hemmorhage. Sibb Brown at Maxcy's. 5th or 6th child. Labour quite natural. The funis had a watery transparent appearance and was soft and flabby. It was tied as usual. That night it bled profusely and was tied again by the nurse after it was discovered. There were a number of clothes wet with the blood. It died next day. I suppose from loss of blood. Presentation head. Richard Stewart's wife at Middletons. 15th Labour. Labour slow but natural. Presentation head.
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    For Dr. Sams was called to see John's wife at Ben Whaly Place C.B's. Woman with labor pains very slight. It is about full time. The belly is very large. There have been several hemorrhages during the past two hours I saw some blood on the floor and some blood and urine in the pot. Patient was alarmed at the blood. I suspected Placenta previa, made an examination found the os partly dilated membranes unbroken, pains very slight so as not to tighten the membranes. Could not feel the foetus at all. Waited four or five hours. Left directions in case hemorhage recurred and went home. That night about ten hours after I left labor came on briskly Dr. S. was sent for and she was delivered of twins.
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    Dennis Gibb's wife Lavinia at Maxcy's. Feb. 4th 1870 The mother of several children. When I was called she had been in pain for over twenty four hours. On making an examination I found the membranes entire, the parts relaxed, the head presenting and the cord prolapsed. Tried to push it up: tried position on hands and knees, which did not have any effect. The head was pressed against the pubis and would not engage in the pelvis. The prolapsed cord seemed to me to occupy so much room in the facral part of the pelvis as to prevent it but I am aware that the best authorities say that it can have no influence upon the labour as it is too soft and compressible. As the labour made no progress and the patient was getting very tired and as the uterine contractions were weak I ruptured the membranes. I could at any time feel the pulsations of the cord, but later in the labor they would cease during a pain. I attempted to hold up the cord until the head engaged but found I could not do so with my finger and when I put in several fingers they occupied so much space in the pelvis that the
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    head could not engage. As the parts were relaxed I concluded to give some ergot and hasten the case through and try restore the child if it was injured. After I relinquished my efforts I found that the pulsation was stopped by the advance of the head into the pelvis. The delivery occupied about 20 minutes after I removed my fingers and gave the Ergot. I found it impossible to resuscitate the child. The mother did well. She was threatened with a rising of the breast which was very painfully distended with milk. The application of Belladonna Ext. as recommended in the Med. News and Library had the desired effect of checking the secretion. March 22nd Menstruation returned.
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    March 13th Mrs. Benj. Bailey act. about 40 multipara taken in labour at full term late in afternoon. Labour progressed easily and naturally to a termination at about 10 oclock P.M. No trouble presentation head. Fanny wife of Scipio Felder at John Wright's S. Side Plantation. Act. about 40 years 1st child had miscarried before. Supposed herself to be in the 9th month. On the morning of the 5th of March 1870 was called by her husband who supposed her to be in labor. I found no pains no mucus. No dilation of the os tineae. There had been some red unclotted blood but not much. Staid about two hours and left. 9th Early in the morning was called in haste. Found that she had had a return of the hemorhage it being really a haemorrhage in this case. I saw the blood in the pot and on the clothing. It had ceased when I arrived. The os was not dilated larger than the end of my finger. It was soft and movable i.e. the end of the finger could be partially inserted and the os moved about on the end of it and the placenta, was I supposed, could be felt opposite the os tineae. There were a few coagula of blood in the vagina. I staid several hours but there was no renewal of the haemorrhage.
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    I then left leaving directions for the nurse never to leave her and leaving sponges for the nurse to force into the vagina if the flooding should return again in so sudden and alarming manner. I prescribed also rest horizontal. Very light diet, bowels to be kept soluble. Acetuh of lead and opium internally. 11th Called early in the morning again found she had flooded again. She had scarcely any pulse at the wrist and showed signs of sinking which were not. Something prevented my continuing the notes on this case. The hemorrhages continued to recur. I asked for consultation. Met Dr. Randolph, he concluded not to turn and deliver at the time of our consultation. We heard not long after of her death. We were not sent for as she sank rapidly on a stormy night. I regret exceedingly not having had an opportunity to make a post mortem examination, as I had been under the impression for two years that she had a tumor of some kind in the anterior part of the womb. I had attended her for a short time two years before when I made a digital examination. She was subject to abortions, and floodings.
