Author Question: Treatment of Burns circa 1807

Michelle G asks:

I'm working on a historical (surprise, surprise) 1807, to be exact, in England, and wondered if you could give me a little medical advice? I've burnt the leg of one of my characters, a little boy, like 9, and I want him up and about in 3 weeks or so, but he can use a crutch. What would that leg look like? How much pain? How would he react that first week? I don't want to overdo it, nor do I want to gloss over it either. What's your .02?

Here's what happened to him...

“Thomas leaned over the hearth to scoop a ladle of stew from the pot. He moved too fast, with too much force. The hook broke. The pot fell into the flames. Coals shot out, catching the fabric of his trousers. He tried to whack it out, brave boy, but ended up fanning it larger. He ran. I stopped him. I thought he was…” She gulped back the lump in her throat. “I thought he was dead.”

Jordyn Says:

This sounds like a pretty significant burn-- his pants catching on fire. Easily partial thickness and could even be full thickness in some places. Have you considered just having the pot of stew fall on him-- maybe with bare legs? This would be more partial thickness and could more likely heal in your time frame.

Full thickness burns are problematic because they usually require grafting so back then treatment was likely very limited. We also do fluid resuscitation for significant burns and if both of his legs were this severely burned-- he'd need quite a bit of fluid, and again, I'm not sure this would be available during your time period.

So, I might try to back down the injury to second degree burns. Those should heal up pretty nicely in your three week time frame. Second degree or partial thickness would include skin blistering and peeling, big concern for infection (intact skin is your largest protector against infection) and dehydration initially because burns also leak a lot of fluid. He could probably walk with crutches. It's not really a muscle injury (it would be if you go with full thickness burns-- like his pants catching of fire) so he should be able to walk.

Pain is going to be a big issue. Burns are very painful. So, he's going to need something.

Here is a very interesting link that has tons of information on the evolution of burn surgery. It will give you some treatment options for your time period. 

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Keep up with the exploits of Michelle Griep at Writer Off the Leash, Facebook, Twitter, and Pinterest. You can check out her latest novel,  A Heart Deceived, at David C. Cook as well as Amazon, Barnes & Noble, and ChristianBook.  

Author Question: TB and Lung Surgery

What happens when a surgeon takes out the wrong lung?

This writer's question came from Lana and actually brings up several interesting points of discussion for her novel. First of all, the question stems from a family incident in 1954 which would really be considered historical as far as medicine is concerned.

Let's dive into Lana's question.

Lana asks:

I am a new writer and have some questions regarding a medical incident that occurred in my family in approximately 1954, but today the details are sketchy. Dr. Mabry (thanks Richard!) gave me your name.

The story: My uncle was told he had TB and must have his diseased lung removed. He had surgery, but the wrong lung was taken out.

Question #1: Would they have planned to remove the lung because of TB and would a doctor have actually taken out a whole lung or would it have been one lobe?

Question #2: Would the doctor have been able to see his mistake immediately after surgery? I'm not sure how the mistake was made or discovered.

Question #3: After removing the wrong lung (or lobe), how long would it have taken to reschedule another surgery?

Jordyn says:

One-- I have to thank a physician coworker for her help on these-- thanks, Liz!

Question #1: It depends on how diseased the lung was. Back then-- there weren't antibiotics to treat TB like there is now so this was considered treatment. However, since it didn't cure the infection like antibiotics would-- I'm not sure how beneficial it was for the patient. If on x-ray it looked like the whole lung was involved then they would have taken the whole thing out. If it looked like just part was involved-- then perhaps just a lobe.

Question #2: The doctor would not have known about his mistake until the pathology report came back. The doctor I spoke to said on the outside-- the lung might be very normal appearing (which perhaps played into the wrong lung being removed) but all removed biological things go to pathology to confirm a diagnosis. The wrong something being taken out or off is rare but does happen and lots of things play into these surgical errors. I'm going to provide some links below that talk about how these happen in some other situations.

