1860's Medicine: Laurie Kingery (Part 3/3)

It's been my pleasure to host Laurie this week. In her final post she gives a brief overview of medicine during the 1860's. This is great information for any historical writer. Thanks Laurie for all of your hard work!

THE STATE OF MEDICINE IN THE 1860'S

A writer always wants to make her hero an admirable person, perhaps even exceptional for his time, but still realistic. Nowhere is this more of a challenge, I believe, than when one's hero is a doctor in the past.

Medical colleges were in their infancy, and though my hero attended one, most doctors were still trained by apprenticing themselves to doctors already in practice, and reading what textbooks were available. There was no national requirement that doctors attend a recognized medical school. Doctors saw patients in their office, but more patient visits took place when the doctor arrived in his black buggy.

When the story begins, Dr. Walker had just come out of the Civil War, in which he had been a doctor with the Union Army. In that war, as in many others, as many soldiers died of unsanitary conditions and contaminated food as died on the battlefield. Medical tents and buildings used for medical treatment were overcrowded and doctors worked around the clock, hampered by lack of supplies and knowledge. The most common treatment for wounds was amputation; the most common non-traumatic death was caused by dysentery.

Making Dr. Nolan Walker exceptional in his medical practice was more about what he didn't use in the way of medical treatment than what he did. Many doctors of the time still used blood-letting as a treatment. One of the most popular medicines used was calomel, a compound whose main ingredient was mercury, which we know today to be a toxic substance. But back then it was used for almost every ailment, and was believed to be a stimulant, a cathartic (meaning it induced bowel movements) and an antimicrobial (though before bacteria were fully understood). Most often used for syphilis and given orally, it gave the patient foul breath, excessive salivation, and muscle trembling. It produced brain damage, and Dr. Walker was too smart to use it.



AbSinthe_laudanum/PhotoBucket

Another very common medicine was laudanum, and it was readily available over-the-counter. Its chief ingredients were opium and alcohol. Though useful as a sedative when that was truly needed, it was addictive and often abused. Even when used judiciously, it could produce nightmares in the patient.

The use of carbolic acid, discovered by Lister in Europe, as a disinfectant before and during surgery had just begun, but was not generally accepted. Many doctors still operated in street clothes and didn't wash their hands between patients. Indeed, my doctor Walker was scorned as "fussy" by his fellow Army doctors for using it, but his amputation patients died much less often that those of his scorners. Dr. Walker uses it when Sarah Matthews falls and cuts her arm.

The wise doctors of the time, such as my hero, used remedies such as willowbark tea to reduce fever, and scorned the patent medicines sold over-the-counter and by medicine-show quacks. The key to treatment, in their view, was supportive therapy—any treatment which strengthened the body's ability to heal itself. He believed in the tenet of the Hippocratic Oath which says "First, do no harm."

It's impossible to give a thorough summary of the state of medicine in the mid-1800's in a blog. Indeed, it's the subject of many fascinating and lengthy books. My object in this blog entry was to give you a quick glimpse of medicine as practiced by Dr. Nolan Walker in the town of Simpson Creek, Texas. (He appears in all my "Brides of Simpson Creek" books, including the one I'm writing now, when one of the main secondary characters suffers an apoplexy, or stroke.)

There were several books I used in writing THE DOCTOR TAKES A WIFE. Below is a list the ones I used most:

A Textbook of the Theory and Practice of Medicine, edited by Wm. Pepper, MD, W.B.

            Saunders, 1893 (which I found in an antique store!)

A History of Medicine, Dr. Jenny Sutcliffe and Nancy Duin, Barnes and Noble Books,

            1992.

Lotions, Potions and Deadly Elixirs: Frontier Medicine in America, Wayne Bethard,

            Taylor Trade Publishing, 2004

Bleed, Blister and Purge: A History of Medicine on the American Frontier, Volney

            Steele, MD, Mountain Press Publishing Company, 2005

Civil War Medicine, Robert Denney, Sterling Publishing Co., 1994

My website and blog are located at: http://www.lauriekingery.com . I answer all mail.

Thanks, Jordyn, for giving me this opportunity to talk about mid-1800's doctoring and promote The Doctor Takes a Wife and my other "Brides of Simpson Creek" books published by Love Inspired Historicals.

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You can find out more about Laurie at her website: http://www.lauriekingery.com/index.html

1860's Medicine: Laurie Kingery (Part 2/3)

Laurie continues her three part series today with an excerpt from her novel, The Doctor Takes a Wife. This scene makes me thankful I'm a nurse now and not in the 1860's.

An Excerpt from The Doctor Takes a Wife, by Laurie Kingery

(Love Inspired Historicals, January 2011)

This excerpt illustrates just how limited the physicians of the nineteenth century were—no I.V's, no aspirin, no antibiotics or anticonvulsant medications…

Just then, a harsh, guttural cry erupted from the woman on the bed. Her spine arched like a tightly-drawn bow.

"She's having a seizure!"

Sarah's slender frame threw itself into a racking series of alternating contractions and relaxations. The bed frame thudded in a horrible rhythm against the wall with the force of the convulsion.

