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bill watson
07-03-2007, 12:36 PM
Of the Civil War? What three things are we fond of telling people at living histories and demonstrations that are so much bushwa and squalling born out of bad memories and wishful thinking and our tendency to turn the unusual into the rule of thumb?

I'd put "no anaesthesia" at the top of the list except I'm pretty sure I spelled it wrong.

I'd follow that with bullet-biting.

What about that horsehair suture story? Did that turn out to be true? (Use of horsehair required boiling, boiling killed germs unbeknownst to anyone, ergo wounds sutured with horsehair healed better. My thinking is they might have got the horsehair squared away, but that still left fingers, needles, knives, swabbing cloths, bandages and generally septic conditions as sources of contamination.)

Anyone have any contributions?

Frenchie
07-03-2007, 01:12 PM
Lopping off limbs whenever possible. The "common knowledge" is that amputation was done for even relatively minor wounds.

hanktrent
07-03-2007, 01:30 PM
I'd add:

Surgeons were stupid because they didn't sterilize their instruments, wash their hands, use modern medicines, etc.

Period medicine was a complex field in its own right. The fact that much of it has been improved upon or proven wrong, doesn't mean that individual surgeons were stupid, any more than individual soldiers were stupid for using what we consider obsolete weapons and tactics. Or, for that matter, that modern doctors are stupid for not applying today, discoveries from the 22nd century.

Hank Trent
hanktrent@voyager.net

NoahBriggs
07-03-2007, 01:49 PM
Modified from Hank's post above -

Surgeons and doctors were uneducated/apethetic. They had no idea of anatomy and knew nothing about the body.

Educational abilities varied based on practice and education and attitudes. The book Tarnished Scalpels lists some of the questions posed to surgeons who were applying to be regimental surgeons. Not only are the questions complex, but the applicant had to defend their response. One also had to answer general cultural literacy questions such as reasons for the American Revolution.

The list of references I posted earlier makes a lie of the italicized statement above. There were texts on specific specialities, all laid out in excrutiating detail, complete with diagrams.

Marc
07-04-2007, 10:28 AM
Must agree with Hank and Noah on defending the medical practices of the time period. I have always tried to stress that 19th century medicine was performed by the doctors with the best knowldege they had available at the time. Of course as in any profession a few stood out as incompentent.

The bite the bullet legend is right up there also.

TimKindred
07-04-2007, 02:02 PM
Bill,

What all those folks have said. Add to that one that there were female nurses in the field. Well, yes, there is always an exception to be made, but it's always a time/place specific thing.

I get so pissed off about the "no anesthetic" thing. I even heard that from an honest-to-goodness doctor. Ignorance of the cause of sepsis is not the same as willful disregard in the face of evidence. Doctors really DIDN'T know the cause of infections, although some were begining to catch on.

That "bite-the-bullet" carp is another myth that keeps getting recycled through idiot ebay sellers who are marketing "CW Pain Bullets" on a regular basis.

Anyone who thinks that CW surgeons, doctors, and all medical types were stupid, or drunk, or incompetent, or any combination of that, hasn't read any of the period medical bulletins, or even any part of the raging discussions over the use of calomel.

Judging CW oeriod medical professionals by todays standards is no different then judging CW society by todays morales. It is an effort in futility and false propoganda.

Respects,

NoahBriggs
07-04-2007, 06:38 PM
I wonder if the surgeons' reluctance to perform surgery in the abdominal/thoracic region stemmed not from ignorance, but a desire to maintain the Hippocratic Oath - First Do No Harm. The thinking being, the doctor would do more harm to the patient with the surgery than the illness/wound was doing to the patient. As an example there are several accounts of leaving projectiles in place; as going after them would put the patient's life in jeapordy.

I have two hypotheses to counter the "bite the bullet". One, the bite marks are those of pigs who were rooting around for truffles. This is not gospel, but supposedly truffles and lead bullets give off a similar scent. (Feel free to correct me on this one; the truffles part sounds a little outlandish.) The physiological structure of pigs and humans are similar, thus pig bite marks might pass for human.

