PDA

View Full Version : 19th Century Triage



Orianna2000
07-04-2011, 07:23 PM
Suppose a man has just been rescued from prison, where he's been severely injured and basically left to rot. (We're talking one of the worst prisons of the the 19th century.) Most of his injuries happened when he first arrived in prison, and now it's been two months. He was attacked by a couple other prisoners and fought them off, but was injured in the process. Rather than give him medical attention, they threw him into solitary confinement.

So, he has a dislocated shoulder that was never set, along with an infected gouge to his face and eye. He was shot in the the chest a few weeks prior to being arrested, so that's going to be festering as well, although they did give him some medical treatment for that before putting him in the cell with the other inmates. He'll also have infected rat bites, cuts on his wrists from the iron manacles, and other injuries associated with being in a primitive cell, with no bathing, no blankets, no sanitary facilities whatsoever.

My first question is, once he's rescued and being looked after, which of these injuries is going to stand out as, "This needs to be taken care of first"? They can't afford to bring in a real doctor, because they just broke the guy out of prison, so it will be basic first aid and some herbal treatments.

How difficult would it be to set a dislocated shoulder that's been like that for eight weeks? It would probably have some extra damage caused by him trying (and failing) to set it himself, while chained.

Beyond that, is there anything I should know about the state he'll be in? Physically, I mean. (I know he'll be messed up emotionally.) I fully expect that his injured shoulder will never heal, he'll have extremely limited range of motion in that arm, and he'll have some scars on his face. I don't really know what other injuries he might have, other than rat bites and perhaps some kind of bedsores from being unable to move around much in his cell.

Snick
07-04-2011, 08:06 PM
It depends on where he was, and exactly when this took place. There were no antibiotics except alcohol and garlic, so the infections could have been a major problem, if the person treating him didn't know how effective garlic is. The dislocated shoulder might have become a lifelong problem, if it had been left untreated for a long tim; but people have been sucessfully treating dislocated joints for thousands of years. That might have been handled in the prison.

If he was shot in the chest, and that became infected; then that might be the most serious injury. That would depend on the individual and how long one takes to heal.

Buffysquirrel
07-04-2011, 08:22 PM
It would help if you could narrow this down in terms of time and place :). Also, what skill level do the people attempting to provide treatment have?

Orianna2000
07-04-2011, 08:36 PM
It would help if you could narrow this down in terms of time and place :). Also, what skill level do the people attempting to provide treatment have?
The year is 1882 and they are in Paris, but since they've just rescued the man from jail, they cannot hire a doctor unless it looks like he's going to die. I may have them bribe a doctor out of desperation, if it gets bad enough, but it would be extremely risky for them to do so.

Right now, there are two people treating him, one is a soldier so he probably knows a little first aid, but nothing major. The other is a former police chief; he knows some herbal medicine and things like how to set a dislocated shoulder. The patient himself is quite knowledgeable about herbal remedies, but of course he won't be able to help them much, since he's drifting in and out of consciousness.

They do have access to his collection of dried herbs, so I can give them whatever herbal medicines are necessary.

The bullet wound was treated in prison, so I'm guessing it's the least of his injuries right now. The prison doctor did not bother setting his shoulder, however, so that's been left untended for weeks. (When he first arrived, they wanted him fit enough to stand trial, so they treated his bullet wound. Then some other prisoners attacked him, he fought back, and they tossed him in solitary. After seeing what he did to the other prisoners, they decided not to risk sending the doctor in to him, in case he got violent again.)

Tsu Dho Nimh
07-04-2011, 08:37 PM
The dislocated shoulder can be as much of a problem and source of pain as your plot needs it to be. What happens is that the ligaments get a permanent stretch in them, so it's easier to dislocate again. They can also develop scar tissue and lose flexibility or even scar so much that the joint can't be put back together.

Putting it back in place: a serious dose of laudanum to knock him out and pressure in the right direction on the joint, followed by some strapping and a sling to keep it in place for a while is all you can do. He will have very limited mobility and hand strength for a while, but it can recover to almost 100% or you can leave him as disabled as your plot needs.

http://www.howtodothings.com/health-fitness/how-to-set-a-dislocated-shoulder is a pretty good description. You have to pull DOWN (away from the joint) with quite a bit of force to get the ball of the joint in the right position, then it will snap back into the socket as you push the ball towards the joint. It's one of those things I can do, but it's mostly by feel, so it's hard to explain.

WOUNDS: Clean him up, using soap and warm water, to distinguish wounds from dirt and bruises. Change rags and rinse water frequently. The most practical bath pattern is extremities to torso (fingers to shoulder, toes to crotch) on one side, then the other side, and then do the torso front and sides, roll him onto his side to get the back.

