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 Medicine and Injury in the Old West

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JDSampson

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PostSubject: Medicine and Injury in the Old West   Sun Jun 10, 2012 12:41 pm

I'm working on (yes, yet another) one of the boys gets hurt bad and needs medical treatment story. You know, cause of all the angst, etc.

So this time around Heyes gets caught in a rockslide - falls off horse, he, horse and lots of rocks tumble down hill. So he's got a broken wrist, probably broken ribs and tons of bruises and scrapes.

At first he's just in a lot of pain, but I'd like something to happen that goes from . . hmm, he's feeling bad, to yow, he's in dire straights! The most logical is that he has a broken rib which has finally punctured a lung so now he can't breath. But is that fixable in 1880? Did doctors know how to stick a tube in and relieve pressure or what all or is that farfetched?

I don't want to do one of those miracle survival stories, just something to jolt Curry for a bit (cause he's with a lady when it happens so he can feel extra guilty about stepping away from Heyes! LOL.)

Thoughts?
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nm131

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PostSubject: Re: Medicine and Injury in the Old West   Mon Jun 11, 2012 3:51 am

So glad to see you writing new ASJ stories since I have loved everything I have read from you that I could find (especially For Those Who Tame Wild Horses and the Learning Curve stories).

The treatment for a punctured lung would be a chest tube to drain the fluid and reinflate the lung via an underwater seal chest drainage system. You can google "underwater seal chest drainage" for explanations of the set-up and how it works, if you need details. I wasn't sure exatly when the method came into practice so a simple internet search yielded the below.

"The importance of pneumothorax and haemothorax was realized in the 18th Century and many devices were devised to suck wounds out of the chest, sometimes using the mouth of a specialist to use his own inspiration to suck air or fluid from that of the injured. Later devices such as the Arel Syringe were developed which certainly improved the hygiene of this technique. Although trocars had been developed, caution in the use of these instruments was urged as early as the 18th Century and it was felt, even then, that the insertion of a finger in a carefully made incision was preferable to introducing a sharp pointed trocar which may damage the lung and other intra-thoracic structures.

There has been much misinterpretation in recent literature as to the nature of contusions, but it is interesting that Morgagni refused to use the concept of contusion when it came to lung injury, even though he was familiar with it elsewhere in the body. He, rather wisely, described lacerations of the lung as the mode of injury in blunt chest wall damage. Perhaps if we had learnt from Morgagni we would not have gone through the cycle of attempting to treat lacerations of the lung with steroids and diuretics as we have in the past when the word "contusion" was loosely applied to such injuries.

Underwater seal systems owe their development to a series of English physicians, and flutter valves were also used in the American Civil War. The Heimlich valve was a successor of these early flutter valve and the more effective flutter valve incorporated in the 'Portex Emergency Chest Drainage Bag'(Trade mark Portex Ltd) is the ultimate outcome of many less effective systems which have undergone development. The first scientific description of the flutter valve was by R. McDonald in Dublin Quarterly of Medical Science in 1864. Since that time, however, the underwater seal has become the mainstay of safe drainage of the thorax.

Operations were carried out in the 19th Century notably by Dupuytren and Kafstein who were repairing major lacerations of the lung with early recovery and good outcome. At the outbreak of World War 1 there were few surgeons with wide experience in the management of chest trauma and it was felt that the best treatment for the vast majority of chest injuries was conservative. However, it was felt by medical specialists in all armies that an unnecessarily high mortality resulted when conservative management was used for virtually all injuries. Quite independently, Moynihan in the British Army, Sauerbruch in the German and Pierre Duval in the French Army decided that better results could be obtained if early thoracotomies were carried out for lung lacerations. At the time of such operations other injured areas of the thorax were actively treated and the mortality rates in these very ill patients treated in those primitive circumstances was less than 20%. These surgeons were undoubtedly brave, skilled and experienced and were therefore prepared to operate. Today however, less brave, less skilled and less experienced surgeons who are not familiar with the thorax on a day-to-day basis, and do not have large experience of thoracic injuries, may prefer to treat almost every thoracic injury conservatively. "

http://web.mac.com/kieran.mcmanus/Chapters/Trauma/History.htm - searched under history of chest trauma/ underwater seal chest drainage.