The second came off of one of the obscure medical terms list. Forgot which one. In the excitement of battle the soldier accidentally bites down on the wrong end of a cartridge. Hard for me to accept, since the rounds were typically loaded into a cartridge box bullet down, to make it easier to grasp the paper tail in the teeth (and I guess make the box's center of gravity ride a little easier).

Another peeve. Misidentifying ink erasers as "double-bladed scalpels". Me and another scrivener got into an online war asking an eBay seller to provide documentation his ink erasers were scalpels. he insinuated they were scalpels and were dumped on the surplus market to be fawned off as ink erasers, and if we had documentation they were sold before 185X he'd think on it. I found them listed in several post-war catalogues - ink erasers. We even sent him some collector's newsletters to work him over. SOB never budged. You could smell his wallow of ignorance over the internet connection.

Accidentally misidentifying I can see. Deliberately, and out comes the can of verbal whoop-***.

bill watson
07-04-2007, 08:47 PM
I'm not buying truffles, but I am buying pigs. They don't need truffles. They eat people. Reports of pigs feeding on bodies: Ambrose Bierce used it in one of his short stories, Faulkner as well. Presumably they were building on something they believed to be true, that pigs will forage on human flesh.

TimKindred
07-04-2007, 09:40 PM
Bill,

And why not? We eat pigs. Seems to me that turnabout is fair play. :)

Now, don't get me wrong. I love me some pork barbecue. But i understand where the pig might take exception to that.

I agree with Noah about that ink eraser thing. The other item that is always being pawned off on ebay (and other sites) is the "amputation saw/knife". This is actually a butcher's knife with a saw blade on one end. It was, sadly, mis-identified by the great Francis Lord (who has other mis-identified items in his collection) and to this day, folks quote him as gospel without any further research.

Every medical bone saw has a reenforcing piece along the top, or spine, of the saw. This is often brass, but sometimes iron or steel. It is there to keep the saw from bending while cutting. A butcher is interested in speed of the cut. He's probbaly getting paid by the piece, as it were. A surgeon depends upon the accuracy of his work, and thus needs better tools.

All sorts of carp gets pawned off of ebat as "CW Medical". There is even one fellow who takes modern ( as in WWI/WWII) steel scalpels, tenaculums, etc, and gues wooden slabs over the metal handles, then sands and finishes them to look like CW period items. It's a field ripe for fraud and one has to do some serious research to authenticate items before actually plunking down money.

But I digress. Bill, there are so many things, so many myths, that it's like being an editor of war stories at the local VFW hall. One doesn't know where to start.

Ther saddest part of all, to my mind, is that the information is out there if folks will just spend some time looking for it. Yeah, some of it is labour-intensive. In fact, much is. But there is a HUGE amount of info available just in the official records. With those now available on CD, it's easy as pie to do a search for medical reports. What better place to start than with the reports of the participants?

Ah well....

Respects,

tompritchett
07-04-2007, 10:20 PM
They don't need truffles. They eat people. Reports of pigs feeding on bodies: Ambrose Bierce used it in one of his short stories, Faulkner as well. Presumably they were building on something they believed to be true, that pigs will forage on human flesh.

According to my father, when he was a kid one of his father's farm worker accidentally slipped and fell down in the pig pen with some sows with piglets. The farmhand was killed by the sows and then eaten by all the pigs in the pen. Obviously, there is now no one alive that can verify that story as it happened in the very early part of the 20th Century.

Robert A Mosher
07-05-2007, 09:00 AM
Tom -

I've read similiar accounts of this kind of behavior on the part of pigs in connection with 18th and 19th century battles in Europe.

Robert A. Mosher

NoahBriggs
07-05-2007, 11:04 AM
I think the myths can be grouped into three broad categories:

Physician knowledge

Anesthesia

Instrument mis-identification.

Any others?

