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Jas. Cox
12-19-2007, 07:08 AM
Last night my wife and I watched the movie "The Shooter." The main character is former military and gets wounded. One of the things he does seems to be to pour processed sugar in his wounds to fight infections. In the commentary after the movie, the script writer was saying these things were well researched and that sugar was used as far back as the Napoleonic wars to fight infections, although I'm sure at the time they had no idea why it worked. I just tried a Google search and really didn't find anything in the 10 billion hits other than refined sugar is poison (as I sit here drinking a Mello Yello).

So, has anyone else heard of this as a treatment? Was it used in the US Civil War? Is it something we can add to our impressions, knowledge base, ...?

I did a thread search and nothing popped out at me.

And this is the only reference I found on Google that somehow related:

Refined sugar first appeared as a "military drug" in Napoleon's army, as a lightweight energy source, during The War of 1812.... which he lost!!!!

SmellyFed
12-19-2007, 07:35 AM
Sugar draws moisture in, therefore drawing it out of bacteria in surrounding tissue. This leads to bacterial-dehydration, which effectively neutralizes or kills the bacteria. It's an effective way to stop infection and promote wound healing.

It's not a new concept and I believe its still used in operating rooms today.

RJSamp
12-19-2007, 08:55 AM
Sugar draws moisture in, therefore drawing it out of bacteria in surrounding tissue. This leads to bacterial-dehydration, which effectively neutralizes or kills the bacteria. It's an effective way to stop infection and promote wound healing.

It's not a new concept and I believe its still used in operating rooms today.

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

June 17, 2004

Honey as Medicine
Sweet relief

When I get a sore throat, I always find a cup of tea with some honey very soothing. But thanks to my proper Western scientific conditioning, I always assumed that the restorative power of honey was mostly in my head. Sure, it tastes good and has a pleasant texture that coats my irritated throat, but it’s practically pure sugar, after all. What good could it possibly do me other than diminishing my perception of discomfort for a few minutes? So I’ve been content in my belief that honey is little more than a tasty placebo. Now, ironically enough, my convictions are being challenged, as researchers are turning up new evidence of honey’s medical benefits left and right.

Historically, honey has been used as a folk remedy in cultures around the world for millennia. It has been prescribed informally as a cure for smallpox, baldness, eye diseases, and indigestion. It’s even been used as a contraceptive. As with most natural “cures” unsupported by scientific studies, I sort of chuckle and sigh when I read about things like this—honey may be a silly substitute for real medicine, but at least it’s not bloodletting. However, in this case, the bees may have the last laugh. It turns out that honey’s properties make it a surprisingly effective cure-all. Or, let’s say, cure-much.

Bee Fruitful and Multiply
Honey’s salutary effects stem primarily from its antimicrobial properties. Most bacteria and other microorganisms cannot grow or reproduce in honey. I found this quite surprising, because all things being equal, bacteria love sugar. Honey contains around 40% fructose and 30% glucose—among other sugars—making it seemingly a great treat for microbes. However, honey is also somewhat acidic, and acids prevent the growth of some bacteria. More importantly, honey does not provide the water and oxygen needed to support bacterial growth. Although honey contains a fair amount of water, it’s supersaturated with sugar—meaning the water is not available to the microorganisms.

So what happens when you dilute honey with water—the bacteria just multiply like crazy, right? Well…yes and no. Amazingly enough, diluted honey supports the growth of bacteria that are helpful to humans while killing off dangerous strains. Some microorganisms do indeed flourish in a dilute solution of honey—such as the yeast used to ferment it into mead. Also, certain types of beneficial bacteria that live in the human intestines and aid digestion do well in a mixture of honey and water. But honey also contains a substance called glucose oxidase. When combined with water and oxygen, glucose oxidase forms gluconic acid and hydrogen peroxide—the very same stuff you probably have in your medicine cabinet right now. This means that diluted honey can serve as an excellent antiseptic, while being far less likely than ordinary hydrogen peroxide to harm already-damaged tissue.

Show Me the Honey
What does all this mean in practical terms? For one thing, it means that honey applied topically to a wound can promote healing just as well as, or in many cases better than, conventional ointments and dressings. Its antibacterial properties prevent infection. It also functions as an anti-inflammatory agent, reducing both swelling and pain. As if that weren’t enough, it even reduces scarring. In studies around the world, honey has been shown to be extraordinarily effective in the treatment of wounds, burns, and surgical incisions. Honey also functions as a moisturizer, making it a useful treatment for sunburn as well as a general-purpose skin softener.

Jas. Cox
12-19-2007, 11:07 AM
Reminds me of the old T-shirts, bumper stickers Bee Healthy Eat Your Honey.

And now honey bees are fighting for survival. This past summer and spring was the first time I had seen a number of honey bees in years. As a kid, I would accidently be stepping on them barefoot all the time (or nails).

hanktrent
12-19-2007, 11:57 AM
So... Any primary sources on this?

Among the uses of sugar in the 1851 US Dispensatory, none are for what we'd call infections (what they'd most likely call inflammation or some other description of symptoms). Most of the uses aren't even topical; they're internal. Syrup or honey for sore throats and coughs, yes, but that's different from battlefield wounds.

Can't recall any Civil War surgeons recording the use of sugar for an inflamed wound either, or period non-allopaths recommending it.

If it really was a known period remedy, there's got to be more documentation than a script writer said so. :D

Now if we're talking about sugar of lead as a period topical remedy for open sores and inflammation, that's another matter.

Hank Trent
hanktrent@voyager.net

SmellyFed
12-19-2007, 01:10 PM
Hank - while I'm familiar with the concept of using sugar to pack wounds, I have never seen it in a Civil War context. That doesn't mean it isn't there though.

Another substance often used to pack wounds - sterilized, crushed volcanic rock. But thats another discussion.

Jas. Cox
12-19-2007, 03:59 PM
So... Any primary sources on this?

Among the uses of sugar in the 1851 US Dispensatory, none are for what we'd call infections (what they'd most likely call inflammation or some other description of symptoms). Most of the uses aren't even topical; they're internal. Syrup or honey for sore throats and coughs, yes, but that's different from battlefield wounds.

Can't recall any Civil War surgeons recording the use of sugar for an inflamed wound either, or period non-allopaths recommending it.

If it really was a known period remedy, there's got to be more documentation than a script writer said so. :D

Now if we're talking about sugar of lead as a period topical remedy for open sores and inflammation, that's another matter.

Hank Trent
hanktrent@voyager.net

That's exactly what I'm asking. I have never seen nor heard of this before and didn't find anything with a cursory search of the Internet. I was just saying that this Script Writer was the first I heard of it. Not exactly a reliable source. Not that the Internet is necessarily either. I was wondering if anyone else in the group may have a solid reference source. One would think that such a thing would have been mentioned before and frequently. Perhaps it is a medical myth.

NoahBriggs
12-19-2007, 10:43 PM
I have read in some secondary sources that the Egyptians had a real honey fetish for treatment of external wounds and for internal illnesses. Understandably it's hard to verify it with primary sources, as I don't read heiroglyphs, so I cannot tell you exactly which physician's scroll mentions it.

It's a treatment that is unusual and unconventional enough that if it were observed being performed someone would take the time to write it down. yet another piece of esoteric trivia to post on the mental BOLO board when next grabbing your surfboard to head to the Internet Ocean.

Edited to include:
More than once I have been tempted to chase down a director, script-writer or researcher and demand they produce the sources they use to justify some of the stuff. I wish there were ways to hold Hollywood accountable for some of the historic claims they make. God forbid it might lead to a language policing on Deadwood, which otherwise is a great show.

SmellyFed
12-20-2007, 01:24 AM
I was wondering if anyone else in the group may have a solid reference source. One would think that such a thing would have been mentioned before and frequently. Perhaps it is a medical myth.

It's definately NOT a medical myth. You just don't know what terms to search for:

Sugar helps heal wounds. Sugar has been used for centuries to successfully aid in the healing of wounds. Sugar dries the wound thus preventing the growth of bacteria.
http://www.sugar.org/consumers/15_calories.asp?id=47

Application of honey (or concentrated sugar preparations) to wounds might help appears to prevent infection and possibly speed healing.15-27 Honey is thought to work primarily through its high sugar content, which directly kills microorganisms.
http://healthlibrary.epnet.com/GetContent.aspx?token=e0498803-7f62-4563-8d47-5fe33da65dd4&chunkiid=21615

Sugar paste should be considered for the management of all
infected and malodorous wounds. It is a far less expensive
alternative to Debrisan and similar products which are of
dubious efficacy and are often difficult to remove from
wounds. In our experience, sugar paste is also superior to
charcoal dressings for treating malodorous wounds as it re-
moves the cause of the smell and in this respect is similar
to metronidazole gel.
http://www.smtl.co.uk/WMPRC/DressingsTimes/vol3.2.txt

Jas. Cox
12-20-2007, 01:49 AM
It's definately NOT a medical myth. You just don't know what terms to search for:


http://www.sugar.org/consumers/15_calories.asp?id=47


http://healthlibrary.epnet.com/GetContent.aspx?token=e0498803-7f62-4563-8d47-5fe33da65dd4&chunkiid=21615


http://www.smtl.co.uk/WMPRC/DressingsTimes/vol3.2.txt

What terms did you use in this search?