So it seems as if you could reasonably go ahead with your plot scenario and I will be looking forward to reading.

nm131 (Nell Mckeon)



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AllegraW



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PostSubject: Re: Medicine and Injury in the Old West   Tue Jun 12, 2012 11:56 am

Hi there - hope you don't mind. Just a couple of thoughts.

I've had a bit of fun at work today talking this through with one of my doctors - the thing is that although there was a lot of research in this area, and indeed, much exciting progress going on especially in England and Germany, we were a bit skeptical about just how far this research (and posssibly equipment) reached - as in just how far out into the fronierlands of the wild wild west. (Or would Heyes be off to a hospital in the city which is a different scenario?) We reckoned a complete collapsed lung would then still have had a pretty dire prognosis most probably. Hygiene was almost non-existant and I'm not sure of Heyes' chances realistically. That saying, a lung doesn't have to completely collapse and, that being the case, can even heal up all by itself and still cause Heyes (and the Kid) a great deal of angst. Bear in mind that once a lung has collapsed that it has a higher chance of it happening again - do you want to weaken Heyes that much? It would have serious long term consequences.

So... maybe a partially punctured lung and the doc - perhaps having read up on the new and exciting findings which were coming through thick and fast - wondering about carrying out a drainage procedure which I am sure would produce the proper palpatations and guilts in the Kid. Heyes would be very unwell, and deadly infection a real and serious possibility but maybe he'd make it in the end without a still pretty iffy medical intervention.

I've just read this back - I have been no help at all have I? Sorry. It's been one heck of a long day!
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JDSampson

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PostSubject: Re: Medicine and Injury in the Old West   Tue Jun 12, 2012 5:47 pm

Thanks for the input, both of you. I felt like it might be too much to deal with and yes, it's fan fic but I like to be as realistic as I can be in these kinds of things.

Maybe I'll just give him a nice concussion and let him collapse or something! LOL. Not as dramatic but it works. What's funny is, I hadn't planned on this turning into a big medical sit by the bedside and angst story so maybe I should just get that out of my mind and move forward with plot B
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BeeJay
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PostSubject: Re: Medicine and Injury in the Old West   Tue Jun 12, 2012 8:43 pm

nm, I have to disagree swith you and agree with Allegra. Wow, I started to write my response and I keep scrolling down to Allegra's, and find she has already mentioned the points I have been considering. I also would imagine such treatment would be available in a hospital in an Eastern city, but the chances of it being availbale in the West would be close to nil. Western medicine was incredibly basic, and most doctors complained about sitting bedside and watching their patients die.
One positive point about your proposed puncture wound(or your formerly proposed puncture wound-is that it resulted from an internal source-the rib).

I am going to get a little off the track here, I'll get to concussions in a moment; but I would like to mention that, overlooked in our story writing, is the high rate of infection from puncture wounds-mainly those numerous bullet wounds the boys suffer. Not just from the lack of hygiene on the part of doctors. And, to be fair to doctors in this time period, the use of ticture of iodine and carbolic acid were being used after wounds were sutured or bound. But the iodine and carbolic acid could only be used on the wound's surface. The problem is that a punture wound carries particles of clothing along with it deep under the surface causing infection that could not be treated until the arrival of sulfa drugs, and anibiotics. There wasn't any way to treat an infection systemically.
Many infections in those days never did resolve, even if the patient survived initially. Just like the weakened lung that Allegra mentions, people often lived for years, but with dibilitating infections that eventually did kill them. And anyway, most chest and stomach wounds were just plain not survivable in the old West. That said, there was the rare individual who did survive, like Andrew Jackson, with a bullet lodged in the chest probably- one inch from his heart. However, he was in chronic pain(the bullet wound in his arm didn't help), and suffered from lifelong infection. He spent a lot of his spare time draining his arm, bleeding himself and self-medicating. But Old Hickory also walked barefoot in the snow while ill with smallpox(before the bullet wounds), so it is likely he had an unusually strong constitution. But that is part of my point-even with such a strong constitution he suffered from the effects of his bullet wounds the remainder of his life.