Marc
07-05-2007, 11:59 AM
I think the myths can be grouped into three broad categories:

Physician knowledge

Anesthesia

Instrument mis-identification.

Any others?

IMHO those are the three......

jjack
07-05-2007, 12:13 PM
Amputation was done in the case of shattered long bones (as 58 cal shot was prone to do) or uncontrollable bleeding. Vascular repair was not practical in an overwhelming triage condition where many casualties were in need of immediate attention. As you can imagine these kinds of wounds were quite commom.

NoahBriggs
07-05-2007, 02:04 PM
There is also the ability to perform an exsection (removing the shattered area and uniting the two ends of the bone with metal sutures).

26thSC
07-05-2007, 04:33 PM
at the National Museum of Civil War Medicine: http://www.civilwarmed.org. Check us out when you're in the Frederick (MD) area!

Leone Bollinger

SVSUSteve
07-07-2007, 02:06 AM
at the National Museum of Civil War Medicine: http://www.civilwarmed.org. Check us out when you're in the Frederick (MD) area!

Leone Bollinger
I would have to say one of the major misconceptions was that surrounding the use of tourniquets- insofar as that the tourniquets themselves were responsible for loss of limb, rather than improper use in a setting where the access to definitive care was excessively delayed. I have actually written a journal article on the topic, however it is currently under peer review with a medical journal so I can not post it here. Once it is published though, I will gladly post a link to it here (the journal is one with open access to articles).

hanktrent
07-07-2007, 07:38 AM
I would have to say one of the major misconceptions was that surrounding the use of tourniquets- insofar as that the tourniquets themselves were responsible for loss of limb, rather than improper use in a setting where the access to definitive care was excessively delayed.

Are you saying that the design of the tourniquets was poor, which caused the problem, rather than improper use? Do you mean the typical Petit tourniquet, or a makeshift one like "the use of the handkerchief, either smooth or with a knot, and made tight by twisting with a stick, bayonet or ramrod passed between it and the limb" (Moore 1863)?

If the tourniquet caused the loss of limb, I'm guessing the steps then would be: tourniquet applied in emergency due to arterial bleeding; when surgeon sees patient, he decides against primary amputation and ligates the artery, hoping for recovery; gangrene or other complication ensues; secondary amputation is necessary. Is that what you're thinking of or am I totally off base?

I'd be interested in more information on that. I know you can't share the whole article yet, but maybe just a little discussion. Sounds like a good topic.

Hank Trent
hanktrent@voyager.net

celtfiddler
07-07-2007, 11:20 AM
I would have to say one of the major misconceptions was that surrounding the use of tourniquets- insofar as that the tourniquets themselves were responsible for loss of limb, rather than improper use in a setting where the access to definitive care was excessively delayed. I have actually written a journal article on the topic, however it is currently under peer review with a medical journal so I can not post it here. Once it is published though, I will gladly post a link to it here (the journal is one with open access to articles).

I'll be looking forward to reading the article and hopefully seeing a discussion of it here.

SVSUSteve
07-08-2007, 10:54 AM
Actually I was saying that the belief that is was the tourniquets themselves that caused the issues is flawed. The problem was how they were used, by whom and under what circumstances. While the designs could have been better (can't they always? ;) ) the real issue lay in the lack of rapid access to care that was demonstrated in the CW.

hanktrent
07-08-2007, 03:40 PM
Actually I was saying that the belief that is was the tourniquets themselves that caused the issues is flawed. The problem was how they were used, by whom and under what circumstances.

Ah, I see! And thanks for emailing the article.

Do you think that period surgeons actually felt it was acceptable to leave the tourniquet on for extended periods? From what I've read, they understood the danger, but whatcha gonna do, short of training men to periodically loosen tourniquets themselves, and/or apply hand pressure specifically to the artery.

Gross in A System of Surgery 1864 says "...it is to be borne in mind that the compression, even if it is maintained only for a few hours, may become a source not only of excessive pain, but also of mortification. The greatest possible vigilance should therefore be exercised in [the tourniquet's] employment."

