Medicines Of The Times

Doctor’s Office.

The role of doctor (male or female) is a peculiar one on this game. There is quite a bit of idle time in between crises. Once the bullets start flying, and fighting starts in the streets, the first name they call out is that of the doctor.

OOCly in game doctors needs to have a fair amount of knowledge about medicine of the era. Fortunately most of it was primitive by today’s standards. Most times doctors will be removing bullets and patching holes. There is the odd accident, severe beatings, and the odd exotic illness. A player that takes on the role of doctor on Cimarron must be willing to break up the scene they’re in to go take care of ICly patients. They must be willing to RP with all level of players that may be on the grid at the time.

A player taking on the role of doctor needs at least a basic knowledge of removing bullets, setting broken bones, stitches, gangrene , and other diseases of the time. It would also be helpful to be familiar with physician’s instruments of the era. A players isn’t expected to be an expert, but should be willing to research the information as its needed.

We suggest watching Doc on Gunsmoke, or the first scene of Dances with Wolves

This character comes with coded commands which will need to be used during curing/recovery.


Medicine in the 19th Century

Medicine, 19th-century

The 19th century was a period of enormous medical change and progress. Many diseases that had been fatal in 1800 were either treatable by 1900, or a cure would be found very early in the 20th century using techniques developed by 19th-century scientists. Doctors, chemists, and scientists investigated medicine using the new scientific technology made available by the Industrial Revolution, and made discoveries that changed the face of medical practice. Government involvement in medicine and public health also changed dramatically during the 19th century. In 1800 governments refused to act to protect the health of the public, but by 1900 the principle of government responsibility had been well established in many European countries. The training of doctors and nurses was fundamentally altered, along with the organization of hospitals. Most important was the development of germ theory by Louis Pasteur, a discovery that gave doctors and scientists the key to understanding, treating, and preventing disease.

Disease

The understanding and treatment of disease developed rapidly in the 19th century. The first major breakthrough was the work of the English doctor, Edward Jenner. In 1796 Jenner developed the first vaccine, using a preparation of cowpox virus to produce immunity against smallpox. Although Jenner could not explain why or how his vaccination worked, he had made a great leap forward in the treatment of disease. For the first time it was possible to prevent the spread of a killer disease using medical treatment.

In the 1860s the French chemist Louis Pasteur demonstrated that dust in the air contained spores of living organisms, providing the link between germs in the air and disease – a key breakthrough in the understanding of disease. Scientists were now able to discover the specific cause of a disease by finding the relevant virus or bacteria, and develop more vaccines, treatments, and cures from this research. Once Pasteur had shown that the causes of decay and disease were natural phenomena that could be scientifically explained, previous theories, founded on a lack of scientific knowledge, could be rejected.

The German bacteriologist Robert Koch further developed Pasteur's work. Koch showed how germs caused disease in humans. By 1875 Koch had found the bacillus that causes anthrax, and doctors were able to conclusively prove that bacteria caused human diseases. By 1894 scientists had discovered the bacteria or viruses that cause leprosy (1879), typhoid fever (1880), diphtheria (1882), tuberculosis (1882), cholera (1883), tetanus (1884), pneumonia (1884), and bubonic plague (1894). Vaccines were developed from this research to prevent infection by a specific disease.

Further work on disease continued as scientists tried to develop techniques for treating a patient already infected with a disease. In 1911 the German bacteriologist and immunologist Paul Ehrlich, who had worked under Koch, discovered a treatment for syphilis in Salvarsan 606. Salvarsan was the first so-called ‘magic bullet’, a chemical substance that could seek out and destroy specific bacteria without harming the rest of the body. Within 115 years scientists had leapt from the first vaccination by Jenner, with no understanding of its scientific basis, to the manufacture of antitoxins that could target disease within the human body. The rate of change in understanding and treatment of disease had exceeded anything previously achieved.

Surgery in the early 19th century

Surgery was an extremely risky business in 1800. The level of hygiene was very poor. Surgeons operated in dirty theatres and used instruments that were rarely washed between operations. They did not wash their hands before or between operations, or wear clean clothes. Lack of effective anaesthesia was also a problem. Surgery had to be carried out quickly, so the only possible operations were amputation, the removal of growths, or operations on problems close to the body surface; complex surgery on internal organs was impossible. Patients had to be held down by a number of assistants while the surgeon amputated a limb, or performed other surgery, as rapidly as possible. Many died from the shock or pain of the operation. Even if a patient survived the operating table, they were likely to die of an infection picked up from unclean hands or surgical tools, or the aftercare on the dirty ward. Blood poisoning was common. If a patient lost a lot of blood there was no way of replacing it, as blood transfusions were not perfected until the early 20th century. The only effective method of stopping the bleeding was to use ligatures to tie the blood vessels, a practice introduced by the French military surgeon Ambroise Paré in the 15th century that had remained unchanged.