Question #3: Reschedule surgery? Obviously-- if they took out the whole lung he could not go back for another surgery to remove a whole other lung-- because then he'd have nothing to do oxygen exchange and would therefore die. I guess they could remove part of the remaining lung but I'm not sure how much lung tissue you need to survive. This could be an area for you do some reading on. I couldn't find a quick answer for you. It looks like the first successful lung transplant was in 1963 and it would have taken time for these procedures to become commonplace. If they did take him back-- perhaps they'd wait for him to recover from the first surgery which might be a good 2-4 weeks I'm guessing.

Here are some links to this particular kind of surgery error:

http://www.nytimes.com/1995/09/17/us/doctor-who-cut-off-wrong-leg-is-defended-by-colleagues.html

http://www.cnn.com/2010/HEALTH/10/18/health.surgery.mixups.common/

http://www.lasvegassun.com/news/2011/jan/29/double-ouch-doctor-operates-wrong-knee/

Has anyone had this experience or known someone this has happened to? Did the hospital disclose why the error happened?

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I’m Lana Kruse—last name pronounced Kruzey, rhymes with doozie! I’m one of the original baby boomers—you know, before we became a whole generation. It’s been fun to have been well-known, watched and written about since birth! I’m a wife, mother of two, grandmother of five (aka Mimi), and friend. I hope you will join me in that last category via my blog. I love people, words, laughter and eating out. Put all of these things together, and I’m in heaven!

Avoiding the Fellas in White Jackets

I'm pleased to host author and friend, Michelle Griep, this week as she blogs about historical medicine.

Welcome back, Michelle!

My mother took me to a pediatrician when I was five because I spent an excessive amount of time beneath the dining room table talking to my best buddy…Daniel Boone. Yeah, I know. He’s dead. I knew it at the time as well, but that didn’t stop me from having heart-to-hearts with him. In my mind, he was as real as the old cat lady who lived next door, only he didn’t smell as funky.

The doctor vindicated me by telling my mom there was nothing to worry about. I simply had a bad case of a vivid imagination. I don’t dare tell her (or the good doctor) that my gray matter now devises horrific murder scenes in cinemagraphic color—and that I actually make money doing it. 

All this to say that writers are a quirky lot. They have to be, or they won’t get paid, which is really interesting because a few hundred years ago, the same twitchy behavior might’ve landed one in the loony bin. It didn’t take much...

Attitude

Husbands committed wives for being “melancholy”. Translation: the fella took a fancy to the hot babe down the lane and wanted to ditch his wife.

Physical Glitch

Yo, mom and dad…got too many mouths to feed and one of them has a slight deformation? Maybe a cleft palate, perhaps? No worries. Pack that kid off to the asylum and voila; one less plate to serve at dinnertime.

Revenge

If someone higher up the food chain has an issue with you, watch your back, buddy. Dueling is against the law, but getting you committed sure isn’t. All it takes is a lie or two whispered into the right ears and you’ll be packing your bags for Bedlam.

Traitorous Tendencies

One of the most famous nutjobs in Bethlehem Royal Hospital was James Tilly Matthews, who was little more than a verbal threat to the crown. Well, to be fair, there was the rumor that he was a double agent, and he did think there was a conspiracy to place bad thoughts into his head by use of an “airloom”, but other than that, he was relatively harmless…unless you happened to be one of the politicians he spoke against and were worried he might froth up the rabble against you.

Getting packed off to a late eighteenth century asylum was about as much fun as stint in a Poorhouse. Many were understaffed, over populated, and the mental health industry itself was in need of reformation—which would and did come, but not in time to help out the heroine in my latest release, A Heart Deceived.

Today, writers, daydreamers and silly hearts don’t need to be as fearful about the men in white jackets coming to haul them away. Still, it wouldn’t hurt if you kept all your talk about airlooms to yourself.

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 A Heart Deceived is available by David C. Cook and at Amazon, Barnes & Noble, and ChristianBook. Keep up with the exploits of Michelle Griep at Writer Off the Leash, Facebook, Twitter, and Pinterest.
 

Author Question: Can Chloroform be Sprayed?

Sarah Asks:

Would chloroform, if shot out from a spray toward the victim, be effective for making a person pass out right away?