But on this whole general topic, a couple of related questions occurred to me that I hadn't thought about before. Who would typically have applied tourniquets to soldiers, and what was used? And also, how far down the medical line, was ligation of arteries practiced?

Obviously, many men either needed to apply a tourniquet themselves or have it done by fellow soldiers almost immediately, or they wouldn't survive. Are these the tourniquets that were left on in the ambulance and while waiting for a surgeon, and were causing the problem?

Or were ambulance drivers and/or soldiers under the direction of the assistant surgeon applying tourniquets? If so, one thing notably lacking from smaller field cases are tourniquets. Was it just assumed that roller bandages or other makeshift tourniquets would be used?

It's an interesting topic. When they put on a tourniquet (or found a man on the field with one already in place) were medical personnel assuming the tourniquet would be removed soon enough, not realizing that further care would be delayed? Or were they thinking that it really wouldn't do any damage if the tourniquet stayed in place for a day or more?

And secondly, who could ligate arteries? Was anybody below a surgeon's rank trained for it? Were even surgeons doing it on the battlefield when possible, or would they prefer to put on a tourniquet and delay the ligation until the patient was transported?

Hank Trent
hanktrent@voyager.net

SVSUSteve
07-08-2007, 04:10 PM
Do you think that period surgeons actually felt it was acceptable to leave the tourniquet on for extended periods? From what I've read, they understood the danger, but whatcha gonna do, short of training men to periodically loosen tourniquets themselves, and/or apply hand pressure specifically to the artery.

Well, actually I think the surgeons understood what was going on and tried to rectify the issue as best as possible. However part of the issue was that many of them placed the blame on the use of tourniquets, instead of correctly placing it on how they are used. It is akin to the current Vioxx fiasco- the drug itself is not as flawed as it is made out to be (in fact it has a better safety profile than aspirin), but the problem is that a little bit of information about its use under inappropriate circumstances (the heart attacks that occured with its use were in those taking massive doses for a study, not those using it as prescribed for pain control) has lead to condemnation.

The periodic loosening of tourniquets is actually not a good idea, because once you've applied it to control hemorrhage and start to periodically loosen it what you are effectively doing is inducing hypovolemic shock by small degrees.


Who would typically have applied tourniquets to soldiers, and what was used?

According to my sources, there were several forms of tourniquets used, and they were applied both by the soldiers themselves and by ambulance personnel to a lesser extent.


Obviously, many men either needed to apply a tourniquet themselves or have it done by fellow soldiers almost immediately, or they wouldn't survive.

Actually it's a common mistake to think that even in combat that wounds with hemorrhage not controllable by direct pressure are common. Very few wounds, even frank amputations, are not controllable with what can be considered basic first aid measures. There is a bit of a pissing for distance contest ongoing between myself and a group of deminers and their docs over whether preemptive use of tourniquets to expedite evacuation is a good idea or not. The main reason for the increased use in US military operations lately is that it frees up the medic to tend to multiple casualties and it often will allow the wounded man to self-extract from a hazardous situation. Granted, this necessarily leads to overuse of the tourniquets but then again with evacuation times of less than 20 minutes in some cases (Iraq), there is exceedlingly little hazard from such action. Even several hours of ischemic time can tolerated according to some authorities.


Or were they thinking that it really wouldn't do any damage if the tourniquet stayed in place for a day or more?
Remember that many of the ambulance personnel, even the assistant surgeons at times, lacked the training equivalent to a modern day EMT in terms of wound managment, so the fear of hemorrhage was often cited as a reason for the manner in which tourniquets were used. Even among well trained EMT students (I have been a clinical and classroom instructor for EMS students for several years), what would be classified by minor hemorrhage evokes a fear reaction that is often times startling.


And secondly, who could ligate arteries?
During the CW, I honestly do not know.