The last source sited carries more weight about the use of sugar than the first one which is a website belonging to sugar promoters: LEGAL © 2007 The Sugar Association, Inc.: All rights reserved Even at that, the last source just proclaims It also provides some topical observations on occlusive dressings that were written fifty years ago! While interesting and does lend some credence to the possibility of sugar being useful for wound management, it doesn't exactly connect it to the US Civil War.

We have a good start and I think an interesting dialog going on here. What else can you find to support this? Can anyone else find any references?

Marc
12-20-2007, 01:49 AM
Quite interesting...perhaps our friends at the Civil War Medical Museum in Fredericksburg, MD could help with any documented use during the CW.

SmellyFed
12-20-2007, 02:00 AM
It's usually referred to as "wound sugar", you might also get somewhere with "honey salve" - I'm in a medical field and this isn't a new concept.

hanktrent
12-20-2007, 02:25 AM
It's definately NOT a medical myth. You just don't know what terms to search for:

Not to put words in anyone's mouth, but I'm thinking the myth aspect is that "during the early and mid 19th century, doctors put sugar in wounds" rather than "sugar is useful for treatment of wounds."

There are lots of things that are/were known and effective, that nonetheless weren't in fashion among allopaths in the 1860s. While it's hard to prove a negative, there are lots of easy-to-access accounts of 19th century medicine and surgery, so if putting sugar in wounds was done, a mention of it should be findable, especially if another researcher is claiming he's already documented it.

I'm heading out of town overnight, so just have time for a quick scan, but I looked over the 1863 Manual of Military Surgery published by the CS government, and in 20 or 30 pages discussing local treatment of gunshot wounds and complications of healing in great detail, saw no mention of sugar among the dozens of possible treatments and preventive measures.

However, I did see sugar of lead (acetate of lead) mentioned a few times. It's a confusing name for something that really was very common, not exactly for "treating infection," but pretty close. I'm really wondering if somebody got some wires crossed and mixed up the usefulness of sugar with a period account of sugar of lead.

Hank Trent
hanktrent@voyager.net

SmellyFed
12-20-2007, 02:44 AM
Not to put words in anyone's mouth, but I'm thinking the myth aspect is that "during the early and mid 19th century, doctors put sugar in wounds" rather than "sugar is useful for treatment of wounds."
Where does that quote come from Hank? I don't think I've ever seen it stated that, "during the early and mid 19th century, doctors put sugar in wounds".

SmellyFed
12-20-2007, 02:52 AM
Here's a pretty vague statement refering to usage in the CW"

"Sugar was used to heal wounds during the Civil War as it helps to prevent infections while promoting healing."
http://www.alexandriaprofessional.com/node/31

And here's one, some guy's Civil War blog and of course, he fails to cite his sources.

12. Infectious wounds: Apply sugar to the wound. Another procedure is to wash the wound with wine, then apply sugar.
http://fspowerscw.blogspot.com/2006/09/civil-war-remedies.html

SmellyFed
12-20-2007, 03:02 AM
An interesting NY Times article about using wound sugar:

Healing Treatment, 4,000 Years Old, Is Revived

To help heal seriously infected wounds, some surgeons have revived a 4,000-year-old treatment, born on the battlefields of ancient Egypt: they pack the depths of treacherous wounds with sweet substances like sugar.

To help heal seriously infected wounds, some surgeons have revived a 4,000-year-old treatment, born on the battlefields of ancient Egypt: they pack the depths of treacherous wounds with sweet substances like sugar.

http://query.nytimes.com/gst/fullpage.html?res=9C0CE4D8123AF936A35757C0A9669582 60&sec=&spon=&pagewanted=all

hanktrent
12-20-2007, 03:03 AM
Where does that quote come from Hank? I don't think I've ever seen it stated that, "during the early and mid 19th century, doctors put sugar in wounds".

It comes from me. :D It was my attempt to summarize briefly the original post in this thread:



One of the things he does seems to be to pour processed sugar in his wounds to fight infections. In the commentary after the movie, the script writer was saying these things were well researched and that sugar was used as far back as the Napoleonic wars to fight infections,


Though it now occurs to me that by dissecting that paragraph word by word, the script writer can be proven correct, at least for the latter part of his statement. Since we can show that syrup or honey was commonly used in the 19th century to treat a sore throat, the script writer is correct in saying it was used to fight at least one kind of infection (to use modern terminology).

However, I think that any reasonable person would believe that by saying these things are well researched, he's implying that sugar was used to fight infections in the way it was portrayed in the movie, by pouring it into wounds. Otherwise, it's a pointless non sequitur.

Hank Trent
hanktrent@voyager.net

chatrbug
12-20-2007, 03:21 AM
wouldnt sugar also help stop the bleeding?

i use honey (not the store bought stuff) on small burns (nothing bad) but on those small grease splatter burns and such from cooking. (please note.. if its a bad burn thats going to need medical attention, i dont put anything on it!!). im one that generally blisters from the teenist burn, but the honey makes it so i dont.

hanktrent
12-21-2007, 08:16 AM
For more on sugar on wounds, check out the last part of post #7 in this thread: http://www.cwreenactors.com/forum/showthread.php?p=53837

Hank Trent
hanktrent@voyager.net

Jas. Cox
12-21-2007, 01:53 PM
For more on sugar on wounds, check out the last part of post #7 in this thread: http://www.cwreenactors.com/forum/showthread.php?p=53837

Hank Trent
hanktrent@voyager.net

Read it first. Excellent. Now we are getting somewhere.

2RIV
01-12-2008, 12:06 AM
Sugar was commonly used up until the 1970s or 1980s to help in the healing of wounds. This practice has since been discontinued, with some possible exceptions, as posted in the Ny Times article. Sugar as of most research was found to actually increase the area of infection by adding fuel to the bacteria. While Paul is right, sugar does dry out intracellular fluid, the human body is in a constant state of moisture, and it does not take long for the sugar packing of a wound to become saturated. Now, wet sugar, including honey, is a great medium for bacterial growth. To simplify things, sugar is the fundamental fuel of all cells. Another thing not mentioned is that certain bacteria goes into a sort of "hibernation" when the enviroment it is in is not right for promoting growth. It will lie dormant for months, in some case even years (anthrax is one of these bacteria) until conditions are optimal for growth. In the OR we use no organic based compounds to promote healing, with the exception of some antibiotics. Organic material (including sugar) is a great place for bacteria to hide, and is a no no in the OR. In fact, after every surgical case, the instruments are sprayed with an enzymatic solution which destroys organic material, and then the instruments are washed by hand, and then place into a sterilizer. This is done because any organic material left on an instrument will hide bacteria and keep it from being killed during sterilization. The latest trends in wound care now use various antibiotics, metal base creams and bandages (including silver, gold, and platinum), as well as mechanical wound debredment, and the latest old time remedy brought back from history, using maggots for wound debredment as maggots only eat dead tissue and promote the growth of healthy tissue. I hope this was helpful, yet long winded.

Aaron J. Siegel, RN, EMT-B

amity
01-12-2008, 01:53 AM
I understand that there is some compound in raw honey that acts as a topical antibiotic. It is not the sugar that does it. Increased levels of blood sugar are associated with increased systemic and localized infections. Elevated blood sugars also can suppress the immune system.

Years ago I was going through multiple rounds of fungal infections, thrush, etc. A doctor suggested I change my diet, even though my blood sugar did not test as high. I cut out all the rice, potatoes, pasta, bread, sodas, etc., and the fungal infections all went away immediately.

MtVernon
01-12-2008, 02:03 AM
(as I sit here drinking a Mello Yello).[/I]

I wouldn't worry about there being any sugar in that - it's sugar's evil cousin, high fructose corn syrup. Talk about poision!

Jas. Cox
01-12-2008, 02:52 AM
The question still is, was it used during the 19th Century to treat wounds to stop infections? As no one seems to be able to find any primary evidence that it was widely used as a treatment by medical professionals*, I'm going to say Busted.