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    A good many cases of abortion, in the early stages as from the ninth to the tenth week, have fallen under my notice, in which the uterus was unable to expel the remains of the ovum, and in which I could not extract it. The female in such cases save one, has always recovered without the ovum having been visably discharged. Meigs-Obstetrics, 2nd Edit. pp 250, 251.
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    Frances Butler Adams step-daughter Miscarried with a dead foetus. Had treated her for Syphilis primary the year before. She had left me after the first week. She had a large soft chancle on the inside of the labia. The foetus was discolored and was a disgusting looking object. The following year she gave birth to healthy looking child which had infantile syphilis in a few months. It got well under the use of Hydrargyrum Cum Creta. This is the same case mentioned 8 pages back with Diana's). Joe Bryant's wife at Riverside. An abortion at about second month, with profuse and alarming hemorrhage. I could not extract the coagulum which was in the mouth of the womb. I did not know but that it was the placenta. The placenta was never seen. It was not certain what the month was. I never saw any placenta nor could I distinctly make out any ovum among the quantity of hard black clots of blood which I had disinterred for my inspection. There was no bad result from leaving the remains of the ovum in the womb. I could feel it in the cervix and pass my finger all around it. I used ergot in this case and iron. Recovered.
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    Jacob Bryan's wife at Monday's Plantation. 1870. A case of miscarriage. Patient on the floor near the fire. A very strong field hand. She was in great pain and as there was nothing to do but wait for the cervix to dilate I sat down by the fire. The ovum complete, containing a small quantity of liquor amnii, was discharged from the uterus with such force that it flew under my chair about two or three feet from the vulva of the woman. I did not at first perceive it but hearing the gush I ran my hand to the parts and perceived the change of the condition of the womb and could not understand what had become of the ovum until I looked round and saw the ovum behind me and under my chair. Patient recovered quickly.
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    May 26th 1879. Was called to see Mary Lusher who was supposed to be in 8th month of pregnancy. Find her complaining and with some pain in back. The abdomen very protuberant could not feel that the abdomen hardened during the accessions of pain. Vaginal examination revealed the parts soft but without much mucus or any show the os was also soft and long, hanging down in the vagina then being a cul-de-sac all around the neck in cervix. On inserting the finger into the os which was easily done I was unable to reach the foetus at all though I felt it strike my wrist the end of the finger several times quite vigorously, so that I knew it was alive but could not
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    make out the position of the child foetus. During the pains there was not the least contraction of the os nor the slightest perceptible tendency toward the formation of the bag of water. She had had an action from bowels the day before. Prescribed Batley's Sedative vii drops and repeat if necessary. All day and night much achieved but on 27th I was called again. Same state of affairs. Repeat the Balley and gave dose Caster oil and ordered little quinine. Rested well under the opiate but symptoms returned. Next day 28th gave dose Morphine and directed the liberal use of a decortion of viburnum prunifolium and directed the continued use of the viburnum tea after effects of the morphine should abate and to continue it as long as
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    the uterus continued so imitable. She got along better I was told and supposed she was doing well until the 1st June when I was sent for again in morning. Find her a little feverish and with pain. An examination revealed the os dilated and the bag protruding down into the vagina. Still even while the pain was off the bag was so large that I could not reach the foetus until I ruptured the membrane when a profuse discharge took place as much as I ever saw so that I had it soaked up with some extra sheets. The head immediately came down and engaged and she was delivered in the course of 15 minutes with its face towards the perineum. The [illegible] caught in the child's mouth and held down like a bit for a while. The shoulder felt as if it had a membrane stretched over it which
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    proved to be only the cuticle which was tough and which was separating from the skin. The child was dead. The cord was hard and stiff almost as stiff as cartilage but this could hardly have been the cause of the death as the child was well developed and appeared to be at full term. It was certainly alive on the 26th and 27th. She had not felt it move for 24 hours or more before the birth. As the child was expelled from the vulva there was an additional and most profuse discharge of liquor amnii more than I ever saw. There was also a large coagulum. This was followed by prompt and very vigorous contractions. Was the death of the child due to the opiates, to the haw tea to syphilis, the father had buboes the year before he [illegible] or could it have been due to Turn over two leaves
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    a separation of the placenta from the uterus? After the gush of water poured onto the bed I found in the midst of the water a large coagulum. When and where did this coagulum form. The blood was not mixed with the water for my shirt sleeve which was soaked was not discolored.