SVSUSteve
07-25-2007, 08:23 AM
By the way, I officially heard back about the tourniquet article this morning. The article should be out by the middle of August and then I will be happy to provide anyone who wants one with a copy.

By the way, this is the second article I've had approved for publication this week ! :D Sorry.....I am just rather excited. :D

TimKindred
07-25-2007, 10:18 AM
Steve, Hank, et al,

I would add that the use of the field, or disposable, tourniquet was more widespread than believed, and that even the detailed men of the Confederate Ambulance Corps or "Infirmary Detachments" were trained in it's application, as well as the use of bandaging material, etc.

That this may be so is derived from a passage in "Todd's American Military Equipage, 1851-1872" 1974, 77, 78, Charles Scribner's Sons, NY, etc.

On pp 470:


"Infirmary Detachments" operating in the field under Confederate medical officers were unarmed, except for NCO;s who were armed to protect the detachment against "stragglers and marauders." There was a litter for every two men, equipped with two leather shoulder straps for easier carrying. Each member of the detachment was given a canteen, a tin cup and a haversack. In the last item were 1/8 pound of lint, four bandages, two long and two short wooden splints, sponges and tourniquets, and a pint bottle of "alcoholic stimulant." This, at least, was the prescribed equipment in the Department of South Carolina, Georgia, and Florida, in early 1863, and probably did not differ greatly from the field medical equipment used elsewhere in the Confederacy.

That each member of the detail is given a haversack with dressing and splint items is telling. That would only be done when training in the use of those items was included, otherwise the risk of mis-application or loss through carelessness, etc, would preclude its issuance.

Interesting. I look forward to reading your article.

Respects,

ncc1701
07-29-2007, 01:34 AM
This thread is facsinating to me. I'm afraid that I may have been giving out misleading (though I'm not sure whether or not I'd go so far as to say false) information for some time. I do not do a medical impression, but I think it a shame that those of us that do not have not done the research necessary in order to give an accurate protrayal of CW period medical techniques. Would you fellows who have some expertise in this area be willing to enlighten those of us without this knowledge? I should hate to give out false information any more than I have to ;).

Cheers,

NoahBriggs
07-29-2007, 05:35 AM
"Would you fellows who have some expertise in this area be willing to enlighten those of us without this knowledge? I should hate to give out false information any more than I have to."

Sure! This is not just "medical only" here. A couple of fellows not specialized in nineteenth century medicine have come in here to ask our opinion on certain details. That said, the next answer is "It depends". We are willing; the question is, what specifically are you needing enlightened? I should also mention the Bill Watson polite response - try doing some research on your own. Here online, somewhere else online, offline. if you still have questions (or a specific question based on your reading) drop in and we will see if we can answer.

flattop32355
07-29-2007, 03:22 PM
What about that horsehair suture story? Did that turn out to be true?

The American Journal of the Medical Sciences (Jan, 1863) pp 227-229 has an article on the advantages of silk, silver wire and horsehair sutures in experiments on dogs. The exact website is too long to put here, but Google search for "horsehair suture", then click on the site for the above named journal.

Boiling the horsehair, while killing the bacteria, may have been for a totally different reason; to soften the hair to make it more pliable to use as suture material, so it wouldn't break as easily.

Seems this one may be true.

NoahBriggs
07-31-2007, 06:51 AM
Originally Posted by bill watson
What about that horsehair suture story? Did that turn out to be true?


Virginia Mescher wrote:

I have done some research on the use of horsehair sutures and below is what I have found. Articles were being published in the US about using horsehair for sutures but how much of the information was reaching war time doctors.

The Civil War Medical Museum in Frederick may have additional information. I know that Tom Lowery did mention that he had additional information that I didn't have and he is a master docent at the museum.

In the Nov. 8, 1862 issue of _The Lancet_ (English), Thomas Smith published an article on the use of horsehair sutures instead of wire. I have not been able to find a copy of that article. Apparently he had done extensive research on using both silver wire and horsehair and found that both materials were non-irritating but horsehair could be removed more easily. He also noted that the wounds healed without infection.