*Not meant as a debate over who was a professional and who wasn't. My interest is strictly on a Civil War Surgeon level.

hanktrent
01-12-2008, 03:11 AM
Sugar was commonly used up until the 1970s or 1980s to help in the healing of wounds.

Do you have evidence that it was commonly used in the early to mid 1800s by military doctors? Most treatments waxed and waned over the years in various cultures, rather than remaining steady from ancient Egypt until the late 20th century and suddenly waning. I think we need to guard against the usual temptation to think that everything old-timey must have been used in the 1860s, because those people were old-timey too, when in fact their world changed just like ours.

Actually, I was hoping this thread would get bumped again because I ran into the following a couple days ago, in History of Cultivated Vegetables by Henry Phillips, 1822. In a long chapter about the history of sugar, there are quotes from Dr. Rush and other foreign doctors talking about its use internally as medicine and for nutrition. Besides the long discussion of its internal use, there are a few mentions of its use on wounds:


Angelus Sala says, that "sugar, used in a proper manner, nourishes the body, generates good blood... [etc. etc., long paragraph on internal use]... it cleanses wounds and punctures in the body; also films in the eyes. It removes pains in ulcers and tumours, by concocting the flux of humours; or, if they have no tendency to suppuration, by dispersing them."

Baptista Porta, another early writer, says, "Sugar, extracted from canes, is not only incorruptible in itself, but preserves all other things from corruption; sprinkled upon wounds, it keeps them from mortifying. I have seen very large wounds cured only with sugar. Therefore sugar should be constantly used by those who wish to prolong life; because it will not suffer the humours, nor the food in the body to putrefy."

Pomet says... [another paragraph about internal use]... it cleans old sores, being strewed gently on them."

That shows that the historic use of sugar for wounds was mentioned in the early 19th century, just like today. Angelus Sala was from the early 1600s, Baptista Porta died in the early 1500s and Pomet's History of Drugges was published in 1694.

But it still doesn't indicate it was actually used on wounds in the 1800s by military doctors.

Their work is particularly well documented, because they were generally literate, and often published and discussed their techniques, so I don't think this is a case where one can say the practice must have been so common that no one wrote about it.

Hank Trent
hanktrent@voyager.net

amity
01-12-2008, 04:20 AM
Hank, way back in December of last year, you said:


"http://www.conservativeunderground.c...ad.php?t=98730

There, the poster cites his source as "The Military Handbook and Soldiers Manual of Information 1862 "

1862 may be a typo, or a second edition, but the 1861 edition is in reprint. The remedies all appear to come from page 93-95, but are heavily reworded.

The original introductory paragraph is:

Quote:
Excellent Recipes for Various Cases. We here subjoin some excellent and very available recipes for various troubles which flesh is heir to in camp and campaign life. The soldier should preserve them and seek to aid his fellows when possible by their use upon others as well as upon himself:
...
The one about sugar reads:

Quote:
To Prevent Wounds from Mortifying.--Sprinkle sugar on them. The Turks wash fresh wounds with wine, and sprinkle sugar on them. Obstinate ulcers may be cured with sugar dissolved in a strong decoction of walnut leaves.

Now that makes sense, and explains why putting sugar on wounds doesn't show up commonly in period medical references. The author is saying that the Turks use sugar and wine on wounds, and is recommending that his readers use the sugar. No indication if it's common in America.

But I doubt he saw Turks doing this himself, so where did he get the idea?

It goes at least back to The New Family Receipt-Book, 1819, where there's the same paragraph on page 400, word for word. The same paragraph also shows up, word for word, in a handful of similar home remedy receipt books.

So this explains the two contradictory things: that one can say wounds were treated in the 19th century with sugar, and that one can also say it's extremely difficult to find in primary sources, compared to many other common period treatments.

At this point, barring further research, it would be like picking one obscure recommendation for home treatment today, and implying that you'd see the average doctor applying it to a wounded soldier in Iraq.

Of course, it's possible that it was common in France, in Napoleon's day, as shown in the movie mentioned in the other thread. But we're a long way yet from showing it was common or even known, on Civil War battlefields or hospitals in America."
Now you are concluding that this somehow means that use of sugar to treat wounds was rare in military medicine during the CW. To me, it it implies just the opposite, that use of sugar might well have been a standard treatment. Are you basing your conclusions on the rarity of this book on CW battlefields? If so, how do we know it was rare? Maybe it is the use of the words "manual" and "handbook" in the title that are throwing me, but to me it means "standard reference work to govern procedures."

BTW, I don't see the reference to Turks as an historical reference, but to the Crimean War, which was only a few years before. Was this practice perhaps observed and reported on by Florence Nightingale or Mary Seacole, who might have used it themselves, passed it on to Clara Barton, etc? At any rate, it seems like one more piece of evidence that use of sugar to treat battle wounds was in common knowledge internationally during the mid-19th cent. The supply pressures of war, Crimean or U.S., often lead to reliance on older more easily available remedies that have fallen from favor for civilian medical use.

hanktrent
01-12-2008, 06:54 AM
Now you are concluding that this somehow means that use of sugar to treat wounds was rare in military medicine during the CW. To me, it it implies just the opposite, that use of sugar might well have been a standard treatment. Are you basing your conclusions on the rarity of this book on CW battlefields? If so, how do we know it was rare? Maybe it is the use of the words "manual" and "handbook" in the title that are throwing me, but to me it means "standard reference work to govern procedures."

We have zillions of descriptions of how to treat wounds and how wounds were treated by doctors during the Civil War, and if this is the only primary source we can find so far that mentions the use of sugar, yes, I fully believe it's an indication the practice was rare, not common.

Let me ask you this: If that's not proof something was rare, what is? If it was so common, why speculate, rather than just presenting primary sources describing its use in CW military medicine?


BTW, I don't see the reference to Turks as an historical reference, but to the Crimean War, which was only a few years before.

As I showed in the post linked above, it was not based on anything from the Crimean war. It was copied word-for-word from another publication at least as far back as 1819, a generation before the Crimean war.

If we're to speculate, I think it would be helpful to include the facts that are already in evidence.

Or are you saying that the identical wording is purely coincidence? If people were actually trying this and recommending it from their own experience, I believe they'd write it in their own words, or expand on it, not just copy it.


At any rate, it seems like one more piece of evidence that use of sugar to treat battle wounds was in common knowledge internationally during the mid-19th cent. The supply pressures of war, Crimean or U.S., often lead to reliance on older more easily available remedies that have fallen from favor for civilian medical use.

I wonder if reenactors really realize how much data from the 19th century exists, when they make the argument that one or two sources are enough to show that something was common?

Let's take an example of something that I'd argue was common: the use of dogwood bark as a substitute for quinine. I could come up with fifty non-identical examples from primary sources in twenty minutes, and probably several hundred within a few days. That's what I mean by common.

People in the Confederacy wrote extensively about the use of substitute and non-imported medicines. Doctors both north and south, before and after the war, published magazines detailing treatments they used. The medical and surgical history of the war is another huge volume listing case after case.

If something was common, especially among a literate, publishing, reporting group of people like doctors, there would either be evidence for it, or we need a logical reason why there isn't. I can see no reason why doctors would keep sugar secret.

Hank Trent
hanktrent@voyager.net

amity
01-12-2008, 07:17 AM
Hank, "The Military Handbook and Soldiers Manual of Information" sounds like a book written for use by soldiers, not doctors. This is what the soldiers themselves might have been advised to do then, not the doctors? When they are in a hospital with a doctor, no more sugar?

Everyone who has seen M.A.S.H. has seen reference to field make-do in a war zone! It is and was a reality. Emergency medicine still makes novel use of ordinary materials today. It has been years since I climbed into the back of an ambulance, but I can remember a few lifesaving procedures involving Bic pens, condoms, windshield wipers, and umbrellas. Never had to actually USE them (and hope I never do), but then I wasn't in a war zone, either!

My interests change from week to week (or at least month to month) and for now I have started to look into medical practices a bit. (Being a generalist is fun!) I have a modern day background in medicine that indicates to me what to look for, and you have the specific knowledge of period medicine. We can both benefit by putting our heads together. Talking about ideas CAN be a synergistic thing where the whole can be greater than the sum of its parts, rather than a competitive research game where we pull primary sources on each other. That can come later and will have to in my case!

hanktrent
01-12-2008, 08:47 AM
I'd be really curious to have an answer to this question from my previous post:

"Let me ask you this: If that's not proof something was rare, what is?"


Talking about ideas CAN be a synergistic thing where the whole can be greater than the sum of its parts, rather than a competitive research game where we pull primary sources on each other. That can come later and will have to in my case!