Nolan's hand dived to her forehead, and flinched as he felt the heat there. She was as hot as if the very sun had taken up residence within her.

"Dear God!" Chadwick cried.

"Help me turn her on her side, Reverend!" he said, fearful that Sarah would choke.

Prissy ran into the room, perhaps drawn by the noise of the bed shaking, and screamed when she saw Sarah convulsing.

"Prissy! Go out and see if there's ice in the rain barrel—or in a water trough in the stable. I need it to get her fever down!" Nolan wasn't even sure if she could get it in time to help her friend, but he sure couldn't think with Prissy's shrieking reverberating in his ears.

He was dimly aware of the preacher trembling and sinking to his knees on the other side of the bed, his hands clasped, his head bent.

The seizure went on for an eternity, though in actuality it probably only lasted thee minutes. Then her body sagged in limp exhaustion and a faint pink crept back into Sarah's chalky, blue-white lips. Nolan felt engulfed by hopeless despair flooding through him. It was never good when a fever soared so high the patient convulsed. He was going to lose her. Perhaps he should have let Prissy cut her hair…

"Reverend, please, pray harder!" he whispered desperately.

What medical treatments fascinate you from this time period?

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You can find out more about Laurie at her website: http://www.lauriekingery.com/index.html

1860's Medicine: Laurie Kingery (Part 1/3)

I'm pleased to host guest blogger and fellow ER nurse, Laurie Kingery. Laurie works combined ED (both adult and pediatrics) at a Level I trauma center. She will be posting this week about her research into medicine during the 1860's and her novel The Doctor Takes a Wife. Welcome, Laurie!

Researching THE DOCTOR TAKES A WIFE

In 2009, when I was in the planning stage for my book, The Doctor Takes a Wife, the second book in the "Brides of Simpson Creek" series for Love Inspired Historicals, I wanted to give my hero, Dr. Nolan Walker, late of the 20^th Maine regiment in the Civil War, a major crisis to surmount. It was all very well to depict a doctor in a small Texas hill country town delivering babies, setting broken bones, and riding to outlying ranches in his black doctor's buggy, but I wanted to give him a dramatic role that twenty-first century readers could relate to. First I thought of a cholera epidemic—there were certainly plenty of those back in the days of unchlorinated drinking water and easily contaminated food, and I could remember hearing about cholera epidemics portrayed on the old TV westerns such as Rawhide and Wagon Train.

But very frankly, cholera is a disease of profuse vomiting and diarrhea. As a veteran emergency room nurse I am certainly used to dealing with those symptoms (though not due to cholera, thankfully) and I was pretty sure readers didn't want to read about that in a romance any more than I wanted to write about it.

But this was the time when we were all bracing for the worldwide pandemic of H1N1 influenza. The first few fatal cases had been diagnosed in Mexico and Texas, and experts were predicting the possibility of deaths on a scale not seen since the influenza epidemic of 1918. Vaccine producers were gearing up to produce immunizations. At work we were told the staff would get vaccinated, "or else." Hysteria was definitely in the air.

So the subject of influenza was definitely a timely topic, but influenza epidemics also occurred in the 1800's, though not on the scale of the "Spanish flu" in 1918. Bingo—my fictional community would endure an influenza epidemic, and my hero Dr. Walker could indeed do heroic things. Then came the question of how to research the topic.

During this time I heard an interview of John Barry, the writer of The Great Influenza, a book about the 1918 influenza epidemic. Due to the threat of an H1N1 epidemic, the book was receiving renewed attention. Thankfully, the library carried the book on CD, so as I drove to work I could listen and research my book.

The story of the 1918 influenza epidemic was both fascinating and frightening. At the height of World War I, the epidemic began mildly enough in an army camp in Kansas. When the troops moved east, it appeared to die down for awhile, and then erupted worldwide. By the time it faded away, it had killed an estimated 100 MILLION people, "more than the Black Death killed in 24 years, more than AIDS killed in 24 years," to quote one review. At one point, cities were running out of coffins for the corpses. It could kill at astonishing speed. The book cited an incident of a healthy person boarding an omnibus for a trip across town being felled by the virus and dying before he reached his destination. A scary fact was that the younger "healthy" adults, such as soldiers, seemed the most likely to die. I heartily recommend the book, though it is long, goes into a lot of pathophysiology, and goes way back into history to give background on the state of medicine at that time. But the author takes care to make it interesting and understandable.

Although several individuals lost their lives during my fictional epidemic in THE DOCTOR TAKES A WIFE, it didn't compare to the 1918 epidemic, of course. But it provided great scope, I think, to show what limited resources the physicians of that time had to combat such illnesses and their complications—mainly willowbark tea to treat fever (a source of acetyl salicylic acid, from which modern aspirin is made), sponge baths to lower fever, fluids, laudanum and prayer. Next I'll post an excerpt from the story showing a crisis point in the book, when Nolan Walker is afraid he will lose the woman he loves, Sarah Matthews.

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You can find out more about Laurie at her website: http://www.lauriekingery.com/index.html