21st century doctor treating infection in mid-19th century setting?

Short of an injectable anti biotic, the patient dies unless their own immune system manges to fight off the baterial infection which it can. As a kid I had septecemia because of an infection in both feet. I never sought medical attention because the medic where they had me was into boys. I was weak and a bit delerious with what I said was the flu. After about ten days, the red lines streaking up my legs (typical of septecemia) fadded, retreated and were gone. So my immune system saved my butt in more ways than one

Penicillin was the first antibiotic and was discovered accidently when a stray bacteria landed in a pitre dish with another bacterial culture growing in it. The researcher found this new bacteria (a pencillian bacteria?)growing happily in the middle of the culture with a circle of pale yellow liquid around it. That was the penicilin which was excreted by the penecillin bacteria as a natural defense against other bacteria. Bread mould usually is the same kind of bacteria . So your protag could set up a crude lab using beef broth as a culture medium and infecting various cultures with various kinds of bread mould looking for the one that kills off the others.

As to how to inject it, I'll leave that one to some one else. I'm not sure they had needles in teh 1850's. They also didn't have electricity either except for running the telegraph system and that was powered by lead acid batteries so no electric lights not until the early 1900's.

There is a saying among surgeons, "The sun does not set on pus."

What this means is that even today more important than any antibiotic is proper wound drainage. One would filet the wound open, cut away any dead tissue and allow pus to drain, washing it out with sterile water (or at least sanitized water) and then do moist to dry dressing changes. (Moisten clean gauze such as, boiled for 20 minutes but allowed to then cool, cotton or muslin and pack the dressings into the wound. When the dressings are dry to mostly dry, tease them out of the wound and repeat the process. Typically this will be 3-4 times per day for weeks. The dried dressings will debride the necrotic tissue in a more selective manner than cutting it away. If it doesn't hurt at all that's a bad sign. It should be painful enough to warrant a couple of shots of whiskey, but typically not so bad as to have people pass out unless it is extensive burns.)

For smaller wounds, honey and distilled liquor have be used as antiseptics.

You might want to read the writings of Galen, a Roman surgeon who eventually became sort of the equivalent of the Surgeon General)

Mike Martyn said:

So your protag could set up a crude lab using beef broth as a culture medium and infecting various cultures with various kinds of bread mould looking for the one that kills off the others.

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The problem with that is that few physicians would have the expertise to be able to accurately identify specific colonies or formulate any significant amounts of an attempted antibiotic in the time allowed. If they were of a specialty such that they had the expertise, they'd likely not have the surgical expertise to treat the problem in the short term. Sepsis will kill people in hours to days. Setting up a lab after the fact would take weeks. If they did want to set up a lab, blood ager would be preferable to animal hoof broth alone. (You'd want to boil down the hooves, not the meat)

19th century germs would vary from 21st century germs in that they are not at all antibiotic resistant. So your modern-trained doctor might try any of the following: moldy boiled potato (this is how one of the very early antibiotics was discovered); maggots to the wound (do a dandy job at eating away any necrotic tissue and will not touch healthy flesh); or wrapping the wound snugly and letting it "stew in its juice." This was used in WWI before antibiotics were readily available, and it worked.

Of course, for the septicemia there are really no good pre-antibiotic answers, save good supportive care (rest, push fluids, perhaps willow-bark tea and/or laudanum) and letting the patient's own immune system do the tough work. Chances are if the sepsis is due to a nasty bug or the patient is weakened in any way, he'll lose the patient.

Mike said:

Penicillin was the first antibiotic and was discovered accidently when a stray bacteria landed in a pitre dish with another bacterial culture growing in it. The researcher found this new bacteria (a pencillian bacteria?)growing happily in the middle of the culture with a circle of pale yellow liquid around it.

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Just a nitpick: Penicillin is a mold, not a bacterium.

Sarpedon said:

Just a nitpick: Penicillin is a mold, not a bacterium.

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Point taken.

And the people in 19th century would think your Dr. was barmy. "Disinfection" and "bacteria" would be a completely alien concept.

Soccer Mom said:

And the people in 19th century would think your Dr. was barmy. "Disinfection" and "bacteria" would be a completely alien concept.

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Depends when in the 19th century it is. By 1865, Lister was already working with the concept of disinfection in surgical wards, and Pasteur had already published several papers.