You seemed okay with sticking close to primary sources over in this thread:

http://www.cwreenactors.com/forum/showpost.php?p=56233&postcount=15
I don't think we should draw on secondary and tertiary sources for scenarios. Wouldn't that be the same thing as reenacting historiography, rather than history?

Talking about ideas is great, but I think actually basing speculation on the best available evidence is even better. I don't see it as a game. I see it as presenting data to support one's conclusions.

If we're talking about competitive research games, what if someone said: I believe it was common for women in the Civil War to wear skirts that ended above their knees. Short skirts go back to ancient Egypt and are still common today. Cloth was expensive in the 1860s, and it needed to be used for uniforms. Hand sewing took time and sewing machines were still not owned by everyone. Here's a photo of someone in a short skirt in the 1860s (a ballet dancer). Just because I can't find many primary sources talking about short skirts doesn't mean they weren't common.

I'd think the most logical counter-argument would be to say that there are hundreds of photos and descriptions of women in ordinary circumstances wearing long skirts so the lack of evidence for short skirts is significant, and to show the few reasons women did wear short skirts to explain the few images of young girls, ballerinas, bloomers, bathing suits, etc.

And yes, after that, it might be a little frustrating to hear that those hundreds of photos and descriptions of women not wearing short skirts were pointless, because the discussion should rely on logic and speculation, not data, otherwise it would be "a competitive research game where we pull primary sources on each other."

If that kind of data isn't considered meaningful, further speculation without data seems pointless to me. And I think that may be where we are on this debate.

Hank Trent
hanktrent@voyager.net

amity
01-12-2008, 08:58 AM
Hank, I am in no way remotely contemplating portraying a doctor, do not worry. I am in no way working on any impression AT ALL. No imaginary scenarios will come out of this discussion (unless you want to do the leg work on that). I promise.

I am just interested. I am just starting reading about mid-19th century medicine as a result of that. I have read a bit about earlier 19th and 18th cent medicine, and also happened by chance on some other sources that got me interested.

Now do you have any ideas on the issues I have raised? Any thoughts?

amity
01-12-2008, 09:51 AM
If we're talking about competitive research games, what if someone said: I believe it was common for women in the Civil War to wear skirts that ended above their knees. Short skirts go back to ancient Egypt and are still common today. Cloth was expensive in the 1860s, and it needed to be used for uniforms. Hand sewing took time and sewing machines were still not owned by everyone. Here's a photo of someone in a short skirt in the 1860s (a ballet dancer). Just because I can't find many primary sources talking about short skirts doesn't mean they weren't common.

I'd think the most logical counter-argument would be to say that there are hundreds of photos and descriptions of women in ordinary circumstances wearing long skirts so the lack of evidence for short skirts is significant, and to show the few reasons women did wear short skirts to explain the few images of young girls, ballerinas, bloomers, bathing suits, etc.

And yes, after that, it might be a little frustrating to hear that those hundreds of photos and descriptions of women not wearing short skirts were pointless, because the discussion should rely on logic and speculation, not data, otherwise it would be "a competitive research game where we pull primary sources on each other."

If that kind of data isn't considered meaningful, further speculation without data seems pointless to me. And I think that may be where we are on this debate.

I would say: You won't find it in Godey's, or in tintypes, or in CDVs. That is not where it is to be found. Instead check representations of the theater, dance, etc. Also look for woodcuts, etc. showing working women. Short skirts WERE fairly common. (Of course, how short is short?) It comes with thinking about what you are looking at and for.

... and that is all I am saying here.

Linda Trent
01-12-2008, 11:40 AM
Hi Terre,

I'd love to know what your answer is to Hank's question, basically what would you consider to be enough proof that something's rare, or at least not a common, everyday, typical practice?

To me, it doesn't matter whether you're planning on portraying a person with medical knowledge, or give a presentation to the public at events, or just learn for your own enjoyment. To me, what's important is finding the facts and that cannot come by looking at one, two or three sources.

We did an extensive amount of medical research in the 1990s while we were building the Bradford Place. We've literally studied hundreds of primary source books ranging from civilian , through military books, and USSC pamphlets in our own private collection, our local library's rare book room, the library at Conner Prairie and other museums, the state archives, and the national archives, as well as what's on the internet. As well as secondary sources that were heavily footnoted to the original sources.

After Hank's last post we were discussing the sugar incident and Hank pulled out the Military Handbook that we've been discussing. It's interesting that the paragraph immediately preceeding the one on sugar for wounds is
"To stop the bleeding of a wound.--Lay on the orifice, lint; if that is not sufficient, put on flour and then lint."
Hank instantly recognized that as something typical and went to his computer and within 30 minutes came up with multiple references to flour and lint.

On the back of a soldier's letter (perhaps printed?) at http://www.48ovvi.org/oh48jer1.html (http://www.48ovvi.org/oh48jer1.html) "To stop the bleeding of a wound apply the inside of puff ball to the wound or use lint and flour." The same was also printed Handbook of Practical Receipts, 1860.

From 1843 Medical Times, London, and reprinted elsewhere in same or similar words: "...after which, the wound may be strapped up: a little flour and dry lint may be used, if required."

Report of treatment of a patient in The Surgical Anatomy of the Arteries, 1839: "19th day--Bled last night from the wound... A piece of lint moistened with a paste of flour and whtie of egg was applied to the wound..."

The point being that we've looked at enough sources that when Hank saw the flour and lint he recognized it as typical; and when he saw the sugar he didn't recognize that as typical. If he wanted to put more than 30 minutes of research into it he knows he'd come up with a lot more on the flour and lint -- while after spending several hours looking at our collection and online we've been able to come up with virtually nothing on sugar other than when used internally.

We'll gladly change our opinion if someone can give more documentation from original sources, but so far it looks like others can't find it either. We're not saying that sugar was never used in wounds. Admittedly there could have been those who purchased the book (published by Beadle of Beadle's Dime Guide fame) and tried doing it, but I don't see it as something that was typical/everyday. If you'd like to find some primary sources that's great, and I hope you'll share them.


(Of course, how short is short?)Hank said "ended above their knees."


I would say: You won't find it in Godey's, or in tintypes, or in CDVs. That is not where it is to be found. Instead check representations of the theater, dance, etc. Also look for woodcuts, etc. showing working women. Short skirts WERE fairly common. (Of course, how short is short?) It comes with thinking about what you are looking at and for. Aren't those the exceptions he mentioned in his post?

The point is we all agree that the majority of the time the majority of the women did not wear skirts above the knee. Yet, how do you prove that? The only way to prove it, is the fact that the preponderance of images, descriptions, and surviving garments of the period don't have women with skirts above the knee. If someone rejects that kind of argument as evidence then what other proof is there? How would you make the case that most women wore skirts below the knee?

Linda.

amity
01-12-2008, 12:07 PM
Linda, gotta run but will try to get back and give you a more comprehensive answer on the philosophical aspect.

I think on the other issue, flour/lint versus sugar, the difference might be "bleeding or infection"?

Linda Trent
01-12-2008, 12:40 PM
Linda, gotta run but will try to get back and give you a more comprehensive answer on the philosophical aspect.

I think on the other issue, flour/lint versus sugar, the difference might be "bleeding or infection"?

I've created a new thread at:
http://www.cwreenactors.com/forum/showthread.php?p=56465#post56465 Determining what's Plain, Everyday, Common in General Research.

Linda.

2RIV
01-13-2008, 01:44 AM
Mr. Trent,

Although my area of expertise in the real world is General Medical and Surgical knowledge, and the historic roles of medication and treat are part of my educational background, and I stated that I am a Surgical RN, I spent the time to dig through my old nursing manuals from when I went to nursing school to find you an exact reference;

Medical Surgical Nursing, Critical thinking in Client Care, 3rd Edition:
Lemone, Priscilla & Burke, Karen
2004 Pearson/Prentice Hall

Microbiology, 8th Edition:
Totora, Gerald J., Funke, Berdell R., Case, Christine L.
2004 Pearson?Benjamin Cummings


An additional source would be to read the writings of Florence Nightingale or her contemporaries, in regards to treatment of the ill.

Additionally Mr. Trent,
I am a graduate of Mountainside Hospital School of Nursing, in Montclair, New Jersey. I am sure they would be willing to testify to my completeion of their regular course of education in nursing, including the historic roles of nursing, and the use of medications from the greek period to the medical enlightenment of the 1840s/50s including the Nightingale revolution of nursing and patient care (including fundamentals of disease prevention). I am Licensed in the state of New Jersey as a Registered Professional Nurse, whic the Attorney General's Office would be more than happy to verify for you. In addition I am certified as an Emergency Medical Technician in the State of New Jersey, which the Board of Health will also be willing to verify for you. I also hold national certifications in Advanced Cardiac Life Support and Pre-Hospital Trauma Life Support which the American Heart Association and the National Association of Emergency Medical Technicians would be happy to verify as well. I hope my general knowledge meets your criteria.