Concussion? Sure, but please don't give him television amnesia. People don't get weird, long-period losses of memory from concussions.
Here ya go:

Concussion Symptoms (curtesy of emedicine health)

•Loss of consciousness after any trauma to the head
•Confusion
•Headache
•Nausea or vomiting
•Blurred vision
•Loss of short-term memory (you may not remember the actual injury and the events some time before or after the impact)
•Perseverating (repeating the same thing over and over, despite being told the answer each time, for example, "Was I in an accident?")

HMMMMMMMM does Heyes even have to be hurt? Can't the Kid be jolted by something else? Instead of an injury how about something just plain weird. Heyes, gone-missing-but not arrested-Heyes behaving differently-but why? Something happens to Heyes while Kid gone but but but what??? Kid returns and Heyes announces he is going to turn himself in. confused Can't Kid feel all angsty over something not an injury????
By the way JD, you can ignore that--I don't write angst-duh-obviously. Rolling Eyes
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JDSampson

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PostSubject: Re: Medicine and Injury in the Old West   Wed Jun 13, 2012 12:10 am

I appreciate any and all input. The injury is already there - it's what led them to this bizarre house in the middle of nowhere with a lovely lady who may or may not be a witch.

My plots are complicated! LOL.

I also just love that image of a slightly dazed Heyes lying in bed trying to keep a stiff upper lip but accidentally calling out for Kid not Thaddeus.

The story is kind of just going where it's going and I'm trying not to reign it in. I went back to two old stories that I loved but couldn't find a way to finish them. I started a voodoo story that went nowhere but this one is working, so I'm going to keep plugging away and who knows where it will go from here.
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HannaHeyes

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PostSubject: Re: Medicine and Injury in the Old West   Tue Oct 02, 2012 4:01 pm

What was the name of the medicine they used for pain in the old west? For the life of me, I can't remember what it was.

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PostSubject: Re: Medicine and Injury in the Old West   Tue Oct 02, 2012 4:09 pm

HH, are you thinking of laudanum?
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PostSubject: Re: Medicine and Injury in the Old West   Tue Oct 02, 2012 4:10 pm

YES!! Thank you Very Happy

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PostSubject: article about honey as medicine   Mon Nov 12, 2012 4:23 pm

I am not a writer, but I love them. That is why I thought of you all when I came across this article today. I saw BeeJay's warning about the danger of infection in 19th century medicine and thought someone might be interested in using "honey as medicine" per one of the uses it lists.

itotd.com/articles/218/honey-as-medicine



Cheers,
Rowah
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PostSubject: Re: Medicine and Injury in the Old West   Mon Nov 12, 2012 7:01 pm

Thanks for the link, Rowah! It's always great to find new tidbits of research for writing, and this one is really interesting. One thing that differs from what I've heard is the warning not to give honey to babies under one year; I've always known that to be not under two years. In any case, since the boys are grown, there's no need to worry about that. Very Happy Thanks again!
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PostSubject: Re: Medicine and Injury in the Old West   Mon Nov 12, 2012 7:30 pm

Thanks for the link, Rowah. That was very interesting. I had no idea honey was good for conjunctivitis and sunburn as well as some of the other uses. And here I was just thinking it was yummy in my coffee!
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PostSubject: Re: Medicine and Injury in the Old West   Tue Nov 13, 2012 8:06 pm

I never heard of any of this, except taking honey for a sore throat. And I thought even that was only about the soothing feel of it. Thanks for the link. This was very interesting.

