Thursday, January 24, 2013

THE DOCTOR'S BAG by Keith Souter aka Clay More

Doctors in the Old West

If you ever watched Gunsmoke you would be sure to know good old Doc G. Adams. If you had bellyache, a touch of rheumatics or a bullet that needed digging out, he was your man. He seemed the sort of guy that you could trust your life with, for he was wise, well read, skilled with a scalpel and familiar with all of the latest advances in medicine.

As a character he had evolved from his CBS radio incarnation, played by Howard McNear, when he was Doc Charles Adams, to Milburn Stone’s television role as Doc Galen Adams. Of course, he was usually just known as ‘Doc.’ The radio version was apparently a lot darker, for he was a man with a past. His real name was Charles Moore, a doctor who fled from Richmond, Virginia after killing a man in a duel. Settling in Dodge City, he took on the name of Doc Adams. His radio persona was a near alcoholic, but by television days he merely had a taste for whiskey at the Long Branch Saloon.

The change of name is interesting. Milburn Stone was given free rein, and so for ten years the name above his office read Dr G. Adams. It was a good choice, since Galen was an ancient Greek physician whose teachings on medicine dominated medical thought right up until the early nineteenth century. The essence of it was the archaic Doctrine of Humors, the belief that there were four fundamental humors or vital fluids that determined the state of health or illness of a person. These were blood, phlegm, black and yellow bile. Diagnosis of the imbalance led the doctor to the right treatment, which could be to blister, bleed, purge or give an enema.


Although things had advanced a little by the time of the Civil War, they had not advanced very far. By then the dominant view was that inflammation caused most diseases. The four characteristic signs of inflammation – heat, pain, swelling and redness – had been known about since antiquity, when they were described by the Roma doctor, Aulus Cornelius Celsus in the first century. Yet the cause of inflammation was not known. Doctors were taught that there two types – direct and indirect inflammation. Direct inflammation was caused by a breach in the body’s integrity - from a blow, a wound, a burn or the presence of a foreign body, such as a splinter, an arrow or a bullet. Surgery was indicated for direct inflammation.

Indirect inflammation was caused by malfunction of an internal organ.This was treated medically, by bleeding, scarifying, purging with calomel, or using a diaphoretic to induce a perspiration or sweating reaction. Tartrate of Antimony, or ‘Dover’s Powders,’ containing opium and Ipecachuana, were favoured diaphoretics.

The actual causes of inflammation were not known until Dr Ignaz Semmelweiss published a treatise in Budapest in 1861, entitled‘The Cause, Concept and Prophylaxis of Puerperal Fever.’ He suggested that women who died from puerperal fever (childbearing fever) had been contaminated by doctors who had not washed their hands between attending morning autopsies and going to the labour wards. Unfortunately, it would not for another twenty years until Louis Pasteur was able to prove the Germ Theory. That would be too late for the many thousands of men who would die from contamination and gangrenous wounds in the Civil War and beyond.

The Doctor’s Bag

In this monthly blog I am going to talk about the state of medicine and surgery in the nineteenth century, and about what the western town doctor had available for his patients. I will be delving into the medical bag to look at the instruments, pills, potions and mysteries of the doctor’s bag.
But first a biographette.

I was born in St Andrews, Scotland, the home of golf and graduated in medicine from the University of Dundee in 1976. I started training in psychiatry, but for several reasons changed tack to become a General Practitioner. I have practiced as a town doctor in Wakefield in the county of Yorkshire, England since 1979. For a while I was a tutor in General Practice at Leeds University and I am also a medical journalist, having writing a weekly newspaper column for thirty years.

My interest in medical history was kindled when I joined my medical practice. I was going through the junk cupboard, a repository for all the old medical instruments that had fallen redundant over the years. There were surgical kits, post-mortem (autopsy) sets, jars with ‘sutures as used by Professor Lister,’ and even a couple of very early scarificators for the letting of blood. Our surgery, you see, had been founded in 1847, so we had a long history and I felt it needed to be on display. So I researched the history of the surgery and set up a large museum case full of old instruments, to delight the patients and make them glad that they did not live back in the nineteenth century. The picture is of the author holding a set of early nineteenth century dental instruments, back in 1983.
The picture earlier in the blog of the doctor’s bag and the medical paraphernalia on the desk are actually mine and have seen good service over the years.