Jordyn Says:

Chloroform Mask 1865

Depends. Are you inside or outside?
I'm not sure that method of delivery will work for Chloroform. I found this paragraph that explains why. It is from this link: http://www.wisegeek.com/what-is-chloroform.htm

"Chloroform can easily be carried in water, and when it is exposed to oxygen and sunlight, a chemical reaction forms phosgene, a toxic gas. If chloroform is exposed outdoors, the phosgene will break down and ultimately become harmless, but in enclosed spaces, it can be highly dangerous: in addition to use in modern manufacturing processes, phosgene had a historical use as a deadly chemical weapon in both World War I. In groundwater, chloroform will build up and take a long time to break down, because it is not readily water-soluble. For this reason, most environmental agencies set safety levels for chloroform content, so that water can be routinely evaluated to see whether or not it poses a threat to consumers."

Must the substance be sprayed? I'm not aware of any substance that could be sprayed that would just knock a person out, leaving them relatively unharmed with their breathing intact. After all, the police would probably readily use it in their work as it wouldn't be as irritating as pepper spray, the taser, or as lethal as a bullet.

Any thoughts for Sarah?

Renee Yancy: Ancient Medicine in Ireland

I'm so pleased to host author Renee Yancy today as she discusses her research into ancient medicine in Ireland. And, as a special treat, if there are 10 or more comments, she is giving away a free copy of her book!

Welcome, Renee!

In my 5th century historical novel, A Secret Hope, my heroine Ciara is studying to become a druid physician. Having a medical background myself, it was a delight to research ancient medicine in Ireland. Here are some of the tidbits I found.

In the 21st century we know Lambs Ear as the soft, silvery-green leaves in a flower garden that children love to “pet.” But once upon a time, Lambs Ear was known as Woundwort, because the leaves were believed to have healing properties. During the Civil War, Lambs Ear leaves were used as bandages. And what did people do before Band-Aids were invented? A single wooly Lambs Ear leaf is perfect to roll around a hurt finger. A long blade of grass or a pine needle could be used as a fastener.

Another staple of ancient medicine was the water-loving willow tree. Willow bark

contains salicin, and salicin is used to create acetylsalicylic acid, better known today as aspirin. The ancient Celts would simmer willow bark, let it steep, and drink the resulting tea. In the cold, damp areas of Britain, Scotland, Wales, and Ireland, the magical willow bark tea would have been a precious commodity for people who suffered the pains of rheumatism and arthritis.

Another fascinating plant is comfrey. Comfrey has had lots of names over the course of history: Blackwort, Knitbone, and Boneset, to name a few. The last two names give a hint as to one of the major uses of comfrey in ancient medicine.

The leaves would be ground to make a vivid green poultice for bruises and sprains. For broken bones, the fresh roots would be grated and applied over the fracture. This root poultice would turn rock hard and be left over the limb until the bones would “knit”. Comfrey contains several vitamins and minerals, allantoin (which aids cell growth) and 18 amino acids. This amazing plant is known as far back as the 1st century, and is mentioned in the writings of Dioscorides, considered to be the Father of modern pharmacology.

Honey has been used for at least 2,000 years as a dressing for wounds and burns. The ancients didn’t know that honey has anti-inflammatory and anti-bacterial properties but they knew that it worked. The use of honey reduced healing time and decreased scar formation. Plus it smells good!

When antibiotics came on the scene in the 1940’s, the use of honey declined. Now seventy years later when overuse of antibiotics has resulted in scary drug-resistant microorganisms, the use of honey is once again current. In my research I read the report of a 15 year old boy who contracted meningococcal septicemia. He developed peripheral necrosis (tissue death) of his hands and feet. He had to endure bilateral amputations of both legs mid-tibia (shin bone) and lost most of his fingers. His hands healed well but he had many unsuccessful skin grafts to his legs. The pain was so intense that his dressing changes had to be done under anesthesia.

Finally honey dressings were tried. Within a few days the skin on his legs began to improve. In ten weeks his wounds had healed and he went on to successful rehabilitation. Something to think about the next time you stir a teaspoon of honey into your tea!