I was not saying that treatments did not go in and out of popularity. Sugar may be the next cure for skin ulcers in 2 or 3 years. I was simply verify that it has been used and somewhat recently. Others have stated period sources for its use, I was vouching for what was already stated. Siting my vast expertise, I think you will find I am more than qualified to verify the statements of others.


All,
Another thing to consider here is different doctors practice differently. It would all be based on their training and their experience in Evdence Based practice (learning what works from seeing what happens to your patients as you try different modalities of treatment), which unfortunetly, none of us can really get experience in at this time. That being said, some doctors may have used sugar as a wound packing material and others may have found it ineffective. I would look into your sepcific portrayal. Find out where the physician you portray was educated. Then try to find out what the focus of treatment was at the school. Did he specialize further after his education. Was he a rural physician, did he work in an urban area. Were more "modern" medicines pre-formulated and at his disposal, or did he have to formulate his own medicines. These questions could lead you in the direction of his practice. Also, look for medical journal articles from the time period. They would have studies on the latest treatments and techniques of the time period.

Sincerely,
Aaron J. Siegel

hanktrent
01-13-2008, 02:38 AM
To clarify: I'm using the scientific method here. As a medical professional, you've already been trained in it, but to clarify for everyone:

Start with data. A movie shows a 19th century doctor putting sugar in wounds. An online article mentions it. The online article is traced to its 19th century source. I can't find any other mention of it in 19th century sources, despite widespread searching. I believe the widespread lack of evidence is significant, therefore it's time to...

Make a hypothesis. Due to the lack of evidence where I'd expect to find it, putting sugar in wounds in the 19th century was rare.

How is the hypothesis falsifiable? That seems to be the step overlooked. Here's what would make me change my mind: If we can find other 19th century primary source references describing putting sugar in wounds, similar to the many references we find for other common treatments, the hypothesis is wrong, and it was either common overall, or common among a particular subset. That's how I would falsify it.

Please share your hypothesis, and how you believe it could be falsified. I may be misunderstanding, but what I take it to be is (please correct me): Putting sugar in wounds was done by a significant number of doctors or nurses in the 19th century. Now, here's the question: How is it falsifiable? What (hypothetically) would make you believe it was a rarely-done procedure in the 19th century?

If the answer is nothing would, then there's really no point in discussing it further. We'll just agree to disagree.

It seems most of your post is proposing avenues for research, which I've already explored. It's possible I've overlooked something in them, which you've found. If so, please share it.


Medical Surgical Nursing, Critical thinking in Client Care, 3rd Edition:
Lemone, Priscilla & Burke, Karen
2004 Pearson/Prentice Hall

Microbiology, 8th Edition:
Totora, Gerald J., Funke, Berdell R., Case, Christine L.
2004 Pearson?Benjamin Cummings

Do these contain footnotes to primary sources to the use of sugar in the 19th century? If so, please share them.


An additional source would be to read the writings of Florence Nightingale or her contemporaries, in regards to treatment of the ill.

Notes on Nursing is sitting within reach of my computer, as are Hospital Sketches, and the Family Nurse. For lots more, I go online or into the other room. Are you claiming that these manuals do recommend sugar in wounds?

Because I've already looked, and haven't found it in them. The closest we've found--and it's not close at all--is a recommendation Linda found in the Family Nurse to put salt or molasses on cuts.


I hope my general knowledge meets your criteria. Next time you get sick I hope you ask all the staff at your local hospital where they have there credentials with and where they were educated.

No, what I'd ask them is for the evidence that the treatment they're recommending works. Scientific studies, y'know. Never got into this argument-from-authority thing. Are you familiar with the 19th century hygienic movement, Trall and Alcott and all that? If there's any period medical movement I sympathize with in modern life, it'd be them. :)


I was simply verify that it has been used and somewhat recently. Others have stated period sources for its use, I was vouching for what was already stated.

What period sources? There's the Turkish one, repeated verbatim a few times in the 19th century. And some from a few hundred years previous. What else?



Another thing to consider here is different doctors practice differently.

So you're claiming that it's possible hydropaths, homeopaths, Thompsonians, hygienists or some medical subset used it? If so, please provide evidence. I've checked writings of the major medical offshoots, and it's not mentioned there either. Do you have examples that I've overlooked? If so, please provide them.

I'm not asking where to look in general, because everything you mentioned are places I've already looked. They're the obvious places. Which is why I believe it's significant that sugar in wounds is not mentioned in them.

What I am asking for is primary source data to support the other hypotheses being presented, and/or what it would take to falsify those hypotheses.

Hank Trent
hanktrent@voyager.net

amity
01-13-2008, 05:13 AM
Hank, I think the concept you are groping for is what today would be termed the "Standard of Care." Every medical practitioner strives to answer to it, because it is the basis for legal and professional judgments of their competency. When a doctor knowingly breaches the standard of care, he will document pages of reasons why, what the specific conditions are that led him to the decision to do so, etc. The SOC isn't written down anywhere in a coherent overarching code, but when it is breached most medical professionals familiar with the field in question do not have difficulty agreeing that it has. IOW, we know it when we see it!

For example, the field I know best is cardiology (not that I am an expert in cardiology, by any stretch!). The American Heart Association has a lot to do with setting standards for the practice of cardiology. The research is done, evidence based as you say, and from one year to the next the algorithm changes a little bit. A class 1 drug this year may be class 3b next year, and so forth. But what might at first seem very cut and dried is really very much subject to the individual approaches of physicians, both individual practitioners and the medical directors of large institutions such as hospitals. There is a lot of variation in practice even now, in the 21st cent.! The standard of care for a particular thing might be quite different in Minneapolis than it is in San Antonio. When I first started working for Austin EMS the very forward-thinking medical director wanted things handled a certain way that I had never heard of before. Certainly not in the textbooks! Certainly outside the standard of care for most of Texas.

I don't know how the standard of care was derived in regard to field wound treatment in the mid-19th c. What was considered within the realm of reason, and what was considered quackery. I feel pretty sure that it was an even less black and white matter than it is today though! National institutions like the AHA did not exist or were in their infancy, so perhaps the most important determinant of practice was the school a physician graduated from? If any?

Please understand that all I am trying to do here is suggest an approach to this subject that goes beyond just a statistical analysis of primary sources. I am certainly not trying to tell you that you are wrong. It just sounds like the reasoning could be fleshed out a bit, so am trying to suggest a way of looking at this subject. I strongly suggest that you give Aaron more heed than me, though. He comes from a background that can be very, very helpful to your analysis.

BTW, what would falsify the sugar hypothesis for me at this point is something like this: A certain officer who has visited a lot of different units, battalions, whatever, visits one and reports that they have a practice there of putting sugar into wounds which he has never seen or heard of before.

hanktrent
01-13-2008, 06:16 AM
BTW, what would falsify the sugar hypothesis for me at this point is something like this: A certain officer who has visited a lot of different units, battalion, whatever, visits one and reports that they have a practice there of putting sugar into wounds which he has never seen before.

Sounds fair enough. There are lots of examples of people commenting on and disagreeing with and arguing about other obscure procedures in the period that were done by a minority of doctors.

The difficulty right now is finding any examples of sugar being put in wounds at all.

Me, I'd like to see those first, but obviously a source such as you mention would be found within them, once we find them. Even the Soldiers' Handbook quote makes no comment on whether it was rare or common or whether the author had even done it or seen it done.

Hypothetically, if it was so rare that we never find an example of someone seeing it to say it was rare, does that mean should we assume it was more common than if we did find such a source?

As far as standard of care, that's hardly something obscure or difficult to research. There are malpractice cases, for example (was reading one last night about a doctor who administered smallpox vaccine to two women who then got sick--did he screw up by using bad vaccine matter, or were they exposed to smallpox naturally before the vaccine had time to work?). A more famous example is the charge against Samuel Thomson, early in his promotion of Thomsonian medicine. And the whole Hammond calomel flap, though it wasn't actually a malpractice charge.

There are the numerous arguments between the medical factions about what's right and wrong within each one. There are the actual medical texts which students studied, and the period journals and books they might have read to further their education later in their practice.

It's not like people didn't debate endlessly about what was normal, what was effective, what was expected, etc.

I hope you realize I'm not talking about a mere "statistical analysis" of primary sources, but looking at the primary sources in context. It just so happens that when one can find sources which state that it's common to do X, one can also usually find X mentioned many times in other sources. No surprise, really.