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    R.L. Johnson. Book B. Asst. Surg
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    R.L. Johnson. R.L. Johnson. R.L. Johnson. R.L. Johnson. R.L. Johnson. R.L. Johnson. R.L. Johnson. R.L. Johnson. R.L. Johnson. R.L. Johnson. R.L. Johnson. R.L. Johnson. R.L. Johnson. R.L. Johnson. R.L. Johnson.
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    R.L. Johnson. High Bridge. Asst. Surg. PACS. High Bridge near Farmville Cumberland County. Virginia. Nov 30th 1864
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    R.L. Johnson. R.L. Johnson. R.L. Johnson. R.L. Johnson. R.L. Johnson. R.L. Johnson.
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    Johnnie Mitchull. Floral Emblems. Maryland. Charlotte C.l.t. Blackburn Hughs. Capt Hulihen. Frank Jenkins. Madame replied Mr. Micawber it is my intention to register such a vow on the virgin page of the future. Dr. R.L. Johnson Asst Surg PACS in charge 1st Regiment Virginia Reserves. C.H. Pooger. Carl J.M. Bristall
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    R.L. Johnson. J.B. Sutherlin. J.B. Somers
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    C. Jas. Evans. J. Hatchell. Wm Barnett. EM Lambert. Lt. Pennington. A. Asa Gamer. David. J.S. Turnbridge. B.F.. D. Coles. Corp. Coats
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    Stanton R. Bridge. Oct. 1st/64. Col. B.L.F. Jr..In reply to yr order of today relating to the disposal of the sick. I have the hospital full, that is as full as convenient. I would be able to accommodate one more if the boxes of ammunition were moved out which are now there, and if nurses were not obliged to have beds in the hospital. Very Resp. and obd.
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    Stanton River Bridge. Oct. 1st 1864. Col. B.L. Farmholt. Comdg. Post..Sir: In reply to you communication of today dated Oct. 30th I will dispose of the sick of this command as in my judgement as Med. officer I think most to their advantage and welfare. Very Respectfully and Obediently R.L. Johnson Asst. Surgeon. Not sent
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    S.R.B. Oct. 5th. Col. B.L.F. Sir: I very respectfully ask that you will, when desiring to make or alter the arrangements of the sick and of the Hospital, communicate with me, as it will save me valuable and prevent any misunderstanding. Very Respect. and Obdly. R.L.J. asst. surg
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    High Bridge Nov. 23rd 1864. Col. B.L. Farmholt: Col. Harry's inspected the camp and the immediate vicinity of the camp on the north side, I very respectfully call your attention to the fact that some step ought to be taken at once to clean and keep clean report to you that they call your attention to the fact that some police regulations. Richard L Johnson A. Surg. P.A.C.S. Thomas Colegate Dennis A. A. Surg PACS. L Phillip Bailey MD Hospital Steward. 1st Regiment Virginia Reserves. Col B.L. Farinholt Comdg. High Bridge S.S.R.R.. Nov 30th 1864 Cumberland Co. Va.
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    High Bridge Nov 25th 1864 Col. B.L. Farinholt Col: I very respectfully call your attention to the fact, that the camp and the ground immediately on the North side of the camp are in a very dirty condition: rendered so by the following circumstances, that the men do not use the sinks, but the ground between the camp and sinks. I very respectfully suggest, that the brush where the men conceal themselves be cleaned away and that such steps be taken as will prevent a continuance of this nuisance. Very Respt. Yr. RLJ.
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    Receipt JM Blacking. Ivory Black lb. 1. Molasses oz 10. Mix and add. Sulphuric Acid oz 2.5. Oil 2.5. Then mix with mucilage of acacia. Dr. D.H. Hardaway's. Receipt for Blacking. Ivory Black 1. Molasses zx. Mix and add. Sulphuric Acid z2.5. Oil z2.5. Then mix with mucilage of Acacia.