In the Sept. 12, 1863 issue of the _Medical and Surgical Journal_ (American)
Dr. Jasper Cargill wrote of his own experiments with using horsehair instead of wire and was pleased with the results and also noted that there was no infection.

Several years ago I was surfing the Library of Congress subject list and ran across the following paper: "Hair as Suture and Ligature" by John T. Darby. It was a paper published in the _Richmond and Louisville Medical Journal_ in
1870. Unfortunately, this was in the Rare Book collections and I was
only able to take notes. Since I am not medically trained, some of the
terms were not clear, but from what I could tell, the results were
positive.

Dr. Darby recorded his finding on using horsehair as suture material.
The paper is a recount of his research and case studies using horsehair.
He described over 20 cases from 11/68 through 12/69, using both
horsehair and wire sutures and comparing the results of both, plus
including the final result of each case.

Dr. Darby wrote at the beginning of the paper that metallic sutures were
scarce in the South, especially in the field. He mentioned that as
early as the spring of 1861, Thomas Smith of St. Bartholomew used
horsehair as suture material. He wrote that an article appeared in the
Richmond Medical Journal, _Lancet_ on March 1866 called "Horsehair
Suture as Substitute for Wire," page 225. [I have been unable to locate
that article and don't know if this was the same article as previously quoted in the 1862 _Lancet_]. In Oct. 1867, Drs. Nott and Nathan Smith were also
working to on horsehair as suture material.

Dr. Darby was looking for a non-absorbent, material that was flexible,
inexpensive, easily applied and removed, and readily obtainable. He
discussed the disadvantages of using flax, silk and cotton sutures, and
the use of using wire for sutures. Fiber sutures tended to irritate the
wound and absorb the fluids in the wound. By 1852, wire was being used
for sutures, and it proved successful. Wires of gold, lead, silver and
iron, and copper (coated with rubber) were used. Dr. Darby listed the
advantages of the different kinds of wire. He recounted that hair
resisted the distructive influences of heat, cold, moisture, quoting
that hair was well preserved in the exhumation of bodies.

After much experimentation with fibers, grasses, sea-weed, and silk worm
gut, both coated and uncoated, he started using horsehair. He said that
hair from a male horse was better than that of a mare because the urine
passing over the hair made it less clean or strong. He preferred to use
black hair over white because was easier to see, not because it was
stronger.

He used either single strands on the more delicate surgeries such as on
the eye or very delicate tissues or deep wounds. For a heavier suture,
he would use multiple strands twisted together. The ends of the
multiple strands should not be cut off the same length, but at different
lengths so as to create a point to make it easier to thread. The ends
were fastened together by using wax, glue, gum, starch or soap.

He used a regular surgeons' knot which he described in detail. He did
not mention boiling the horsehair to make it more pliable. He said that
the removal was easier than that of fiber sutures. He also wrote that
horsehair were good to use especially in plastic [surgery] cases because
they could be left in longer after the surgery without irritating the
wound site.

The surgeries where he used horsehair ranged from eye surgery,
amputations, cleft palates, hernias, breast removal and vaginal surgery.

His conclusions were that hair was easier to apply than wire and were
much better for the eye, scrotum, and penis. It was non-irritating, left
no scar, was very pliable and elastic, and easily taken out. He also
compared the use of ox-tail and human hair. Ox-tail hair was flexible
and could be used singly, and human hair was thin enough that it had to
be doubled to form the equivelant of one ox-tail or horsehair.

I realize that this is not adequate documentation for the use of
horsehair in the war, but Dr. Darby did mention briefly it's use in
1861, and that there was a problem of finding wire suture material in
the South.
__________________
Virginia Mescher
Visit us at www.raggedsoldier.com
www.vintagevolumes.com

TimKindred
07-31-2007, 09:32 AM
Noah, et al,

There is also an example of rubber suture material at the NPS USS Cairo exhibit in Vicksburg. It was among the many well-preserved items that were recovered from the vessel when she was raised.