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PostSubject: Re: Medicine and Injury in the Old West   Wed Nov 14, 2012 12:18 am

A friend, who suffers from hay fever, takes a spoonful of local honey every day in the early Spring to build up his immune system to the local pollens the bees collect. He swears by it.

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PostSubject: Re: Medicine and Injury in the Old West   Wed Nov 14, 2012 12:49 pm

I've heard of honey being used before. I'm not sure how accesible it would be to most of the board, but the Carmina Gadelica documents remedies used by the last doctors who were trained in the ancient bardic medicine as well as 'modern' medicine. Honey is mentioned as are various other methodologies such as using cobwebs to bind the edges of a wound togther as primitive dissolvable sutures. It was translated into English in 1928, and some of it can be found in the internet. Be prepared to trawl though a lot of incantations and superstitions, though
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Rowah



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PostSubject: Re: Medicine and Injury in the Old West   Wed Nov 14, 2012 4:56 pm

It was interesting reading your takes on the honey article. I learned some new things from you all.
Next thing on my free time list is to peruse the Carmina Gadelica online while I enjoy my coffee with honey!

Rowah
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PostSubject: Re: Medicine and Injury in the Old West   Sat Nov 17, 2012 2:32 pm

I, too, had heard/read of honey being used for medicinal purposes though I can't recall where offhand. Perhaps it was on the tour of a meadery I recently went on (short on historical details but generous with samples!). Or maybe from the vendor at my local farmers market in the summer who sold a large variety of products made from honey.

I looked in the two books I have about medicine in the Old West but honey wasn't listed or discussed, not even as a folk remedy or patent medicine. However, I also have several books about herbal medicine and healing foods in general and in them, I found some information about how honey can be used:

From Herbal Medicine (Buchman), 1980: Honey has antibacterial properties (the ancient Egyptians used it for this purpose) and can be used to treat sores and boils; can be used to rebalance the body and overcome fatigue; can eliminate arthritic deposits in joints; is used as a gargle and in other ways to sooth coughs; is used as a moisturizer; can be used as a mild laxative.

From Complete Guide to Healing Foods (Ursell), 2000: "Honey has been traditionally used in Chinese medicine to treat stomach ulcers, high blood pressure, and constipation. It can be applied directly to minor burns and wounds." Also, "People have reported an improvement in [gastritis and duodenitis] through the consumption of honey." Plus, "While no scientific proof exists as yet, it is widely held that honey can help to sober up drunken or hungover people through the effect of fructose on the liver. It is thought that the fructose in honey stimulates the oxidation of alcohol by the liver, thereby speeding up the cleansing of the system." This text also states that honey shouldn't be given to babies who are less than one year old.

From The Illustrated Encyclopedia of Healing Remedies (Shealy), 1998: Lots of uses listed in this text:
--"Honey water can be used as an eye lotion..."
--"Gargle with honey water to soothe a sore throat and ease respiratory problems."
-- Honey and lemon mixed together are a traditional remedy for coughs"
-- "Mix with apple cider vinegar as a tonic or "rebalancer." This may also help to relieve the symptoms of arthritis and reduce arthritic deposits."
--"Honey ointment can soothe and encourage healing of sores in the mouth or vagina."
--"Honey is an excellent moisturizer, and can be rubbed into the skin as a revitalizing mask."
--Honey warmed with a little milk can be used as a gentle sedative."
--"Eating a little local honey will sensitize you to pollens in the area--acting as a natural remedy for hay fever and all its symproms."
--Apply a honey compress to cuts and bruises to soothe, encourage healing, and prevent infection."
--Smear set honey on ringworm or athlete's foot several times a day. Leave the foot uncovered."

Very interesting article, Rowah--thanks for posting it.
Frankie--it looks like your friend knows what he's doing!
Silverkelpie--will have to read that text sometime; I think the spells and incantations will be just as interesting as the other information!

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