I think they disinfected things (not tissue) with diluted carbolic acid. And they would have had chloroform and opiates to use for pain relief. Whiskey would also be used as pain relief. (That's something you might use - a modern-day doctor would know that it's not really good to get your patient drunk but a person of that time would value the pain relief.)

I believe the main 'treatment' they would have had once infection/gangrene had set in would be amputation of the affected limb.

They might also smear honey in the injury and then wrap it. (Honey has anti-bacterial properties.) A modern-day doctor might not know this and think it's nuts (but it really does work).

Do you want the patient to live or die?

Deb Kinnard said:

maggots to the wound (do a dandy job at eating away any necrotic tissue and will not touch healthy flesh);

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That very much depends upon the species of the fly. Most left unchecked will attack living tissue and are small enough that trying to clean them out is very difficult. If you don't know exactly what species you have, you are more likely to make things worse. A modern physician is not likely going to be trained in entymology.

Deb Kinnard said:

Of course, for the septicemia there are really no good pre-antibiotic answers, save good supportive care (rest, push fluids,

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right, and nutrition

Deb Kinnard said:

perhaps willow-bark tea

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which contains aspirin and short of a cold bath would be one of the few things to help with fever

Deb Kinnard said:

and/or laudanum)

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an old opium based pain medicine

BarbaraKE said:

Whiskey would also be used as pain relief. (That's something you might use - a modern-day doctor would know that it's not really good to get your patient drunk but a person of that time would value the pain relief.)

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A lot of that has to do with how alcohol will interact with most of our modern medicines (including the old laudanum) and how the individual patient reacts to alcohol. If you don't have modern medicines, then it is really patient driven. If the patient is the kind of person who giggles in the corner, then it would likely help with performing surgery. If they are a mean drunk who tends to get into fights, then it would likely make surgery more difficult because the patient will be less cooperative.

It's far easier and safer to do surgery on a patient who sits still, so whatever works for that patient.

I would quickly point out that a 19th century doctor would know about bacteria, even though they may not have an idea on how to deal with them (prior to Lister's work); the microscope had been use for centuries, after all, and some of the first things discovered were bacteria.

Of course, if it is an alternative timeline, it's entirely possible that they could have been washing their hands for quite a while. When it's one with magic, then germ warfare in the OR would be actually possible (summoning small imps to go one on one with germs, for example).

FR

Um, I wasn't especially clear. I blame NaNo for frying my brain. It was not commonly known by your average, every day person in 19th century to understand the concept of disinfection and bacteria. A well trained medical person certainly would, especially after the 1860's. But, as you say, if it's alternate history, then Bob's your uncle.

BarbaraKE said:

I believe the main 'treatment' they would have had once infection/gangrene had set in would be amputation of the affected limb.

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I was going to post something in this vein too. If you were/are considering the amputation route, you should know this interesting fact: Before the days of reliable anesthetic, a well-trained surgeon in the 19th century was able to amputate a man's leg in 7 seconds.

Also, because I just found it while looking for some proof, how's this for surgical technique?

Dr. Liston (1794-1847) was...well respected in this preanesthetic era for obvious reasons. Legends of his operating techniques are numerous, including the carved notches Dr. Liston made on his amputation knife following each procedure. He would hold a major artery with his large left hand while making one great cutting pass with the right. With the knife held in his teeth, he would then suture the limb, the whole procedure lasting only a few minutes. On one occasion while he was trying to break his speed record for a leg amputation, Dr Liston accidentally amputated one of his patient's testicles and two of his assistant's fingers.

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Medical history is awesome.

Speed record for leg amputation? Whoa!

Soccer Mom said:

Speed record for leg amputation? Whoa!

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I know! It's crazy some of the stuff they did back then. History of Medicine was my all time favourite topic when I took history in high school.

Also, another fact regarding anesthesia - even though it was discovered around 1842, and it's use was publicly demonstrated in 1846, many doctors refused to use it until well after the Civil War, (because they were crazy and though it was the devil's work) so it didn't become commonplace until 1865 or so.

EDIT:
It's all coming back to me now, I can't stop posting....Surgeons at the time would also have up to 6 'assistants', whose sole job was to hold the patient down so that he wouldn't move whilst being operated on - they would give the patient a few slugs of whiskey, as previously mentioned, then give him something to bite down on, and basically sit on him until either the operation was over, or he passed out from pain and/or blood loss.