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Renee Yancy has been living vicariously through historical fiction since she was a young girl. Her all time favorite book is Shogun by James Clavel. One of her writing goals is to be as historically and archaeologically as accurate as possible. Every object she describes in her novels, including jewelry, dishes, furniture and glassware, are actually in museums all over the worlds. In her other life she is an RN with many years of nursing experience and presently works in an Endoscopy Unit. Learn more about Renee by visiting her website and blog at http://www.reneeyancy.com/ and http://www.reneeyancy.blogspot.com/.

Historical Medicine: Ann Shorey

I'm pleased to have Ann Shorey back with us today as she discusses some uniquie aspects of 19th century medicine with a fun quiz. Do you know the answers? Don't fear, they're posted.

Welcome back, Ann!

As people of the 21^st Century, we’re accustomed to hearing about advanced medical tests, such as an MRI or a CAT scan, even though we may hope we never need the technology. We think of blood tests, urine samples, even DNA testing, as the norm.

But if we lived in the same time and place as the characters in my At Home in Beldon Grove series, none of those advances would be available. The series begins in 1838 with The Edge of Light and concludes in 1857 with The Dawn of a Dream. The “middle child” in the series, The Promise of Morning, is set in 1846.

Here are a few medical questions that arise in the series. The answers appear at the end of the post.

1.      Dr. Karl Spengler is a continuing character throughout the Beldon Grove series. Try to put yourself in his place when faced with a diagnosis of cholera. What was a popular treatment of the day?

2.      What was common therapy for a croupy baby?

3.      How would a doctor have cared for a serious injury to an eye?

4.      When faced with a listless infant who wouldn’t eat and whose limbs lacked any strength, what would the doctor’s diagnosis have been? And if he’d known what was wrong, would he have recognized the cause?

5.      What were the signs of acute heart failure, and with what medication would the patient have been treated? For that matter, what did the medical community call heart failure?

Here are the answers. Some were gleaned from family accounts written at the time, others from research.

1.      Cholera was commonly treated with heavy doses of calomel (mercurous chloride), which we know now is poisonous, and bloodletting via leeches or cutting. Your chances of survival were better without the treatment.

2.       A croupy baby would have had to endure a piece of flannel saturated with turpentine wrapped around its throat.

3.      For an injury to an eye, a poultice of slippery elm bark was placed on the wound. Then the head was wrapped in a bandage and the patient was made to lie flat until healing took place.

4.      The doctor would have had no idea what was wrong with the infant. Only until many years later would it be known as infant botulism, one cause being feeding honey to babies under one year of age.

5.      The signs of acute heart failure haven’t changed (shortness of breath, fluid retention), although diagnosis and treatment are much more sophisticated today. In the mid-1800’s,  the condition may have been treated with a carefully monitored digitalis decoction. In that sense, the medication was the same, although today’s compounds are far safer.

At that time the condition would possibly have been called edema of the lungs, or dropsy. The term “heart failure” wasn’t commonly used until 1895, and “heart attack” came into our vocabulary in the 1930’s.

Makes be glad to be living now. The good old days weren’t all that good, at least not if you or someone you loved was sick!

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ANN SHOREY has been a full-time writer for over twenty years. Her writing has appeared in Chicken Soup for the Grandma’s Soul, and in the Adams Media Cup of Comfort series. She made her fiction debut with The Edge of Light, Book One in the At Home in Beldon Grove series. She’s tempted to thank Peet’s coffee and Dove chocolates when she writes the acknowledgments for her books.

 She may be contacted through her website, www.annshorey.com, which also contains her blog, http://annshorey.blogspot.com/ or find her on Facebook at http://www.facebook.com/AnnShorey.

Historical Medical Question: Laudanum Dosing

I have the great pleasure of hosting Ann Shorey today and Friday. First, I'd like to give her my warmest congratulations on the release of her novel Where Wildflowers Bloom that released Jan 1, 2012. What a great New Year's Day gift. I hope you'll check it out.

Ann Asks:

My wip is set in 1867. One of my characters is a doctor. Here are a couple of questions:

How much laudanum would be needed to give pain control to a four-year-old? How much for an adult male? How would it be administered--diluted in water, or swallowed straight?

Jordyn Says:

First thing to understand about laudanum is that it is an opiate based pain killer. Its contemporary counterparts would be drugs like Fentanyl and Morphine. Therefore, it could have the same type of adverse reactions that these drugs have. If a patient were to receive too much, their respiratory drive could slow down and/or stop. Also, these are not uncommon drugs to have an allergic reaction to.

