Home / General / “Much of the renown acquired for Kentucky by her surgeons was in the treatment of calculous diseases”: Visions of the Past, Thanks to Gutenberg (III)

“Much of the renown acquired for Kentucky by her surgeons was in the treatment of calculous diseases”: Visions of the Past, Thanks to Gutenberg (III)

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amputation

What’s the point of looking into old historical texts if not to explore texts about surgery? Thus, Gutenberg presents us with David Yandell’s 1890 treatise, Pioneer Surgery in Kentucky: A Sketch. * You know this is going to be illuminating. How drunk was everyone involved? Were Kentucky doctors still bleeding patients in 1890? Are they still in 2016?

The last question goes unanswered, sadly.

This is the start of the text:

1806. The earliest original surgical work of any magnitude done in Kentucky, by one of her own sons, was an amputation at the hip-joint. It proved to be the first operation of the kind in the United States. The undertaking was made necessary because of extensive fracture of the thigh with great laceration of the soft parts. The subject was a mulatto boy, seventeen years of age, a slave of the monks of St. Joseph’s College. The time was August, 1806; the place, Bardstown; the surgeon, Dr. Walter Brashear; the assistants, Dr. Burr Harrison and Dr. John Goodtell; the result, a complete success. The operator divided his work into two stages. The first consisted in amputating the thigh through its middle third in the usual way, and in tying all bleeding vessels. The second consisted of a long incision on the outside of the limb, exposing the remainder of the bone, which, being freed from its muscular attachments, was then disarticulated at its socket.

It goes from there. Unfortunately, some of Kentucky’s finest didn’t stay in the Bluegrass. They traveled abroad and came under the influence of the Celestials, and no doubt their opium:

While among the Celestials he amputated a woman’s breast, probably the first exploit of the kind by one from the antipodes. Unfortunately for science, he there learned the method used by the Chinese for clarifying ginseng, and thinking, on his return home, that he saw in this an easy way to wealth, he abandoned the profession in which he had exhibited such originality, judgment, and skill, and engaged in merchandising. Twelve years of commerce and its hazards left him a bankrupt in fortune, but brought him back to the calling in which he was so well fitted to shine. He moved, in 1813, from Bardstown to Lexington, where he at once secured a large practice, especially in diseases of the bones and joints. He was thought to excel in the treatment of fractures of the skull, for the better management of which a trephine was made in Philadelphia, under his direction, which, in his judgment, was superior to any then in use.

Of course, anyone can secure a functional career in Lexington, even under the influence of opium, as Farley can attest.

Most of the book is a combination of somewhat disturbing tales of pioneer surgery and odes to the glory of sweet, sweet Kentucky. Such as:

It would be neither fitting nor becoming on this occasion, and in this presence, to speak in detail of the technic observed by McDowell in his work. That has long since passed into history. I may, however, be permitted the remark that the procedure, in many of its features, is necessarily that of to-day. The incision was longer than that now usually made, and the ends of the pedicle ligature were left hanging from the lower angle of the wound. But the pedicle itself was dropped back into the abdomen. The patient was turned on her side to allow the blood and other fluids to drain away. The wound was closed with interrupted sutures. This marvel This marvel of work was done without the help of anesthetics or trained assistants, or the many improved instruments of to-day, which have done so much to simplify and make the operation easy. McDowell had never heard of antisepsis, nor dreamed of germicides or germs; but water, distilled from nature’s unpolluted cisterns by the sun, and dropped from heaven’s condensers in the clean blue sky, with air winnowed through the leaves of the primeval forest which deepened into a wilderness about him on every hand, gave him and his patients aseptic facility and environment which the most favored living laparotomist well might envy. These served him well, and six out of seven of his first cases recovered. He removed the first tumor in twenty-five minutes, a time not since much shortened by the average operator.

I don’t doubt it, but thankfully we have turned this pure Kentucky water away from something as useless as surgery and toward something of far greater value: bourbon.

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In all truth, this is kind of an interesting book if you are into reading about historical amputations. And who isn’t?

* I am proud to say that I am evidently one of four people who have downloaded this book.

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  • waspuppet

    Close yr italics tag!

  • N__B

    The post title led me to believe this would be about Kim Davis being operated on against her will.

    0/5, would not read again.

  • Hogan

    What with the guns, the knives, the duels, the horses, and the falling down drunk, I’m sure Kentucky surgeons got plenty of practice.

  • The most important attribute of a surgeon then was that he (always he) was FAST.

    • Dr. Ronnie James, DO

      There are some fascinating accounts in Wikipedia of a world renowned surgeon (IIRC Lister) who prided himself on speed and could apparently amputate a leg in 60 seconds or so.

      Surgeons today prize speed as well; you don’t want the patient “open” & under general anesthesia 1 minute longer than you have to. Makes recovery much more difficult. As many have noted, surgeons typically love to operate and hate the opposite: caring for postop patients. At least one surgeon at my hospital system schedules procedures for Friday’s so he doesn’t have to round on the weekends (when the residents do it).

    • I’m sure you know better than anyone here that the invention of reliable methods for keeping patients comfortable (and still) during surgery is kinda a BFD.

  • muddy

    NYT has an interesting article today about Jack Daniel’s, or ought we call it “Nearis Green’s”?

    • DAS

      The article you linked to, in describing American whiskeys, might as well be describing LG&M: ” a product equally beloved by Kentucky colonels and Brooklyn hipsters.”

  • he abandoned the profession in which he had exhibited such originality, judgment, and skill, and engaged in merchandising.

    This almost sounds like a certain orange hued friend of ours. (Assuming the first profession was not renting to black people, of course.)

  • Dr. Ronnie James, DO

    Today, osteopathic (DO) and allopathic (MD) medicine are largely indistinguishable. The existence of osteopathic medicine makes vastly more sense when you learn its founder Dr A.T. Still was a Civil War surgeon, and consider how common amputations, bleeding and copious alcohol were in medicine at the time (one estimate I’ve read was that ~80% of medications in those days were mostly alcohol). Still basically came home from the war and said enough is enough, and developed an ethic that looked for root causes of disease and treatments that could minimize the use of alcohol, cocaine, opium, etc.. Allopathic medicine has transformed itself since then, and in the process assimilated many (though not all) of Still’s principles.

  • Lurker

    I think that the first part where the amputation of a leg from hip is described is really fascinating. The procedure is really difficult, and leg has some major arteries. Doing that kind of operation without killing the patient requires real skill, when you have no anesthesia, no intensive care, no understanding of hygiene and no blood-transfers.

    Though I really feel bad for the young slave who underwent the procedure. I wonder what became of him.

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