FinbarReilly said:

I would quickly point out that a 19th century doctor would know about bacteria, even though they may not have an idea on how to deal with them (prior to Lister's work); the microscope had been use for centuries, after all, and some of the first things discovered were bacteria.

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Not exactly. It would very much depend upon what part of the century and what part of the world. Even into the latter part of the 19th century there were diehard old school individuals who even ran medical schools and taught that germ theory was a myth and that washing hands was unnecessary. The other wrench in the cogs was that surgery was not part of medical school. It was part of barber college. There were no residencies as we know them today. The Hippocratic oath, if you read the whole thing, includes many prohibitions against surgery, probably because physicians and surgeons saw each other as competitors and looked down on each others' training. It's only been a little more than a century that surgeons were required to go to medical school.

GeorgeK said:

The other wrench in the cogs was that surgery was not part of medical school. It was part of barber college. There were no residencies as we know them today. The Hippocratic oath, if you read the whole thing, includes many prohibitions against surgery, probably because physicians and surgeons saw each other as competitors and looked down on each others' training. It's only been a little more than a century that surgeons were required to go to medical school.

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In the U.S. at least, surgery had been taught at medical schools during the whole 19th century. Though schools didn't offer residencies, it was standard for a doctor to apprentice with another doctor for several years--producing much the same result.

While surgeons often weren't required to go to medical school in the 19th century U.S., neither were any other kinds of doctors, depending on the decade and state. You could call yourself "Dr." without adding an "M.D." and be proud to have a certificate from your preceptor after an apprenticeship. In the U.S., licensing and regulations came and went, strengthening, weakening, and strengthening again due mainly to the influence of the AMA.

What's complicating the discussion, I think, is that the 19th century is a long period, stretching from the humoral theory, heroic medicine and no anaesthesia, to the era of the germ theory, and antiseptic surgery with anaesthesia, white gowns and gloves. Even the mid 19th century was a time when medicine was transitioning rapidly. Since it's fantasy, of course it doesn't really matter, but some historical things do seem odd when juxtaposed.

Pup said:

In the U.S. at least, surgery had been taught at medical schools during the whole 19th century.

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No, the 19th century is the 1800's, not the 1900's and even today the typical non-surgical specialists have only a bare minimum of surgical training typically less than 6 weeks and essentially never with actual hands on experience at the medical student level. When I was in residency it was unheard of for an internal medicine or family practice resident to do any surgical rotations at all. Many Internists still have the attitude that they have to "save the patient from the surgeons"

Pup said:

Though schools didn't offer residencies, it was standard for a doctor to apprentice with another doctor for several years--producing much the same result.

While surgeons often weren't required to go to medical school in the 19th century U.S., neither were any other kinds of doctors, depending on the decade and state. You could call yourself "Dr." without adding an "M.D." and be proud to have a certificate from your preceptor after an apprenticeship. In the U.S., licensing and regulations came and went, strengthening, weakening, and strengthening again due mainly to the influence of the AMA.

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However, the American College of Surgeons is not a branch of the AMA.

Pup said:

What's complicating the discussion, I think, is that the 19th century is a long period, stretching from the humoral theory, heroic medicine and no anaesthesia, to the era of the germ theory, and antiseptic surgery with anaesthesia, white gowns and gloves. Even the mid 19th century was a time when medicine was transitioning rapidly. Since it's fantasy, of course it doesn't really matter, but some historical things do seem odd when juxtaposed.

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No, you are talking about the pioneers of surgery, those who were at the forefront of medical science and eventually proven right. The knowlege was there, but practicioners and teachers were resistant. I'm talking about the average or typical training to be expected (in America). McBurney didn't write his paper on appendicitis until 1889 and it wasn't until the king of England required and had an appendectomy in 1902 that it became standard to consider surgery for appendicitis.

For the OP, Sabiston, "Textbook of Surgery" has a nice historical overview

GeorgeK said:

Pup said:

In the U.S. at least, surgery had been taught at medical schools during the whole 19th century.