The two items that struck me most, as they destroyed previous ideas of period items were the rubber sutures, and the men's shoes. Numerous pairs with brass eyelets, as well as cloth lacings with metal tips were recovered.

Respects,

NoahBriggs
07-31-2007, 10:51 AM
Metal sutures I can see being used to hold broken bones together. Wonder what rubber/gutta percha sutures were used for?

dale beasley
08-01-2007, 03:08 PM
1. Officers only get UTIs.
2. Enlisted never get UTIs.
3. Its just a fever blister.

Dale Beasley
(Sometimes I claim to be a Medical Officer)

celtfiddler
08-02-2007, 04:32 AM
Metal sutures I can see being used to hold broken bones together. Wonder what rubber/gutta percha sutures were used for?

A quick google search this am after reading Tim's post found one possible explanation. Samuel David Gross' book "A System of Surgery" volume 2 mentions on p. 303 using gutta percha sutures to hold pins that had been used to close a wound in place

Scooby_308
08-03-2007, 01:49 PM
According to my father, when he was a kid one of his father's farm worker accidentally slipped and fell down in the pig pen with some sows with piglets. The farmhand was killed by the sows and then eaten by all the pigs in the pen. Obviously, there is now no one alive that can verify that story as it happened in the very early part of the 20th Century.


There’s an old saying in these parts of E Ky when someone is in the sinks for a prolonged time… “Where’s Billy?” “The hogs ate him up.”

It is now used when someone is gone for awhile.

killerreb
08-14-2007, 09:20 PM
going back here a bit, i possible theory on "biting the bullet" could be that during the rev. war british (& american) soldiers were known to put bullets or pebbles in their mouths to help produce saliva when dry. dont know how true, just something i heard some time ago, tried it at an event & it did work, made more sense to me than biting on one for pain......

steve hutton

TimKindred
08-15-2007, 06:37 AM
Steve,

In thpse earlier times. it would've been more common to give the patient a piece of leather to bite on, rather than a bullet. A piece of strapping, harness, etc.

FWIW, I know a couple of VA patients with whom I ride to the local VA hospital who were instructed to use a small piece of leather to chew on for chronic pain. They hadn't wanted to use the more powerful pain killers available, so their doctor suggested having a section of belt leather handy to bite down on when they feel the need. They tell me it does help.

The more I read, the more firmly convinced I am that the vast majority of "pain bullets" are either hoaxes or created by hogs.

Respects,

M_Callahan
09-03-2007, 07:59 PM
The periodic loosening of tourniquets is actually not a good idea, because once you've applied it to control hemorrhage and start to periodically loosen it what you are effectively doing is inducing hypovolemic shock by small degrees.

Remember that many of the ambulance personnel, even the assistant surgeons at times, lacked the training equivalent to a modern day EMT in terms of wound managment, so the fear of hemorrhage was often cited as a reason for the manner in which tourniquets were used. Even among well trained EMT students (I have been a clinical and classroom instructor for EMS students for several years), what would be classified by minor hemorrhage evokes a fear reaction that is often times startling.

During the CW, I honestly do not know.

Back in the early 70s, the Boy Scout first Aid manuals suggested that the
tourniquet should be loosened periodicaly to allow blood flow into the injured
limb, especially if you were going to be a long time getting to a Doctor.

Later, in EMT training in the 90s, we were told that once applied, a tourniquet
was not to be removed except by the Doctor, in the ER.

In that same EMT training we were taught that the tourniquet was the very
last thing you used to control bleeding. Direct pressure, elevation and
pressure points being the prefered methods of bleeding control. I can recall
very well my first victim/patient with a "minor hemorrhage". Had no idea that
blood could shoot so high. It was graphic to say the least, and I could see
where even a well trained EMT/Medic could get rattled, I know I was.

Interesting disscussion.