Hank Trent
hanktrent@voyager.net

amity
01-13-2008, 07:12 AM
I already gave my marjoram in chicken stew example. Never read of even one case of someone actually doing it!

2RIV
01-13-2008, 07:35 AM
Mr. Trent,
While there are specific specialties mentioned from the time period, I am in deed referring to Standards of Practice. Then as now, Standards of Practice can vary widely from region to region, and educational institution to educational institution. While I don't doubt your vast array of books on 19th century health care and professions, I suggest a trip some time to your local hospital's medical library. It may be a wealth of information you neither knew of or would normally have access to. Usually you would have to call in advance to make an appointment, unless you are staff at said hospital. Your best source would be a university medical center.

I never once said sugar in wounds was the Standard of Care for every healthcare provider of the 1800s. I said it was used, to what degree I would not be able to say with any certainty. I think your point has been made. You have found no documentation of it being a common remedy. You also have found no documentation that is was not used at all or would have been viewed as "quackery". More research needs to be done, and this I would agree with you on. I have no intent of adding it to my impression, but it may fit for others. I gave other reference sources for the other members here, who may find them helpful. I would ten to agree with the rational that there has yet to be found a period account of anyone seeing this treatment performed, and finding it to be unusual.

Linda Trent
01-13-2008, 08:22 AM
I suggest a trip some time to your local hospital's medical library. It may be a wealth of information you neither knew of or would normally have access to. Usually you would have to call in advance to make an appointment, unless you are staff at said hospital. Your best source would be a university medical center.Thanks for the tip, but actually, our local hospital doesn't tend to keep 130+ year old books in their library due to lack of room, I've already inquired about that when we moved here 13 years ago.

However, we do have Marshall University Medical School a mere 40 minutes from here, and they have an extensive medical library with almost half a floor full of 18th, 19th, and early 20th century medical books. They have text books, medical manuals, surgical manuals, and medical books of every kind and every field, and we have spent countless hours in their reading room studying the books and pamplets.

But the point is that we agree. You and we are saying that it could very well have been used, but that the lack of primary source documents makes it impossible to say it was standard treatment. That to make that claim more research needs to be done. It was Terre who was arguing it "might well have been standard treatment." (post #26)

Unless primary sources come up, I'm done with this thread because I think that the point has been made.

Thanks again,

Linda

amity
01-13-2008, 08:47 AM
That statement of mine had to do with the difference between hospital medicine and field medicine. Maybe considering our later conversation about standards of care, it might have been an unfortunate word choice. I wasn't really referring to the standard of care. I should have said PEC. I think the sugar thing could have been PEC fir pre-hospital care. This based on the source you provided.

And can you tell us more about that source? Union or Confederate? Army issued to each unit? The fact that it has been widely reprinted makes me think it might have been a popular and widely read book in its day, etc.?

2RIV
01-13-2008, 09:20 AM
Mrs. Trent,
That is unfortunate that your local hospital does not keep books from that far back. I guess that would vary a great deal based on how old the hospital is. There are a couple of Hospitals here in North Jersey that have wonderful medical libraries, as well as UMDNJ in Newark (affiliated with Rutgers).

I too think we have gone in circles to come up with the same conclusion.

Linda Trent
01-13-2008, 11:43 AM
By the way, Hank's been out all afternoon, so I've been replying, but now that I've put over three hours of continuous work documenting the following, I ain't giving this back to him. :p


I should have said PEC. I think the sugar thing could have been PEC fir pre-hospital care. This based on the source you provided.

I'm not going there again, I guess we'll just have to agree to disagree on that.


And can you tell us more about that source? Union or Confederate?Union


Army issued to each unit?No. Probably compiled quickly from a variety of sources and sold for 25 cents each to make a profit off the war. This was put out by Beadle of Beadle Dime Guide fame, who published a number of cheap books.


The fact that it has been widely reprinted makes me think it might have been a popular and widely read book in its day, etc.?Not necessarily, but possibly. You'd need to put the research into how many copies were sold during the 1860s, I've wasted enough time on this already. And, just because something's mentioned in the book doesn't mean that it was in common useage -- we need more data.

It claims to have been written by Louis Le Grand, M.D. and published by Beadle. However, apparently Dr. LeGrand was a pen name for Orville Victor, http://www.ulib.niu.edu/badndp/legrand_louis.html (http://www.ulib.niu.edu/badndp/legrand_louis.html) Orville was a newspaper editor from Sandusky, Ohio who married Metta Victoria Fuller in Richland, Ohio on July 3, 1856 (marriage record on Ancestry.com), and moved to New York, in 1858, where she had a contract working for The New York Weekly.

Orville got a job as an editor for Beadle in 1861, for the Dime Library, and apparently compiled a bunch of stuff from various sources in order to get a book on the market quickly and cheaply. One page has some recipes from Mrs. Victor's recipe book :
These recipes are the most delicious dishes for the sick or concalescent, and can be made for the soldier in any ordinary hospital or camp, with a little exertion. We are indebted to Mrs. Victor's 'Recipe Book' for them."

The book is actually put together as a collection of information. When not referring to actual US military regulations, "The Official Articles of War; Instructions to the Volunteer" and that sort of thing, it becomes a collection of various things, some appeared to be useful to the compiler while some did not. For example almost 5 full pages are devoted to recipes from Soyer, an Englishman, and then at the end of the receipts says,
"This will do for Soyer, which dishes, after all, appear to us to be too expensive. For instance, in the preparation of his soups he gives one pound of meat to every man to be fed. As the men are only rationed with three-quarters of a pound of pork per-day, or twenty ounces of salt or fresh beef, the entire daily ration is thus consumed to prepare one dish. We never, in our own household, use so great a proportion of meat in soups..."Emphasis by author. It's not like the compiler needed to put Soyer in there, but it apparently helped to fill up the pages. ;-)

As you said, we should look for things in primary sources before we look at Godeys or DeBows, or even movies! The only reason we're even discussing this one remote source is because some script writer mentioned it. So why are we putting so much weight on one book! One book that wasn't written by a doctor, and that is nothing more than a compilation of a bunch of recipes?

Well, that's about all I can tell you. Until other primary sources come forth,

Linda Trent,
signing off this thread

amity
01-13-2008, 12:36 PM
Ah, Beadles! Interesting that they put medicine on a flat par with dancing and etiquette and dressmaking and all the other topics they published on. That puts it all on a considerably lower level in my eyes, too.

Linda Trent
01-18-2008, 03:24 PM
Hallelujah! We've finally been able to find a case of sugar being used!

We've run across recommendation of sugar being used on old sores and ulcers that won't heal, but here's an example of that same philosophy applied to a gunshot wound in a military hospital during the Civil War. It's being used not to prevent complications on a fresh wound, but long after the initial wound and after complications have set in. This is a different use than the military handbook quote which recommended it to "prevent mortification." Ironically it's mentioned in a report about the effectiveness of buttermilk where sugar failed.


Reuben Holladay, aged 19, private Co. A., 24th New York Cavalry, was admitted March 12th, 1865, into Ward P., Satterlee U.S.A. General Hospital, West Philadelphia, Pa., from Camden Street Hospital, Baltimore, Md. with a gunshot flesh wound of the left thigh. The wound was caused by a minie ball, at the battle of Hatcher's Run, Va., February 7th, 1865.

The wound became swollen, discharged offensive matter and hospital gangrene set in on March 26th. The doctor reported on that day,
"Cleaned the wound out with acid. nitric. dilut., and filled both openings with common brown sugar; syringed the wound with a solution of sugar, and covered the whole with oakum. Dressed wound four times a day."

The patient continued to get worse and on April 6
"Was recommended by Dr. W. F. Atlee to use buttermilk, instead of sugar and solution potass. permang."

On the next day the patient was reported to have improved and continued to improve with the buttermilk treatment.

Source: The American Journal of the Medical Sciences, edited by Isaac Hays, M.D., Vol. 1 pub. Philadelphia, 1865. http://books.google.com/books?id=8AwCAAAAYAAJ&pg=PA62 (http://books.google.com/books?id=8AwCAAAAYAAJ&pg=PA62)

So finally we have an example of sugar actually being used in a wound, but not on a fresh wound, and not to prevent mortification, instead it's being used on an old wound where gangrene has set in as an attempt to cure it. Ironically it didn't work, but it's the first piece of data that shows its actual use (and how it was used) in a CW hospital.

Linda

TimKindred
01-21-2008, 01:19 AM
If I may,

It would seem to me that a point being overlooked here is the entire concept of infection during our period of interest. My own reading of period accounts suugests strongly that the formation of pus was considered to be a stage of recovery, an expected result of an injury. The wound was drained, cleaned, and it was what occured AFTER that point which was of greater interest to the medical staff. Either the patient started to heal promptly, or at least noticably, or things worsened and the advent of gangrene was expected.