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    Number of Turtle Eggs found on Eding’s Bay by our family in Summer of 1866 beginning at about the 20th of May. 66. Continued. 125. 154. 142. 125. 127. 279. 118. 1841. 143. 2120. 153. 140. 17 nests 46. 17)2120. 130. 17. 100. 42. 116. 34. 127. 80. 139. 68. 109. 12. 1841. Average 125 eggs to the nest
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    Jan 11th. $2.84 to A. Lawrence. for 284 lbs. Fodder. 11th Jan. $1.89 to Dinah. For 189 lbs fodder. 11th 31c to Joe W. for Minus’ picking which amounted to 56c 25 being deducted for time bought. 11th .36 Paul. 11th .20c Wilson. 11th .44c F and R. 11th .30c Small. 12th 20 to Solomon. Rotz .08 Rose. Minus .12c
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    Jan 23rd Sophy 45. Sophy. Good for 40c. 23rd D.S. 40c. 23rd Sally 40c. Good for 40c. Paul 23rd. 23rd Violet 30c. 24th Solomon fodder 30c. 24th Rinah 40c. 24th Becka 35c. 24th Nelly 50c. 24th Savy 50c. 24th Sophy 50c. 24th Charlotte 50c. 24th Paul 35c. 2 days. 31st Dinah 84c. Feb 4th Rinah 28c. 5th 28c. Rinah 70c for 2 days
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    Florida .18c. Diana 14c. Soloman 11c. Jan 16th. .65c S.V. 16th. Diana 53c. 16th P.G. .35c. 16th Destroyed due not. 16th. Same as above. 17th Savy 26ch. 17th Rose 32c
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    Feb. 14th 167. Due Billy Wright $3.00 for fodder. Rinah 14th Feb. 20c. April 19th. Tom 25c. Cyrus 25c Charlotte 60c. Catherine 50c. Cyrus 60c
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    Jan. 17. Sophy V. 51c. Jan 18. Savy 25c. Jan. 18 Minus 17c. Jan. 19th 54c to Charlotte. 19th Savy 39c 19th Minus 21c. 19th Rinah $1.09 For sorting cotton on the 16th, 17th, and 18th insts. 19th 39c Diana 21st 35c Rinah. 21st 39c Nelly. 21st 26c Sancho. 21st 28c 14.9.H.G. 21st 54c. C
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    21st 27c Rose. 21st 47c Savy. 22nd Rinah 29c. 22nd Becka 39c. 22nd Sophy 41c. 22nd Paul 28c. 22nd Soloman 54c. 23rd $2.50 for 8 lbs. fine ginned cotton. 23rd Rinah 38c. 23rd Becka 30c. 23rd Nelly 35c
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    April 1867. 22nd Planting cotton during part of fourth week of this month There was none at all planted as early as 15th I think. 27th Hoeing joint grass out hands.Rain. May 1867. During first week hoeing and harring A.P. and breaking out middles. Rain. 8th 18 hands setting out potatos in afternoon 12th 13th 14th Setting out potatos Ditching etc. 15th Ploughing sweeps on Islands. Hoeing J.P. which had been barred. 16 M.F. 18 G.F. 20th B.F. Hoeing J.P. and A.P. Slight rain. 21st 21st PM barring back field weather clear. 22nd almost to Engine house Hoeing A.P. 24 hrs. 19 acres. 23rd Hoeing Islands and part of M.F. Plough hands hoeing
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    May 1867. 24th Hoeing G.F. 25th and began B.F. 27th Finished hoeing B.F. 28th 7 ploughs on at J.P. in forenoon and 5 in afternoon. 29th 5 wagon went to Bay. 30th 8. June 1867. 1st Ploughing Islands. Hoeing A.P. 13¾ acres. 3rd 7 ¾ 4th M.F. 14. 5 reached G.F. 1 and both Islands and part of M.F. 6th Plough at G.F. Hoed M.F. at night Heavy Rain. 7th Forenoon heavy Rain PM. Thinned cotton in G.F. Too wet to plough. 8th Still very wet. Thinned cotton in B.F. all hands. 9th Sunday Cloudy 10th ground Hoeing G.F. Ploughing at A.P. The wet grass part with 3 scooters
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    June 1867. 11th Hoeing G.F. Ploughing A.P. with 3 scooters in wet grass following one solid sweep—the other sweeps ploughing the clean part. 12th Hoeing B.F. Ploughing A.P. and T.P. 13 15th by Sams house etc by Sam's house with scooters. 17th round by road. 18th Raining hard. Easterly wind 19th. 20th. 21st. 22nd. 23d Morning cleared off. Afternoon heavy rain from the South. Night clear, west wind. 24th Thinned at T.P. 25 Setting up fallen cotton and putting a little earth to the bottoms with hand very wet. 3 scooter ploughs in Mitchell F. joint grass. 26th Broke out middles at A.P. very boggy all over the field. Hoeing Mitchell F. 27th Same as 26th