Mike Callahan

TimKindred
09-03-2007, 08:07 PM
Comrade,

Having undergone angioplasty, I can assure you that arterial pressure is amazing. It took some 20 minutes of constant pressure to ensure that sufficient clotting had taken place in my artery to allow for the nursing staff to relax their vigil somewhat. Apparently, even low-normal pressure, as mine is, is nothing to sneeze at.

I'd be the first to apply a tourniquet in any such situation. It's interesting to note that the military issues a one-handed tourniquet in their IFAK pouches for every soldier, along with sufficient training in it's use. Of course, they also include a pack of quick-clot as well.

Respects,

Jas. Cox
12-11-2007, 04:12 AM
Modified from Hank's post above -

Surgeons and doctors were uneducated/apethetic. They had no idea of anatomy and knew nothing about the body.

Educational abilities varied based on practice and education and attitudes. The book Tarnished Scalpels lists some of the questions posed to surgeons who were applying to be regimental surgeons. Not only are the questions complex, but the applicant had to defend their response. One also had to answer general cultural literacy questions such as reasons for the American Revolution.

The list of references I posted earlier makes a lie of the italicized statement above. There were texts on specific specialities, all laid out in excrutiating detail, complete with diagrams.

Actually broad generalizations probably shouldn't be made for either side. In the book I'm reading now (again) for my myths talk, Bleeding Blue and Gray, there is some validity to some physicians being under educated and incompetent. Paraphrasing somewhat [President Lincoln directed the state's governor to appoint a surgeon and assistant surgeon to each of the new volunteer regiments "after having passed an examination by a competent Medical Board ... the appointments to be subject to the approval of the Secretary of War." Despite this, it often came down to asking the local town doctor to accompany the troops. Often this doctor would be wholly unprepared for troop and battle illnesses and injuries.] And there are listed cases of "physicians" being no more than barbers (bleeders).

Although as the war progressed, and the Federals realized it wouldn't be over in the optimistic 90 days, the overall medical treatment improved immensely through efforts of people like Letterman and The Sanitary Commission. Blah, blah, blah.

Overall, it is a myth, but in cases it is not. The exception that proves the rule perhaps?

hanktrent
12-11-2007, 05:43 AM
Actually broad generalizations probably shouldn't be made for either side. In the book I'm reading now (again) for my myths talk, Bleeding Blue and Gray, there is some validity to some physicians being under educated and incompetent.

I think a distinction can be made, though, between doctors who were uneducated according to the standards of their day, and a belief (myth) that doctors were stupid because they didn't know what we know today.

The latter seems silly when held up for discussion, because it's obvious that we shouldn't expect each person in the 1860s to have discovered on his own what we ourself needed to learn from others.

But somehow, it seems natural to think a doctor who doesn't wash his hands between patients is incompetent, or a doctor who doesn't know that mosquitoes spread malaria is ignorant. But it's harder to wrap your mind around the fact that a doctor who administers mercury in large doses for most ailments is considered "ignorant," while a doctor who only administers mercury in large doses for certain conditions, is considered "well educated."

And thus a myth is born, when people read period accounts of incompetent doctors and mix it up with doctors lacking modern knowledge, and assume that's primarily what made doctors ignorant.

Hank Trent
hanktrent@voyager.net

Jas. Cox
12-11-2007, 09:19 AM
I think a distinction can be made, though, between doctors who were uneducated according to the standards of their day, and a belief (myth) that doctors were stupid because they didn't know what we know today.
Hank Trent
hanktrent@voyager.net

Good point and I wanted to see a little action in the "medical .... section" of this forum. It's been too quiet. :)

mmartin4600
12-11-2007, 03:08 PM
I'm not buying truffles, but I am buying pigs. They don't need truffles. They eat people. Reports of pigs feeding on bodies: Ambrose Bierce used it in one of his short stories, Faulkner as well. Presumably they were building on something they believed to be true, that pigs will forage on human flesh.

What Bill said. Pigs will eat human flesh. Those "Pain Bullets" were probably chewed out of a corpse.