To say that sugar was used to prevent or treat infection is to completely overlook what most doctors and scientists considered an integral part of healing. It wasn't called "laudable pus" for nothing, after all. You'll note as well that the one reference found to date involves brown sugar as a treatment for gangrene, not the typical sepsis expected as a result of the original wound.

White sugar (Item #15, 10 oz) is included in the Pannier issued to medical units, and was a constant on both US & CS pharmacy lists. However, to infer it was used in treating wounds is not completely logical. Also included in the pannier is salt, beef bullion, condensed milk, tea & coffee. Should we consider that these are being used in wound treatments as well? Of course not. they are there for to supply nourishment and sustenance to the wounded when other rations or mess facilities might not be readily available. These items are also included in the issue lists for all US Ambulances, as the ambulance driver and antendants were responsible for caring for the wounded until they reached their destination.

It is perfectly plausible that sugar was used in the treatment of gas gangrene, as is indicated by the example formerly listed, though that is only one instance. however, i would argue that using it as a primary antiseptic is not in line with our knowleadge of period medical treatments and philosophy, let alone the entire concept of germs and bacteria being their casuitve agent.

Other's mileage may, of course, vary, but that's my 2-cent's on the subject.

Respects,

hanktrent
01-21-2008, 02:10 AM
BTW, what would falsify the sugar hypothesis for me at this point is something like this: A certain officer who has visited a lot of different units, battalions, whatever, visits one and reports that they have a practice there of putting sugar into wounds which he has never seen or heard of before.

I do believe I've found several examples of exactly that, thanks to Linda's work at tracking down the Atlee reference.


The use of sugar as a treatment for gangrene was reported being done by three doctors in military hospitals in the Philadelphia-Baltimore area:

Dr. W.F. Atlee
Dr. J.H. Packard
Dr. W. Kempster

Here are the attitudes expressed by other doctors, or those doctors themselves, about their use of sugar for treating gangrene. I've underlined the relevant parts.

When Packard published his use of sugar to treat gangrene in The American Journal of the Medical Sciences, January 1865, he claimed that the treatment was unusual. He said the treatment was suggested by Lieut.-Col. Le Conte, Medical Inspector U.S.A. "based upon chemical views."

Packard wrote: "Let me premise by saying that in so doing it is not my object to claim originality for these views, although some of them have never met my eye in print, nor do I know of their being held by others. But it is very possible that a like experience may have brought some of my fellow-labourers to adopt similar ideas." http://books.google.com/booksid=lw4CAAAAYAAJ&pg=PA114 (http://books.google.com/booksid=lw4CAAAAYAAJ&pg=PA114)

Twenty years later, Packard publicly claimed to have been the first to use powdered white sugar to treat gangrene. While probably not true, it indicates he was unfamiliar with anyone else using it. In an 1884 discussion on the treatment of syphilis by the Philadelphia County Medical Society, in which Dr. Packard participated along with several other doctors, he was reported as saying:

"As to sloughing sores, and their treatment by means of powdered white sugar, Dr. Packard stated that he believed he had been the first to use this article as a dressing in cases of hospital gangrene, at the suggestion of the late Dr. Le Conte, in 1864. The results obtained had been published in the Am. Journal of the Medical Sciences, for January, 1865. Dr. Packard was then acting as consulting surgeon to the U.S.A. Hospitals at Haddington and at Beverly, N.J., and a very large number of bad cases of this kind were under care at both places." Source: http://books.google.com/books?id=uZ0DAAAAYAAJ&pg=PA212 (http://books.google.com/books?id=uZ0DAAAAYAAJ&pg=PA212)

In making the above claim, Packard chooses his wording carefully, specifying powdered white sugar, since he'd also worked at the Satterlee Hospital in Philadelhpia, and was aware that Atlee had used sugar syrup there in 1863.

Concerning Atlee and Packard, Dr. Samuel Jackson wrote that his "young friend, Dr. W. F. Atlee, consulting surgeon at the U.S. Satterlee Hospital, two years since [1863], treated gangrenous wounds with sugar. This discovery has been confirmed by Dr. J. H. Packard, one of the surgeons to U.S. Hospital, Beverly, N.J." (The quote is from "The Use of Sugar and Lactic Acid in the Animal Economy," published April 1865 http://books.google.com/booksoutput=html&id=lw4CAAAAYAAJ&pg=PA370

The fact that Jackson calls it a "discovery" implies that he thought it was new and unusual.

Here's another reaction to Atlee, which seems to indicate surprise that sugar is equally effective: "Bromine has acquired its reputation in the cure of hospital gangrene, by its general use in this form... There can be no doubt that thus applied it is quite effectual, but not more so than nitric acid, permanganate of potassa, chloride of zinc and other agents of this class. Indeed a reviewer [Dr. Atlee] of Dr. Goldsmith's monograph on bromine in hospital gangrene, asserts that, a saturated solution of sugar is equally efficacious if applied in the same way!" (The article goes on to mention the efficacy of oil of turpentine.) (http://books.google.com/books?id=lw4CAAAAYAAJ&pg=PA275 (http://books.google.com/books?id=lw4CAAAAYAAJ&pg=PA275) The American Journal of the Medical Sciences, January 1865)


The third doctor, Kempster, mentions using sugar for gangrene at the Patterson Park U.S. General Hospital, Baltimore, in the American Journal of Medical Sciences, April 1866, reporting on cases from 1864.

His main area of concern is the importance of constitutional symptoms. He reports on the specific treatment of several patients, stating what he prescribed for them, and sugar is not mentioned in those cases, but speaking in general of the treatments tried overall, he says, "The local treatment has already been indicated; [nitric] acid answered in all cases; other means were tried, turpentine, bromine, permanganate of potash, Labarraque's solution, sugar, &c., but none of these were as satisfactory or so much relied on as the acid." Source: http://books.google.com/books?id=_gwCAAAAYAAJ&pg=PA351 (http://books.google.com/books?id=_gwCAAAAYAAJ&pg=PA351)


So he'd apparently heard of sugar and tried it, but as only one of several remedies which were not "as satisfactory or so much relied on" as nitric acid. He was geographically close to Atlee in Philadelphia and Packard who was working in Philadelphia and New Jersey, so he may have heard of their successes first-hand and tried it, and/or may have read Atlee's response to Dr. Goldsmith published in January 1864.

So there are some examples of doctors using or reporting about the use of sugar as a treatment for gangrene, and in each case commenting it was either new, not the most common treatment, reacting with surprise, or something similar.

It also seems to indicate that the Philadelphia area was ground zero for the (re)introduction of its use: sugar syrup in Satterlee Hospital by Atlee in the summer of 1863, and granulated sugar by Packard in the Philadelphia-New Jersey area in 1864. Or at least they thought they were unique, unless we can find the same thing being done unknown and independently of them elsewhere.

In my next post, more on Atlee and Packard's treatments and reasoning.

Hank Trent
hanktrent@voyager.net

amity
01-21-2008, 02:23 AM
Here is one other from immediate post-CW Texas, which is to put a corn meal poultice on a deep infection.

Hank, again, these sources seem to indicate that sugar was fairly widely used, certainly not unheard of. It wasn't the treatment of choice in most hospitals, but elsewhere .... ?

hanktrent
01-21-2008, 02:25 AM
Since we've come this far, here are the actual methods Atlee and Packard employed:

Here's Atlee's description of his sugar syrup treatment that he used in 1863, in his own words:


The putrid tissues were thoroughly removed; infiltration of the unhealthy secretions among the muscles and under the skin was prevented by the proper application of bandages, and a saturated solution of white sugar was poured upon the sore. We were satisfied with the effect produced by this treatment; we are certain that we should not have any reason to be so at another time, or in other places.

Circumstances vary cases of disease as of everything else; they make them curable by simple syrup, or by the application of a simple ointment, or so violent as to defy the actual cautery, and nitric acid, and also, it is most likely, bromine itself.

Atlee's sugar worked for him in 1863 and 1864, but his friend Dr. Samuel Jackson suggested it was the lactic acid formed from the sugar, not the sugar itself, that was effecting the cure in an article on "The Use of Sugar and Lactic Acid in the Animal Economy," and that using sour milk to apply lactic acid directly would be more effective.

So when the sugar and other treatments were failing to cure the gangrene of a private at Satterlee Hospital in March 1865, Atlee followed Jackson's advice, substituting buttermilk for sour milk, which he didn't have. This is what Linda found a couple posts above.

The patient responded so well to the buttermilk, that Atlee switched to using it.