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    June 1867. 28th Ploughing Back F. Hoeing Mitchell F. 29th and A.P. July 1867. 1st Ploughed Mitchell F. with barshears---threw earth to the cotton. Hoed 8½ acres at A.P. 18 hands. 2nd Ploughing Islands with sweeps. Finished hoeing A.P. about 25 hds. 3d M.F. T.P. 40 hands. 4th Hauling A.P. in wet grass 5th G.F. 6th Finished Finished hoeing. 8th B.F. Islands. Rain, lightening and in P.M. 9th M.F. 10th Back Field and G.F. 11th A.M. At house. P.M. at A.P. 12th 17th Hoeing from Back F. round to Mitchell F. 18th, 19th Middle F. 20th Hauling A.P. During the above week A.P. was barred up Preparatory to the hauling which was begun today. 22nd Hauling A.P. 23d T.P. Ploughing Islands
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    24th Hauling T.P. Plowing M.F. 25th Plowing G.F. 2 furrows with barshears and hauling up with hoes 26th Same as yesterday with hoe hands. 27th in B.F. 29th 27th. Between the 30th and 5th of August 1867. Hauled Mitchell F. and hauled one side of bed in Islands and M.F. and both sides of bed in small pieces by road. 6th Hauled from yesterdays work and finished Back F. 7th and 8th At A.P. in wet grass part barring down; then throwing back the earth and hauling up. In the rest of the field three furrows siding and hauling. 9th Hoes crowding Plows. Plows. 9th Plows sweeps running one furrow down alley in T.P. Hoes hauling. 4½ acres in A.P. 23¾ in T.P. 22 out hands. 20th Since 9th weather generally clear cotton growing fast and well in bloom clipping grass where it is heaviest. Stop hoeing today. 21st Night rain. 22nd Heavy rain. Latter part of this month all hands ditching letting of water etc.
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    September 1867. 1st week rainy weather. Caterpillars found. 2nd. 17th A good many catpilers in Mitchell F. mending Roads splitting woodrails etc etc etc. By Oct. 1st Plantation eaten out clean by catapilers. October 1867. No hands. no lbs. Average. 3d. 9. 275. 7th. 10. 200. 8th. 9. 230. 9th. 10. 257. 10th. 14. 333. 11th. 15. 419. 12th. 19. 335. 14th. 356. 15th. 17. 396. 16th. 16. 418. 17th. 15. 342. 18th. 11. 243. 19th. 12. 238. 21st. 16. 306. 22nd. 16. 447. 23d. 16. 459. 24th. 13. 311. 25th. 14. 281. 26th. 60. 29th. 14. 267. 30th. 9. 193. 31st. 10. 228
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    1st Light frost. 7th 8th etc Potato vines killed; heavy white frost. Digging potatos, yield, where listed, banked high, and well drained about a good basket to the row, otherwise much less.
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    Died at Summerville, on the 13th of June 1862 at the residence of Dr. Jenkins, of congestive fever Dr. William J. Miller in the 21st year of his age. Sad indeed to have to record the name of this valued friend among the dear departed. Death has indeed deprived us of one whose future promised a wide spread career of usefulness. A short illness has terminated the life and blasted the hope of bright prospects in which we were want to indulge. Our young friend was early deprived of a mother's love and a father's protection; the world therefore soon received a youthful competitor to baffle its pursuits. Pursuing his studies with alacrity and zeal he manfully sought and obtained in every instance an evaluation which was gotten alone through his two strong characteristics, energy and perseverance. Although he had no fostering case to shield him through the vicissitudes of life he passes on and soon attains his important position in medical life where we find him discharging. Faithfully his incumbent duties in administering to the wants of his fellow man.