I found a great resource for Ann. It's an old medical text written by Dr. Chase, a physician during this time period. I was able to link to the exact information she needed. You can view it here:

http://www.archive.org/stream/drchasesrecipes01chas#page/132/mode/2up. The text gives a recipe on how to mix the drug and states: "From 10-30 drops for an adult, according to the strength of the patient or the severity of the pain." So for children, I would imagine you would start with single drops.

I also wanted to point to this post written by historical author Ann Love (who I think has the best historical author name ever!) over at Anne's Love Notes. She writes a more in-depth piece concerning Dr. Chase that will be of interest for historical authors. You can find it here: http://anneslovenotes.blogspot.com/2011/11/researching-19th-century-primary-source.html.

Any other thoughts for Ann?

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ANN SHOREY has been a full-time writer for over twenty years. Her writing has appeared in Chicken Soup for the Grandma’s Soul, and in the Adams Media Cup of Comfort series. She made her fiction debut with The Edge of Light, Book One in the At Home in Beldon Grove series. She’s tempted to thank Peet’s coffee and Dove chocolates when she writes the acknowledgments for her books.

 She may be contacted through her website, www.annshorey.com, which also contains her blog, http://annshorey.blogspot.com/ or find her on Facebook at http://www.facebook.com/AnnShorey.

Historical Overview of 19th Century Medicine

I ran across these guest posts by Eleanor Sullivan over at The Writer's Forensic Blog which were excellent and a good resource for the historical authors that follow here. They are must read as I learned a lot of fascinating facts.

To supplement, I thought I'd add a few words to her list of terms that were used then and what they mean. These are referenced from Frontier Medicine by David Dary which is another excellent resource.

Acute Indigestion: listed as a cause of death. Probably a heart attack. This is interesting as in modern medicine, women can present quite differently from their male counterparts when they are suffering from heart attack. One of these symptoms can be indigestion.

Bad Blood: syphilis

Barber's Itch: infection of the hair follicles of the face.

Black Fever: Rocky Mountain spotted fever.

Camp Colic: appendicitis

Domestic Illness: polite label for mental breakdown, depression, or the aftereffects of a stroke where a person was housebound and in need of regular nursing.

Dry Bellyache: lead poisoning

Grip/Gripe: influenza

Quinsy: tonsillitis

Scrivener's Palsy: writer's cramp

For an outstanding generalized overview of 19th century medicine, check out these links to Eleanor's Guest Posts:

1. http://writersforensicsblog.wordpress.com/2011/10/09/guest-blogger-eleanor-sullivan-19th-century-medicine-part-1/

2. http://writersforensicsblog.wordpress.com/?s=Eleanor+Sullivan

Old versus New Medicine: Blistering

Prior to the birth of modern medical theory, the pervading thought for illness was that disease was caused by an imbalance of body fluids. To right this, common medical practices included purging, starving, blistering or blood-letting to place things back in order.

Maybe you think we don't use any of these practices anymore. Think again.

Let's consider blistering a patient.

In historical medicine, blistering used a caustic substance on a portion of the patient's skin to induce a burn or blister. The goal was to create infection as physicians of the day thought that the subsequent puss draining from the wound would be beneficial for the patient.



Blister Beetle



 

Blistering is still used as a medical treatment. Molluscum is a wart-like virus that is very common in pediatrics. Cantharone is a blistering agent made from beetles. Some physicians will refer to it lovingly as "bug juice". A very minute amount (this stuff is powerful) is applied to the lesion with a wooden stick. Over the next several hours, it will cause a water blister to form over the lesion. The goal is that when the blister forms, it will pull up the viral core, to resolve the lesion more quickly.



You can read more about that here: http://www.childrensmemorial.org/depts/dermatology/mollus.aspx


Does it surprise you that a blistering agent is still used as a medical treatment?

Western Medicine Circa 1890: Part 4/4

Lacy concludes her four-part Friday series today on western medicine during the 1890's. It's been a pleasure to have her and I hope you'll check out her novel. Lacy, best of luck and many blessings on your writing career. I hope you'll stop in again.