The introduction of anaesthetics

The development of a safe and effective system of anaesthesia began with the work of Humphrey Davy in 1799. Davy experimented with nitrous oxide, also known as ‘laughing gas’, and discovered that it reduced sensitivity to pain. However, his ideas were not adopted by the medical profession. In 1846 the Scottish surgeon Robert Liston began to experiment with the use of ether as an anaesthetic. He first used it on a patient having his leg amputated but, although the ether sent the patient to sleep and made him unresponsive to pain, it also caused irritation of the lungs and the patient coughed throughout the operation. However, surgeons now had two limited methods of anaesthesia: laughing gas, which deadened pain but did not put the patient to sleep; and ether, which was dangerously flammable and caused damage to the patient's lungs.

The real breakthrough to effective anaesthesia without dangerous side effects was made in 1847. The Scottish obstetrician James Simpson, professor of midwifery at Edinburgh University, was the first to use ether for childbirth and experimented with various other gases. In 1847 he discovered that chloroform was highly effective in putting patients to sleep while removing their ability to feel pain. Chloroform also had no obvious negative side effects. Simpson used the gas on his patients, and actively encouraged other doctors to do so. However, many doctors were fearful of the risks associated with chloroform, and their misgivings were heightened in 1848 after the death of Hannah Green, a 16-year-old who inhaled too much chloroform during an operation to remove her toenail. Surgeons were unsure about the correct dose of chloroform to give a patient. A number of practitioners opposed anaesthetics completely, believing them to be unnatural and against the wishes of God. They argued that pain was a natural phenomenon and should not be interfered with.

However, Simpson, along with surgeons such as John Snow, continued to champion the use of chloroform as an anaesthetic. When Snow, the first specialist anaesthetist, administered chloroform to Queen Victoria during her labour while giving birth to Prince Leopold in 1853, its use became more widely accepted. With the widespread application of chloroform in the second half of the 19th century, surgeons were able to carry out surgical procedures that had been impossible in 1800.

Antiseptic and aseptic surgery

Infection stemming from dirty operating conditions and poor hygiene remained a problem well into the second half of the 19th century. In 1847 the Hungarian obstetrician Ignaz Semmelweis, while working in Vienna, tried unsuccessfully to introduce asepsis (better medical hygiene). Semmelweis studied the high death rate among women who had just given birth and observed that the doctors were handling dead women in the mortuary and then delivering babies on the maternity wards without washing their hands in between. He concluded that they were transmitting infected matter from the bodies, and ordered all doctors and nurses on his ward to wash their hands in chlorinated lime. The results were dramatic – the death rate fell from 30% to 1.5% within 12 months. However, Semmelweis was opposed by his superiors, who refused to acknowledge the value of his work – sepsis at this time was thought to be a kind of combustion caused by exposing moist body tissues to oxygen. The use of chlorine of lime was also unpopular as it irritated the skin. In 1850 Semmelweis was forced to resign from his post and he returned to Budapest. In Vienna his regime was not enforced and the death rate rose again to around 15%. Meanwhile, in Budapest, where Semmelweis continued to practise simple asepsis, the death rate was less than 0.5%.

The work of the English surgeon Joseph Lister, who pioneered the use of antiseptics in the 1860s, met with greater success. Lister was aware of Pasteur's work on germs, and set about finding a method of reducing the risk of germs in the operating theatre. He knew that carbolic acid was used to treat raw sewage, and realized that it worked by breaking down the bacteria concerned; he had also noticed that sewage and certain septic wounds, such as gangrene, have a similar smell. Lister discovered that a spray of carbolic acid, applied to the bandages used on patients' wounds, cut infection dramatically. He then introduced carbolic acid into his operating theatre – carbolic acid was sprayed into the air around the patient, killing the bacteria on the patient as well as on the surgeon and the instruments used. The results were startling – death rates fell from 46% in 1864 to 15% in 1870. However, like Semmelweis, Lister faced opposition from others in the medical profession. Carbolic acid burned the skin of those who were exposed to it, and caused irritation to the lungs. Opposition declined, however, as doctors became increasingly aware of Pasteur's work. Lister was able to give a scientific explanation for his results, and eminent surgeons such as William Cheyne enthusiastically adopted his methods.

The final step towards bacteria-free surgery in the 19th century was the introduction of aseptic surgery. Semmelweis had been unsuccessful in his pioneering of asepsis through washing in chlorinated lime because he had been unable to prove his results scientifically, and he was also hampered by the unpleasant effects of chloride of lime and the innate conservatism of the medical profession. However, in 1880 Charles Chamberland, a French bacteriologist who worked with Louis Pasteur, developed the first medical sterilizer – the ‘Chamberland Autoclave’. The autoclave worked on a similar principle to the pressure cooker, boiling the surgeon's instruments and removing all traces of bacteria. The technique was further developed by the German bacteriologists Robert Koch and Curt Schimmelbusch. They designed a non-pressurized steamer that could sterilize the dressings for wounds. The German surgeons Gustav Neuber and Ernst Bergmann, who had worked with Koch in 1885, introduced the practice of sterilizing everything that came into the operating theatre, including the gowns and masks of the surgeons and nurses. In 1889 the US surgeon William Halsted introduced the practice of wearing gloves during an operation. The operating theatre had become a germ-free environment, and death rates plummeted around the world. Between Lister's announcement in 1867 that his wards at the Glasgow Royal Infirmary had remained clear of sepsis for nine months and his death in 1912, the number of operations had increased tenfold. Surgeons could perform operations with more confidence, as by 1900 the risk that successful surgery would be jeopardized by infectious conditions had been greatly reduced.

