Phantom Limb Pain: 1/2

Author and Christy Award nominee (two nominations!) Jocelyn Green joins us again this week for a two-part series on phantom limb pain.

As an added bonus, Jocelyn has graciously offered to give away a personalized copy of her latest novel, Widow of Gettysburg, to one commentor. To enter, leave a comment on any of her posts WITH your e-mail address. Must live in the USA. Winner drawn midnight, Saturday, May 11th, 2013 and announced here at Redwood's on May 12th, 2013.

Jocelyn has also graciously said she'll send you a signed bookplate if you have any of her novels and would like one. Again, MUST have your e-mail. 

You can view Jocelyn's previous posts at Redwood's here and here.

Welcome back, Jocelyn!

Though the phenomenon of phantom limb pain had been recorded long before the Civil War, it was Silas Weir Mitchell, a Philadelphia physician specializing in nerve injuries during the Civil War, who coined the term. Phantom limb pain, or PLP, occurs when a patient feels pain in an arm or leg that has been amputated. Mitchell studied PLP (or sensory hallucinations, as he also called them) in depth at the Turner’s Lane hospital in Philadelphia, dubbed the Stump Hospital because it focused on caring for amputees.

If a character in your story is an amputee, like one of my characters in Widow of Gettysburg, the following will be helpful to you.

What Mitchell Found

·         Almost every amputee at Turner’s Lane Hospital experienced PLP. 

·         Most of them came out of anesthesia feeling the presence of the amputated limb.

·         Those who did not immediately feel PLP usually felt it within three weeks.

·         Usually, the patients felt the missing hand/foot but not the section of limb directly beyond the stump.

       Mitchell wrote: “The patients describe themselves as knowing that they have a hand which is connected to a stump, and feel able to move it, but of the rest of the limb they are unconscious, and the subjective sensations which are so common are always referred to the hand or foot, and rarely to the continuity of the member.”

·         In about one-third of the leg cases, and in one-half of the arm amputations, the patient felt that the foot or hand is nearer to the trunk than the extremity of the limb.

·         The type of pain could be burning, itching, stabbing, or cramping.

·         Missing legs usually felt as though they are hanging straight down, while missing arms felt as though they were bent at the elbow or locked in the last position they were in prior to the operation.

·         Treatment of water dressings on the stump helped with burning sensations in some cases, but most efforts to relieve PLP were ineffectual.

·         Amputee veterans wrote to Mitchell decades after their operations and shared that in their dreams, they had all their limbs perfectly whole.

    

      Return Friday as Jocelyn finishes up her Civil War medical series.

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A former military wife, Jocelyn Green authored, along with contributing writers, the award-winning Faith Deployed: Daily Encouragement for Military Wives and Faith Deployed . . . Again. Jocelyn also co-authored Stories of Faith and Couragefrom the Home Front, which inspired her first novel: Wedded to War. She loves Mexican food, Broadway musicals, Toblerone chocolate bars, the color red, and reading on her patio. Jocelyn lives with her husband Rob and two small children in Cedar Falls, Iowa.

              

       

Author Question: Burn and Crush Injuries

Amitha Knight returns to give her medical insight in this reader question.

Welcome back, Amitha!

Q:

I am writing a novel and understand that you give medical information online which I would be really grateful for.  The two main characters in my current book are hurled out of a burning bus which has smashed into a building after going out of control.  They land on concrete.  One of those characters has been in the smoke-filled bus about 15 minutes.

I would appreciate it if you could tell me the following;

1) What type of injuries would they have received, burns, fractures, concussion etc and what procedures are followed by medics who turn up at such accidents. What equipment would they use? 

2) I want one of the characters to be in intensive care for about 3 days and then be allowed onto the ward, what type of follow up treatment could she receive, what machines would she be attached to etc.

3)I want the second character to be unconscious for about three weeks and then wake up with temporary amnesia.  Is this plausible and what treatment would he receive while he's

unconscious .... what machinery would he be attached to.

  

Thank you in advance for your help!!!

M.G.

Amitha says:

I will help you the best that I can. My specialty was pediatrics and not intensive care or emergency medicine, so keep that in mind.

1) What type of injuries would they have received, burns, fractures, concussion etc and what procedures are followed by medics who turn up at such accidents.  What equipment would they use. 