For wound disinfection use herbs simmered in wine with olive oil (toss the herbs, add about 30% olive oil use the wine/oil as a wound wash), cover with soft old cloths soaked in the aromatic herb mixture, cover it with clean dry dressings. Thyme, rosemary and oregano have some nicely anti-bacterial components, as does the wine and the oil (complex phenol molecules). Juniper, pine pitch and needles also work.

Lance (slash open) any abscessed wounds so they can drain, squeeze out the pus and wash them too. (major stink! really icky oozy crud) If it's a deep abscess, insert a piece of well-washed and boiled goose quill into the wound so it can continue to drain. (some docs kept a supply of de-calcified goose wing bones to use as surgical drains - soaked them in vinegar to remove calcium, leaving a cartilage tube). If you don't have a goose quill, a tuft of oiled wool works - the developing pus can soak out through it like a wick.

Ongoing wound care: remove dressings, wash any wound that is still open with more wine/oil mix, drain any abscessed wounds and wash them, re-apply herb-soaked dressings and bandage. Older wounds, massage gently with olive oil to loosen the scars.

Source - Ambrose Pare's book of surgical techniques. He was a French battlefield surgeon in the late 1500s.

Other things to worry about:
LICE! Body lice would be in his clothing, but pubic and head lice also abounded. A good washing-down, shave the beard, cut his hair really short.

Body lice carried typhus (jail fever) so you can worry about that possibility too.

******************
ADDING: Most books of household medicine - meant for housewives - had this information in them. Women were expected to do a lot of nursing and care of sick household members.

Orianna2000
07-04-2011, 10:08 PM
Tsu Dho Nimh, THANK YOU! This was exactly the kind of information I needed. :)

WriteKnight
07-04-2011, 11:52 PM
Honey is a topical anti-biotic. It was used from ancient times through the Napoleonic wars. (Though they didn't understand anti-biotics specifically) It was applied to wounds to aid in curing.

Still is in some hospitals.

Orianna2000
07-05-2011, 02:28 AM
Honey is a topical anti-biotic. It was used from ancient times through the Napoleonic wars. (Though they didn't understand anti-biotics specifically) It was applied to wounds to aid in curing.

I'd read that somewhere before, but thanks for reminding me. Can it be used in combination with the red wine/olive oil mixture?

Sarpedon
07-05-2011, 05:19 PM
Wine is ineffective as a disinfectant. I don't know about olive oil.

Stick to the hard stuff.

And I wouldn't be too crazy for the 'herbal treatments.' What he really needs is food, fresh fruit and vegetables especially. Fresh milk and meat would also be a good idea, once his condition has stabilized.

Tsu Dho Nimh
07-05-2011, 06:03 PM
Sarpedon - Red wine has plenty of anti-bacterial compounds, as do aromatic herbs, and the olive oil. They are terpenes, phenols and resins. Look up "Thymol", which comes from the her thyme.

It's been used since at least biblical times. The Good Samaritan washed wounds with "oil and wine", didn't he? And many of my ancient medical books specify using these ingredients as a wound wash, with Parč even running comparisons between some of the treatments and picking the ones he saw the best results with.

Honey works best on wounds that are unusually slow to heal - burns and granulomatous ulcers, for example.

***************
The invalid diet! I forgot that. The danger of letting someone who was semi-starved gorge themselves was well known.

http://chestofbooks.com/food/recipes/Invalid-Cooking/Diet-Lists-Or-Menus-For-The-Sick-Convalescent-s-Diet.html has some good information

He starts out with bread soaked in water and mushed into the consistency of thin oatmeal (pap) for a few days. Then they will be feeding him up with various meat broths, many with an egg beaten into it or more bread mushed into it. Custards and puddings were also popular for invalids, with or without fruit.

The concept of fresh fruits and vegetables being necessary for healing had not developed yet, except as a treatment for scurvy. Vitamins were just being investigated.

Orianna2000
07-05-2011, 06:38 PM
Sarpedon -- I'm a little confused as to how fresh fruits and vegetables would be effective in healing severely infected cuts and bruises? Especially in a half-starved man who would be unable to keep anything other than broth down.

Also, herbal remedies have been used for centuries with good results. Sure, garlic and honey might not be as effective as penicillin, but since antibiotics didn't exactly exist yet, they have to work with what they have, right?

Tsu Dho Nimh -- Ah, yes. I had a vague idea of feeding him broth for a few days, until he grew strong enough to eat stew or porridge, but your information is much more specific. Thank you!