I hope you’ve enjoyed the excerpts from Marrying Miss Marshal that I’ve shared the last three weeks. This week, I thought I’d talk a little bit about my current project, which is now on my editor’s desk (hopefully soon to be bought!).

The story is set in the same time period and area as Marrying Miss Marshal but with different characters. In it, the hero has several adopted children and one of them falls off a ladder in the barn and breaks his leg. Because of this, the hero has to rely on the heroine’s help or he risks losing the hay he needs to put up to make it through the winter.

FRACTURES

In the reference Family Physician: A manual of domestic medicine, it is recommended that only medical doctors be allowed to treat fractures, otherwise the results could be lost of use of the affected area (finger, limb, etc.).

However, according to Bleed, Blister and Purge, if there was no doctor available, the only choice was for the homesteader or whoever it was to do their best to repair the broken bone. Treatment included splinting and then wrapping with surgeon’s plaster to put the limb in a cast. I would assume that sometimes in this case, the fracture would not be set exactly right and probably resulted in loss of some functionality of the arm or leg. However, in my story, I did choose to make a doctor available to help.

Here’s an unedited excerpt from my current project. Enjoy!

Penny found the house dark, and a bent-shouldered Jonas sitting on the porch steps. The lightening sky provided enough light to see his head was between his hands. Was he sleeping?

“Jonas?” she called softly and his head jerked up. Not sleeping, then. “Everyone all right?”

He stood and raised a hand to the back of his neck, half-turning from her so she couldn’t see his face.

“Yes. The doctor arrived just after you left—”

“After you made me leave.”

“—and set Maxwell’s leg. It’s splinted now with a plaster cast. He’s supposed to stay off it for a few days—or as long as I can keep him down.”

“Did he get any sleep last night?”

“Doc gave him some pain medication, knocked him right out.”

She couldn’t resist reaching out to touch his arm. He jumped at the contact but didn’t pull away.

“And you?”

He shook his head, ran his other hand down his face. “Couldn’t get my mind to quiet. We’re already behind on the haying, and with the Sumners’ fields to cut, too—without a driver—without Maxwell, I don’t see how we’ll finish.”

“Can you hire someone else?”

He was shaking his head by the time she’d finished her question. “Everyone’s hired out for the season. It’s not likely.”

“Well, what about Poppy?” As she said the words, she thought about her grandfather’s continuing exhaustion, though he’d been trying to hide it from her. “No, he probably shouldn’t be out in the sun all day.”

“There’s no one…”

She’d never heard Jonas so disheartened before. She knew part of his defeated attitude was because of his worry for Maxwell and loss of sleep. Maybe that’s why he’d overlooked the last obvious answer.

“What about me?”

Copyright © 2011 by Lacy Williams.

REFERENCES:

Family Physician: A manual of domestic medicine (1886) is available in the public domain on Googlebooks:

(Treatment of fractures begins page 717)

http://books.google.com/books?id=C1IpAAAAYAAJ&source=gbs_navlinks_s

Bleed, Blister and Purge by Volney Steele, M.D. (2005)

CONTEST REMINDER

Don’t forget to leave a comment to be entered to win a copy of Marrying Miss Marshal and three other Love Inspired Historical books. You’ve have until 11:59pm EST to comment and I’ll be drawing a winner tomorrow! Full contest details were posted June 30th.

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As a child, Lacy Williams wanted to become a veterinarian “when she grew up”. However, the sight of blood often made her squeamish so she gave up that dream before her teen years. As a college student, Lacy was a physical therapy major for approximately two weeks—until she found out she’d have to take a cadaver lab to complete that degree plan. As a writer, Lacy has finally found a way she can handle blood and gore—fictionally. 

A wife and mom from Oklahoma, Lacy is a member of the American Christian Fiction Writers and is active in her local chapter, including a mentorship program she helped to start. She writes to give her readers happily-ever-afters guaranteed and mostly reads the end of the book first. You can find out more about Lacy at her website http://www.lacywilliams.net/. She is also active on Facebook (www.facebook.com/lacywilliamsbooks) and Twitter (www.twitter.com/lacy_williams).