The types of injuries sustained could range from anything from a few bruises to severe cranial fractures and multiple broken bones. When medics show up, they will place a neck collar in case there are spinal injuries and basically follow the "ABC" rules for emergency medicine. (some links to read more about this: http://en.wikipedia.org/wiki/ABC_(medicine)) This means if the patient isn't breathing, they'll make sure there is no obstruction, then they will intubate the patient as necessary. They will also start IV fluids and take them immediately to the hospital. What they would do *exactly* would depend on the extent and severity of the injuries. For fiction purposes, I would think hard before going into too much medical detail.

2) I want one of the characters to be in intensive care for about 3 days and then be allowed onto the ward, what type of follow up treatment could she receive, what machines would she be attached to etc.

This depends on the type an extent of the injuries. if there was a perforation to the lung, they may have a chest tube. They probably can't get up and thus would need a foley catheter for urine. they would definitely have some kind of IV fluids attached. This website has some good information about smoke inhalation injuries: http://www.emedicinehealth.com/smoke_inhalation/article_em.htm

3)I want the second character to be unconscious for about three weeks and then wake up with temporary amnesia.  Is this plausible and what treatment would he receive while he's

unconscious .... what machinery would  he be attached to.

This person who is unconscious might be intubated for at least some of that time, which means they would have a ventilator machine in the room in addition to everything I said in #2. As far as amnesia, there is a blog post on Jordyn Redwood's blog that may help with this: http://jordynredwood.blogspot.com/2011/08/remember-me-use-of-amnesia-in-fiction.html 

Her website is a great place in general for information like this!

I hope this helps.

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 Amitha Knight is a former pediatric resident turned writer of middle grade and young adult fiction. She’s also a blogger, a book lover, an identical twin, and a mom. Follow her on twitter @amithaknight or check out her website: http://www.amithaknight.com/. 

Opium Abuse during the Civil War Era: 2/2

Author Jocelyn Green returns with another installment in her series of posts on Civil War Medicine. Jocelyn was here last week discussing amputees and prosthetics. You can Part I and Part II by following the links.

As an added bonus, Jocelyn has graciously offered to give away a personalized copy of her latest novel, Widow of Gettysburg, to one commentor. To enter, leave a comment on any of her posts over the next three weeks WITH your e-mail address. Must live in the USA. Winner drawn midnight, Saturday, May 11th, 2013 and announced here at Redwood's on May 12th, 2013.

Jocelyn has also graciously said she'll send you a signed bookplate if you have any of her novels and would like one. Again, MUST have your e-mail. 

Good Luck!

Today, Jocelyn continues her discussion on opium abuse during the Civil War. Here is Part I.

In severe cases, the individual may have a weak pulse, lower blood pressure, reduced heart rate, difficulty or labored breathing, and changes in the color of lips and fingertips. Seizures, convulsions, hallucinations, confusion and psychomotor retardation also take place.

Common Opium Abuse Withdrawal Symptoms

If the patient suddenly stops taking opium, either by choice or from lack of supply, which often happened among Confederate soldiers especially, the following symptoms could be present.

§  emotional instability §  depression §  feeling shaky §  nightmares §  exhaustion

§  general body weakness §  lethargy §  mental fogginess §  anxiety §  nervousness

Signs of Opium Abuse Withdrawal

§  trouble sleeping §  nausea and vomiting §  heart palpitations §  headaches §  clammy §  sweaty skin

§  decreased appetite §  unusual movements §  hand tremors §  alterations of the pupils §  pale skin

Severe Opium Withdrawal Symptoms

In extreme cases, the following might present themselves.

§  irrational thoughts §  irritability §  anger §  confusion

§  fever §  seizures §  convulsions §  hallucinations

Treatment

So what did doctors do when a patient was overdosed on opium? The following case study from the archives of the University of Virginia offers some answers. Though this example took place a decade before the Civil War broke out, we can imagine many doctors may have used similar methods.

“On May 7, 1850, Dr. John William Ogilvie traveled eight miles to a plantation in Barnwell County, SC in response to a reported overdose of Laudanum, or a tincture of opium. The patient had attempted suicide, swallowing the tincture at 4:15 that morning. Arriving at 7:15 AM, Dr. Ogilvie found him still alive. Apparently in a state of melancholy, the patient was conscious and calm, but expressed regret that the doctor had come as he still wished to die. Dr. Ogilvie, however, proceeded to treat the patient without any apparent difficulty. Initially, he administered ten doses of zinc sulphate solution, five minutes apart. The patient began to vomit fifteen minutes after the last dose, and Dr. Ogilvie smelled and saw the drug in his regurgitated fluids. The doctor then proceeded to put a tube down his patient's throat and forced four pints of warm water into the man's stomach. Dr. Ogilvie left at 10:45 AM, his patient stabilized and quickly recovering.”