Sarpedon
07-05-2011, 07:24 PM
Fresh fruits and vegetables are meant to fight scurvy and other vitamin disorders that are a frequent side effect of poor diet, presumably that he would have had in prison. It is not meant to be immediate treatment for the wounds.

And wine, while it may contain certain chemicals that may in isolation be anti-bacterial, wine itself is an ideal environment for bacterial growth. If you don't believe me, open a bottle of wine and leave it alone for a few days, and see what happens. Here is an article from the straight dope on the subject. http://www.straightdope.com/columns/read/2978/can-liquor-be-used-as-an-emergency-antiseptic The only conceivable advantage wine might have is that it was probably cleaner than the water available. If its the 19th century, there should be a variety of distilled alcohol available. Any of it would be far superior to wine. In the 1860s, Pasteur and Lister were pioneering the germ theory and the use of disinfectants. If this story takes place after this time, they should be available.

And I wouldn't go to the bible for medical recommendations. The biblical cure for leprosy is prayer and the sacrifice of a pigeon. Just because a treatment is traditional doesn't mean it works. For people in the 19th century to use such treatments is anachronistic, especially in the latter half.

Orianna2000
07-05-2011, 09:36 PM
I can easily change the wine/oil to whiskey, and have them use dried garlic and other herbs in addition to the alcohol. I read elsewhere that vinegar can be used to kill lice, too.

As far as the treatments being primitive or anachronistic, that's to be expected. They have no doctor, so they're relying on folklore and what small bits of medical knowledge they've picked up over the years.

James D. Macdonald
07-05-2011, 09:55 PM
The word for what you do with a dislocation isn't "set," it's "reduce."

Paris in the late 19th century was getting on towards modern medicine: The Germ theory of disease had already caught on. But in practical terms, especially without a doctor, the best you can do is keep him clean, in a nice sunny, well-aired environment, give him good wholesome food and water, and let his own immune system either save him -- or not.

Orianna2000
07-05-2011, 11:08 PM
The word for what you do with a dislocation isn't "set," it's "reduce."

Paris in the late 19th century was getting on towards modern medicine: The Germ theory of disease had already caught on.
Would the average person in 1882 know the term wasn't "set"? I didn't know, for example, so I'm wondering if the characters in my novel would be ignorant as well. One has military training, while the other has some amount of medical training but it was in Persia, so he's not overly familiar with the local terminology.

Also, at what point would the germ theory have been taught at school? In the late 1870s, when my MC would have been in school, would it have been on the science curriculum? I'm just wondering if my MC would be familiar with the idea, or if she'd be skeptical. She would have attended a local school in Paris, and then a music conservatory, so she has no background whatsoever in science or medicine.

Sarpedon
07-05-2011, 11:53 PM
Don't forget the huge newspaper reading culture that existed in the 19th century. Breakthroughs in medicine were well publicized, and the average city dweller in those days could be expected to be well informed of them. Even more so than today.

Tsu Dho Nimh
07-13-2011, 04:10 AM
Would the average person in 1882 know the term wasn't "set"? I didn't know, for example, so I'm wondering if the characters in my novel would be ignorant as well. One has military training, while the other has some amount of medical training but it was in Persia, so he's not overly familiar with the local terminology.
The basics of cleaning wounds, reducing dislocations, and feeding invalids was well-known all over the place.


Also, at what point would the germ theory have been taught at school? In the late 1870s, when my MC would have been in school, would it have been on the science curriculum? I'm just wondering if my MC would be familiar with the idea, or if she'd be skeptical. She would have attended a local school in Paris, and then a music conservatory, so she has no background whatsoever in science or medicine.
It wasn't being taught in the 1870s except in colleges of biology, because it was hot new research, and it was pretty controversial.

http://en.wikipedia.org/wiki/Koch%27s_postulates dates from the mid 1880s ... and it was vehemently debated.

You can make them as ignorant as the plot needs.

*****************
Sarpedon: From that link, "Ethyl alcohol, or ethanol, kills germs by penetrating cell walls, destroying the cellular proteins and enzymes, and dehydrating the cells."

You don't want to do that to wounds, because it damages the tissue you are trying to heal. Alcohol-based sanitizers are used on the hands of the medical staff, and on the instruments, not the wounds.

The wine/herb/oil wash is bacteriostatic because of the various phenols and resins - it slows bacteria reproduction down so the body can deal with them. And it's not going to damage the patient's tissues in the process. It is also sterile because you simmered it for a while.

BTW, I'm a microbiologist, medical technologist, and have EMT-level training for ski patrol. Add to that my pharmacist dad whose career started before antibiotics and my large collection of medical books from the 1700s through the 1940s ... I'm not giving advice that won't work.