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    And here last in life we see him in his vacation of Assistant Surgeon relieving the noble defenders of our sacred soil. In the present conflicting struggles of war his generous impulses yearned for the battle field; but, laying aside the promptings of his heart, he obeyed the dictates of conscience by remaining at his past to discharge duties here; and doubtless his exposure and self sacrifice in remaining unflinchingly at his post produced his untimely end. Although destined not to die at home his lot was cast among friends who soothed his conch with every attention and tenderness which nature demanded. The touching chord vibrates at the absence of a cherished and loved sister in those dying hours; but thanks to God an only brother, one bound by the ties of nature bent over the sufferer and relieved his every want. The impressive manner of our friends last hours his fervent and heartfelt prayers leave us the comforting assurance of a triumph in death. To a devoted sister and brother consolution be granted to heal the wound so forcibly felt. In the departure of one so esteemed and loved may we be the more forcibly re
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    minded of the transient dreams of life in having our thoughts deeply concentrated on a God of mercy who afflicts wisely. Upward let us turn our view; Peace is there and comfort too; There shall those we love be found, Tracing joys eternal round.
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    Little Ned. All that is like a dream. It don’t seem true. Father was gone, and mother left, you see, To work for little brother Ned and me; And up among the gloomy roofs we grew, Locked in full oft, lest we should wander out, With nothing but a crust of bread to eat, While mother worked for poor folk round about, Or sold cheap odds and ends from street to street, Yes, Parson, there were pleasures fresh and fair, To make the time pass happily up there, A steamboat going past upon the tide, A pigeon lighting on the roof close by, The sparrows teaching little ones to fly, The small white moving clouds, that we espied, And thought were hi in the bit of sky, Little sights like these right glad were Ned and I; And then we loved to hear the soft rain calling,
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    Pattering, pattering upon the tiles, And it was time to see the soft snow falling, Making the housetops white for miles on miles, And catch it in our little hands in play, And laugh to feel it melt and slip away! But I was six and Ned was only three, And thinner, weaker, wearier than me; And one cold da, in winter time, when mother Had gone away into the snow, and we Sat close for warmth and cuddled one another He put his little head upon my knee, And went to sleep, and would not stir a limb, But looked quite strange and old; And when I shook him, kissed him, spoke to him He smiled and grew so cold. Then I was frightened, and cried out, and none Could hear me; while I sat and mussed his head, Watching the whitened window, while the sun Peeped in upon his face and made it red. And I began to sob, till mother came
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    Knelt down and screamed and named the good God’s name And told me he was dead. And when she put his nightgown on, and weeping, Placed him among the rags upon his bed; I thought that Brother Ned was only sleeping, And took his little hand and felt no fear. But when the place grew gray and cold and drear And the round moon over the roofs came creeping And put a silver shade. All round the chilly bed where he was laid I cried, and was afraid. Robert Buchanan
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Title:
R.L. Johnson Medical Journal
Creator:
Johnson, Richard Love, 1841-1913
Date:
1863-1883
Description:
Medical record book of Richard Love Johnson (1841-1913). Johnson documents the Assistant Surgeon's cases during the Civil War, cases of pregnant newly freed women during Reconstruction, and his work on a farm in South Carolina.
Collection:
Richard L. Johnson Medical Record Book, 1863-1864, 1867-1883
Contributing Institution:
Beaufort County Library
Media Type:
Manuscripts
Topical Subject:
United States--History--Civil War, 1861-1865--Medical care, Confederate States of America. Army--Surgeons, African Americans--Medical Care--History, Amputation, Childbirth, Wounds & injuries--1860-1870
Geographic Subject:
Charleston (S.C), Edisto Island (S.C.), Wadmalaw Island (S.C. : Island), McPhersonville (S.C), Georgetown (S.C), Richmond (Va.), Sharpsburg (Md.), Fredericksburg (Va.), Staunton River (Madison County, Va.)
Language:
English
Internet Media Type:
image/jpeg, image/jpeg
Digitization Specifications:
600 dpi, 24-bit depth, color, Epson Expression 11000XL, Archival masters are tiffs.
Copyright Status Statement:
Public Domain.
Access Information:
For more information contact the Beaufort District Collection at the Beaufort County Library, Beaufort, S.C. 29902