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No, the 19th century is the 1800's, not the 1900's and even today the typical non-surgical specialists have only a bare minimum of surgical training typically less than 6 weeks and essentially never with actual hands on experience at the medical student level.

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Um, I'm not sure what you mean. It's trivially easy to show that medical schools normally included surgery in the 19th century (1800s). Here for example is a list of medical schools in 1860 from the American Medical Times that year, including the professors and the subjects taught. Flip through the pages, and you can see that virtually all of them had a professor of surgery and many had city hospitals or infirmaries connected, where surgery was demonstrated.

Naturally, it's not the same amount of training as today, but then no branch of medicine required the same training then as today. Surgery, though, was given comparable emphasis to other fields of study when a 19th century medical student entered a college or university.

GeorgeK said:

No, you are talking about the pioneers of surgery, those who were at the forefront of medical science and eventually proven right. The knowlege was there, but practicioners and teachers were resistant. I'm talking about the average or typical training to be expected (in America). McBurney didn't write his paper on appendicitis until 1889 and it wasn't until the king of England required and had an appendectomy in 1902 that it became standard to consider surgery for appendicitis.

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I'm talking about ordinary doctors. Yes, people resisted and knowledge lagged, as it always does, but only by two or three decades. Appendectomies are in fact a good example. They had to wait until aseptic surgery, due to the dangers of opening the abdominal cavity, but thirty years after aseptic surgery began to spread, appendectomies became standard.

With a lag of two or three decades, there was time within the century for new ideas to take hold, like anaesthesia, the decline of heroic medicine, the carbolic acid era, and so forth, even though older small-town doctors incorporated information more slowly. Doctors' surviving personal journals and daybooks, showing treatment given to patients and medicine administered, offer evidence of what country doctors were actually doing (as one example, The Journals of William A. Lindsay, published by the Indianapolis Indiana Historical Society), in contrast to the information in period books and published papers that discussed new techniques and spread the latest information.

Pup said:

Um, I'm not sure what you mean. It's trivially easy to show that medical schools normally included surgery in the 19th century (1800s).

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To say that all medical schools in the 1800's taught surgery is like saying going to a lecture by Al Gore would make someone an expert in Global Warming. Did they have a few lectures? Certainly. Were all of them current? Certainly not. Was there hands on training? Generally not. Did the medical students even act as first assistant? Generally not. Were all of them taught in an objective manner? Certainly not. Some medical schools talked ABOUT surgery, mainly to warn physicians away from it and sometimes very inappropriately so. That is not the same as teaching surgery. There was a political agenda. Sometimes that agenda helped patients given the technology of the times, but not always. Would it be possible to find a doctor in the 1800's trained in both medicine and surgery? Yes, and the closer to the close of the century the more likely, but it would be more likely that a given doctor would be trained in one or the other with varying degrees of overlap depending upon who trained them. There was a trend that in the smaller towns, where there were fewer doctors, someone trained in both might be a little more likely.

Kitty Pryde said:

How would she treat a wound with a bacterial infection that is moving towards becoming sepsis/bacteremia (blood poisoning)? I've come up with a couple ideas, but any help would be massively appreciated! Thanks!)

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I'm a microbiologist with a lot of really old medical books, pre-antibiotic era

Externally disinfecting:
-good old soap and water Certainly, but a mild soap.
-alcohol Nope ... burns tissues
-iodine solution (i don't know how to make it!) You won't have the materials
Well-known wound treatments: open it up, drain the pus and keep it open. You want to keep the anaerobes under control.

Available wound washes with bactericidal effect. ... red wine, fresh olive oil, strong tea of edible aromatic herbs (thyme or sage or oregano), pine resins dissolved in hot water, strong creosote bush tea, high quality turpentine. Barberry tea.

That's the reason for the biblical "washed his wounds with wine and oil". In all of these, it's the terpenes and phenols that do the trick.

Internally antibiotic:
-Plants (but which ones? garlic maybe?) Any of the strongly aromatic herbs, like thyme as a tea might help. Barberry tea. Echinacea stimulates the phagocytes.

-mold (but how to grow the right one?) Moldy bread, if you have it, as a poultice.

Nutritional Support:
Vitamin C: Fresh fruits, rose hip tea, fresh greens.

ADDING:
MAGGOTS!!!! You let flies lay their eggs in the wounds, and the maggots eat the dead tissue.