Historically, southern whites were the most susceptible to opium addiction, and prior to 1900, the addiction primarily affected the middle- and upper-class. Country physicians actually had the highest rate of addiction among nineteenth-century professions, so it was not a big leap for me to give an opium addiction to a Confederate surgeon in my novel.

Dependency on the drug during the Civil War was likely magnified by soldiers' traumatic experiences. Opium helped calm frayed nerves and brought sleep to those who otherwise may not have been able to rest. Not only did it numb physical pain, but it numbed emotional pain, as well.

Up until the Civil War, opium use and abuse was so widespread it was not frowned upon. It was not until the significant abuse during and after the Civil War that doctors began to take drug abuse seriously and medical opiate addiction finally began to disappear.

For further reading:

Courtwright, David T. Dark Paradise: Opiate Addictionin America Before 1940. Cambridge: Harvard University Press, 1982.

Hodgson, Barbara. In the Arms of Morpheus: The Tragic History of Laudanum, Morphine, and Patent Medicines. Buffalo: Firefly Books, 2001.

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A former military wife, Jocelyn Green authored, along with contributing writers, the award-winning Faith Deployed: Daily Encouragement for Military Wives and Faith Deployed . . . Again. Jocelyn also co-authored Stories of Faith and Couragefrom the Home Front, which inspired her first novel: Wedded to War. She loves Mexican food, Broadway musicals, Toblerone chocolate bars, the color red, and reading on her patio. Jocelyn lives with her husband Rob and two small children in Cedar Falls, Iowa.

Opium Abuse during the Civil War Era: 1/2

Author Jocelyn Green returns with another installment in her series of posts on Civil War Medicine. Jocelyn was here last week discussing amputees and prosthetics. You can Part I and Part II by following the links.

As an added bonus, Jocelyn has graciously offered to give away a personalized copy of her latest novel, Widow of Gettysburg, to one commentor. To enter, leave a comment on any of her posts over the next three weeks WITH your e-mail address. Must live in the USA. Winner drawn midnight, Saturday, May 11th, 2013 and announced here at Redwood's on May 12th, 2013.

Jocelyn has also graciously said she'll send you a signed bookplate if you have any of her novels and would like one. Again, MUST have your e-mail. 

Good Luck!


As you can image by the title of my novel, Widow of Gettysburg, writing it required extensive research into the condition of wounded soldiers and their treatment. I soon discovered that opium was considered a wonder drug by battlefield surgeons. It was sprinkled on wounds to help slow blood loss, and taken orally to relieve pain and induce sleep. Opium and morphine were the most popular painkillers—but they were also used in the treatment of cholera and sometimes dysentery.

The most significant incidence of opium abuse in the United States occurred during the Civil War, when an estimated 400,000 soldiers became addicted to the drug. Two of my characters in Widow of Gettysburg struggle with it. The following signs and symptoms helped guide those storylines.

Opium Abuse Side Effects

These side-effects depend on factors such as the dose, how the drug is taken, and the individual’s metabolism. In addition, these side-effects depend on the duration of time in which the drug has been taken. Opium abuse brings about side-effects such as:

• Drowsiness
• Sedation
• Depressed or slowed breathing
• Glazed or red eyes
• Slurred speech
• Headaches
• Confusion
• Dizziness
• Small pupils
• Nausea
• Sleeping disorders
• A runny nose
• Sinus irritation
• Excessive energy
• Rapid speed
• Mania
• Loss of appetite
• Mood swings
• Depression
• Apathy
• Slowed reflexes
• Vomiting
• Constipation and other gastrointestinal problems
• Extreme anxiety
• Restlessness and tension

In most cases, side-effects are experienced at the early stages of abuse and decrease as time goes by.

Depression was one of the most serious side effects of long-term users, and could lead to suicide.

In severe cases, the individual may have a weak pulse, lower blood pressure, reduced heart rate, difficulty or labored breathing, and changes in the color of lips and fingertips. Seizures, convulsions, hallucinations, confusion and psychomotor retardation also take place.

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 A former military wife, Jocelyn Green authored, along with contributing writers, the award-winning Faith Deployed: Daily Encouragement for Military Wives and Faith Deployed . . . Again. Jocelyn also co-authored Stories of Faith and Couragefrom the Home Front, which inspired her first novel: Wedded to War. She loves Mexican food, Broadway musicals, Toblerone chocolate bars, the color red, and reading on her patio. Jocelyn lives with her husband Rob and two small children in Cedar Falls, Iowa.