Blood transfusions

Although the problems of infection and anaesthesia had been solved by 1900, the treatment of blood loss remained a challenge – blood loss could thwart the success of an operation, even if it was performed skilfully, painlessly, and in a clean environment. Although doctors had the ability to perform blood transfusions, they could not guarantee their success. The technique was first used by the French physician Jean-Baptiste Denys in 1667, who transfused blood from a sheep to a human. In 1818 the first successful transfusion from human to human was carried out in England, the two people being connected by a tube in the same room. However, further attempts failed regularly, as doctors were unaware of the existence of blood groups. If the blood types of donor and recipient were incompatible, coagulation of the blood would occur, along with the possible death of the recipient. It was not until the ABO blood group system was discovered by the US immunologist Karl Landsteiner in the years 1900–02 that the first steps to safe blood transfusion were achieved.

Diseases

In the West, a person could be a doctor if he or she said so, whether or not he or she had any training was irrelevant. Much of the area relied on the knowledge and common sense of individuals who had no formal training.

Diseases and Treatments

*Ague (Malaria or Chills): Treated with quinine, Dr. Sappington's Anti-Malarial Pills or Dover's Powders.

*Antiseptic: Products included carbolic acid (introduced by Joseph Lister in 1867) Dr. R.P.R. Gordon in Mondatna used turpentine as an antiseptic.

*Asthma: Treated with buttercup tea.

*Bleeding: Home remedies called for using wood ashes or cobwebs to staunch the flow of blood. People also put gunpowder or flour on cuts to staunch the bleeding.

*Blood Letting: The use throughout the period as doctors was to purge, blister or bleed. They may apply blood-sucking leeches, which were sold at drugstores.

*Blood impurities: Treated with sulphur and molasses.

*Boils: "Ripened" by using bacon rind, or poltices of bread and milk; warm, fresh cow manure or mashed potatoes.

*Bowels, Inflamation of: Treated with opiate to reduce pain;enemas and "salts" such as magnesium sulfate given hourly until the bowels move.

*Bruises or Sprains: Treated with dried flower heads of arnica.

*Burns: Poultice of slippery elm and Indian meal; a salve of turpentine, sweet oil and beeswax; the natural salve from the aloe vera plant, a salve made from chamomile, sweet clover and the inner bark of sweet elder trees, mixed with mutton tallow and beeswax or a mixture made from the white of an egg and lard.

*Cholera: Pills compounded of camphor, cayenne pepper, opium and calomel or rectal injections of a medicine made from sugar of lead, laudanum and gum arabica. A cholera tincture involved the mixture of pulverized cinnamon bark, cloves and gum guaiac with brandy, taken in teaspoon or tablespoon dosages every one to four hours.

*Croup: Treated with skunk grease.

*Fevers: Coal tar derivatives or a mixture of sulphuric ether, aquaammonia and muriate of ammonia.

*Gunshots: Pulverized gunpowder or flour packed in the wound.

*Headaches: Sick headaches might be caused from "overloading the stomach". Other headaches could be cured by soaking feet in hot water while drinking herb teas such as pennyroyal, catnip or mint, then covering up with blankets until the person sweats for about an hour. Other headache remedies included a couple teaspoons of charcoal dissolved in water and then drunk, or a tonice created by mixing a small amount of castor, gentian and valerian roots with laudanum, sulphuric ether and alcohol. The mixture needs to stand about 10 days before use.

*Pain: Treated with opium, laudanum or paregoric, Frontiersmen used tea made from willow tree bark. The tea was made by boiling the willow bark, then pulverizing the bark and making a tea using a portion of the powder residue.

*Pneumonia: Treated with bromide mixture, moist heat, flax seed meal poultices, corn meal poultices, oiled silk used as a chest dressing or the wearing of quilted pneumonia jackets.

*Snakebite: Raw beef slabs or chicken flesh were used to draw out poison as was "vinegar mixed with gunpowder".

*Sore Throat: Wrapped the throat in red flannel, wrapping it with kerosene-soaked rag or placed a poultice of fried onions around the neck. Also recommended was a liniment made of gum camphor, castile soap, turpentine, oil of origanum, alcohol and opium.

*Pain Killers: Laudanum (tincture of opium), morphine (chief alkaloid of opium - after 1875), willow bark tea or a mixture of alcohol, gum guaiac, gums myrrh and camphor and pulverized cayenne pepper.

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