Since its employment in this case [buttermilk] has been universally used as a local application, at the Satterlee Hospital, in all cases of sloughing wounds, and with the most satisfactory results. I have also used [buttermilk] as a dressing for stumps immediately after amputation, and believe it to have had the effect of keeping parts free from odour that would, under other applications, have been offensive and sloughing." http://books.google.com/books?id=8AwCAAAAYAAJ&pg=PA63 (http://books.google.com/books?id=8AwCAAAAYAAJ&pg=PA63) The
American Journal of Medical Sciences, 1865)


And thus ended the reliance on sugar syrup as the main treatment for gangrene at Satterlee. It apparently lasted from 1863 through the spring of 1865.

Packard used sugar at the suggestion of LeConte, but LeConte's full suggestion was:


after the cleansing, the permanganate of potash, in solution, should be thoroughly applied to destroy any remaining putrilage, and afterwards the sugar. Practical experience convinced [Packard] of the value of this plan, based upon chemical principles; and it was the want of a supply of the solution of the permanganate, which, compelling the omission of the second step of the treatment, proved it to be unnecessary." http://books.google.com/books?id=lw4CAAAAYAAJ&pg=PA118

Packard published an article, "On the Efficient Treatment of Hospital Gangrene" describing his treatment in the American Journal of Medical Science, January 1865.
http://books.google.com/books?id=CY-7TmES2OwC&pg=PA147&lpg=PA147 (http://books.google.com/books?id=CY-7TmES2OwC&pg=PA147&lpg=PA147)

Unlike Jackson, who traced the effectiveness of sugar to lactic acid, Packard believed the sugar was effective because it prevented oxygen from reaching the tissues, and that any substance which achieved that would also be effective. Though this was published before Atlee switched to the buttermilk/lactic acid treatment in preference to sugar, so it's possible Packard was swayed by the later success of the buttermilk also.

To treat gangrene, Packard recommends first cleansing, then if wished to "disinfect" the wound with chlorinated soda or another preparation. Then,

to prevent the recurrence of the sphacelation or necrosis... using as a dressing, a preventive of oxidation. Sugar, a hydrate of carbon, which does not give up its oxygen, and which is well known for its preservative powers in the case of meats and fruit, is admirable for this purpose. Powdered white sugar is thoroughly and thickly dusted over the wound, or a thick syrup is put on like any other wet dressing, by saturating clean rags with it. Dr. Packard prefers the former method, the sugared surface being covered with wet lint or rags, kept in place by adhesive plaster, or by strips of bandage tied just tightly enough to keep their place.

Coal-oil, turpentine, or any other carbo-hydrogen, if pure, would answer but the sugar is less offensive, and does not give pain. A mixture of pulverized charcoal with the sugar answers very well when the odour does not quickly disappear after the cleansing.

Wounds still healthy may be prevented from becoming foul and gangrenous from the neighbourhood of those which are in the latter state, by the use of sugar or any pure carbo-hydrogen as a dressing, and that the spread of hospital gangrene in a ward may be thus checked.

In conclusion, he says,


although hospital gangrene may disappear under the use of the actual cautery, of nitric acid, or of bromine... the cure consists in the removal of all the sloughing and dead tissues, and the prevention in opposing oxidation by means of a dressing with any substance which either contains no oxygen or which will not give it up.

Packard says that LeConte suggested sugar based on "chemical views," and Packard's mention above about sugar's preservative power on meats and fruits implies that LeConte may have based his suggested on that often-reported observation, which also appears in the 1851 U.S. Dispensary under the heading for sugar: "It is a powerful antiseptic, and is beginning to be used for preserving meat and fish..."

Hank Trent
hanktrent@voyager.net

hanktrent
01-21-2008, 02:49 AM
To say that sugar was used to prevent or treat infection is to completely overlook what most doctors and scientists considered an integral part of healing. It wasn't called "laudable pus" for nothing, after all.

I totally agree. The original sources speak of treating gangrene and mortification, and I believe that what we'd consider an "infection" would not be considered of much notice until it progressed to a more serious "inflamation," as they'd call it, or pyaemia or some other period-noticeable complication.

So the idea of preventing suppuration and encouraging healing by the first intention, in every single case, was not the period mindset, and applying a medicine to try to force that outcome, immediately after the injury, would not be a typical goal of treatment.

It's interesting to see period mindset affecting the doctors' perceptions of what was happening. From my post above:


I have also used [buttermilk] as a dressing for stumps immediately after amputation, and believe it to have had the effect of keeping parts free from odour that would, under other applications, have been offensive and sloughing.

While we might think that keeping the stumps free from odor was merely an aesthetic consideration and a sign that the cause of the odor was being treated, surely the doctors in the period considered stopping the odor itself to be part of the treatment and prevention of contagion--just as they washed down the walls with chloride of lime to keep a hospital smelling fresh, rather than applying it where it might actually prevent the spread of gangrene, on the instruments.

Hank Trent
hanktrent@voyager.net

TimKindred
01-21-2008, 03:39 AM
Hank,

I absolutely agree with you. The period concept of disease being born on the winds and through dankness, etc, is something that is alien to us, yet we still see it in somewhat today. Telling kids to get out of the rain before they catch their death of cold, etc.

Good thread.

hanktrent
01-22-2008, 04:02 AM
Hank, again, these sources seem to indicate that sugar was fairly widely used, certainly not unheard of. It wasn't the treatment of choice in most hospitals, but elsewhere .... ?

I didn't see your post with this part edited in until now.

My reaction is--oh for heaven's sake.

Before you would believe it was rare, you wanted a quote from "A certain officer who has visited a lot of different units, battalions, whatever, visits one and reports that they have a practice there of putting sugar into wounds which he has never seen or heard of before."

Did you read the underlined parts of the quotes in my post #48?

I found a doctor who read medical journals and consulted at several hospitals, and who claimed he was the first to use dry sugar in wounds in 1864, and said his ideas for using it had "never met my eye in print, nor do I know of their being held by others." He stated it in front of a panel of doctors and published it in a medical journal, and no one disputed him. That's exactly what you asked for.

I've provided examples of three doctors using it in the same geographical area who learned it from each other, and in each case, it was mentioned as uncommon and/or not successful.

I gave you what you asked for. Talk about a needle in a haystack! I found it.

Now you're claiming it's evidence it was fairly widely used?

No more. This is silly. It seems like a game, where you keep moving the goalposts, expecting more research from me, yet providing none of your own.

Where is your evidence of someone actually putting sugar in wounds while saying it's common? You claim it can't be found or isn't necessary (the rosemary example) but if you expect me to find that level of detail to support my hypothesis, you should be able to provide the same to support yours.

I'm done.

Hank Trent
hanktrent@voyager.net

2RIV
01-22-2008, 11:42 AM
Mr. Trent,
Very well researched and documented. From what you have brought to light, it was not anywhere near common place. This meets the criteria of what I was looking for, in the argument/debate we had on this topic. I also like what no one else may have noticed, it was used under a senior physicians reccomendation, based on it's chemical properties/applications, which when thought about (and without the consideration of germ theory) makes sense.

Mr. Kindred,
I would differ though (and now it is on me to find the source) that puss was thought to be good by all physicians. I will agree that it was the PEC standard of care to view puss as a sign of secondary and/or tertiary healing, I read some where of one physician who viewed it as a sign of mortification based on evidence based practice. I hope I can find that source again.

While I did stray from the topic, thank you Mr. Trent for that "needle in a haystack". I would say case closed.

amity
01-22-2008, 01:43 PM
Thanks, Hank. That was indeed a wonderful job. I wish i dould keep the ball in the air a little longer, but as you have observedk, I don't even have time to read the posts right now. But thanks.

amity
01-23-2008, 08:11 PM
Here is a "local source" on medicine that you might want to look for, with a bit different focus. It used to be very expensive, until reprinted last year, and did not circulate (or at least my local library was not able to get a copy for me).

A Century of Medicine in San Antonio
P. I. Nixon
San antonio, 1936.

I just happened to find it Monday at a friend's garage sale (for 1 buck!).

Linda Trent
01-23-2008, 10:53 PM
Here is a "local source" on medicine that you might want to look for, with a bit different focus. It used to be very expensive, until reprinted last year, and did not circulate (or at least my local library was not able to get a copy for me).

A Century of Medicine in San Antonio
P. I. Nixon
San antonio, 1936.

I just happened to find it Monday at a friend's garage sale (for 1 buck!).

For anyone who's interested it's online. Google (not Google books) "A Century of Medicine in San Antonio" and it'll come up. It's online at UTHSCSA libraries digital collection.

I'm just starting to read over it.

Linda.