The doctors of the old west

We will be looking at one or two medical personalities in later blogs, including the great Dr George Goodfellow, physician and surgeon of Tucson, who treated the victims of the OK Coral shooting in Tombstone and who interviewed Geronimo.

For now I just wanted to say something about who practiced medicine back then. Doc Adams is, of course, part of the mythic west, yet there were many doctors, both qualified and unqualified who provided care for the people of those hard and dangerous times.

Since colonial days doctors could be trained by apprenticeship. That would last anything from two to five years. Or if one had enough money, one could study at a medical school and get a proper qualification. Up to the Civil War the average length of a medical course was a mere two years of nine months each. The truth is that there wasn’t much to learn then. And if one wished to bypass the bother of actually going to a medical institution, one could always buy a diploma for five dollars from one of the diploma mills.

Anatomical dissection was illegal in many states and medical instruments were in their infancy. The stethoscope as invented by Rene Laennec, a Parisian physician in 1816, was a monaural device. That is, it was a simple stiff tube with an earpiece at one end and a collecting horn at the other. It was essentially the same as the ear trumpet used by the hard of hearing. The binaural, flexible tubed stethoscope as perfected and designed by Dr George Cammann in 1852 did not become commonly used until after the Civil War. Few Civil War doctors would have a use for one. Indeed, the esteemed Harvard medical school did not even possess one until 1868!

Many doctors allied themselves with one or other of the medical philosophies of the day. There were allopathic doctors, who gave drugs that suppressed symptoms by creating opposite effects to the symptoms that were complained of. Thus they would give a constipating drug to someone with diarrhoea. Homoeopathic doctors would follow the teachings of Dr Samuel Hahnemann and use infinitesimal doses ofsubstances that created the same symptoms as the patient suffered from, using the principle of similia similibus curentur, or ‘like cures like.’ Thomsonians would use herbal preparations and only drugs made from plants. Eclectics would use a bit of this and a bit of that; essentially using whatever they found that worked. And finally, you would get hydropaths, who would advocate using water treatments, after the teachings of Vincenz Priessnitz, a Silesian farmer.

And digging for bullets

So back we come to Doc Adams and surgery. This is something that may be very relevant in western fiction. We’ll be looking at how to dig out bullets, as well as looking at amputations, midwifery and obstetrics and some of the glorious offshoots of medicine – like phrenology - back in the old days of the west.


  1. This is going to be -not just an interesting -but an extremely helpful blog series. Re: Doc Adams... I always wondered if maybe his father had also been a physician, hence the fact he was named Galen (was his middle names Hippocrates?)... and the TV version of doc was referenced more than once as having been a surgeon in an Ohio regiment during the war. Let me add in this space that your Doctor Logan Munro is, in my opinion, one of the most fascinating town doctor characters in any western I'd come across.

  2. This is definitely a series to follow. So much good information here, Keith -- thank you! I'm already looking forward to the next installment. (And I echo Troy's comment about Logan Munro. Fascinating character, that one. [Every time I see the good doctor's name, I hear whispers of LAST OF THE MOHICANS. ;-) ])

  3. Like Troy said, interesting and helpful. I will be looking forward to your future blogs. If you can work it in one of them, I would love to know what tools of the trade a country doctor might carry in his black bag during the 1870's compared to what you carry in yours.

  4. Oooooooh, phrenology!! Fascinating, Keith. Or should I say Doc? ;-) I'm looking forward to this series! And Yorkshire - one of my fave spots in England. SIGH.

  5. Why, thank you Troy. That's the sort of thing that would make a lot of men blush - but not Logan. Scotsmen don't blush - it comes from having the nerve to wear a kilt, I guess. And of course, he would be wearing one tomorrow night, since it is Burns' Night (when we celebrate the birth of Scotland's national poet, Robert Burns of Ayre.)

  6. Thank you, Kathleen. The Last of the Mohicans is etched in my unconscious. Logan could well have been related to the Munros of the great yarn, since there had been a long military tradition in the clan. Interesting to see that Daniel Day-Lewis, who played Hawkeye in the 1992 film may well add a third Oscar to his tally with Lincoln.

  7. Thanks, Livia. That is a great idea for a topic - The Doctor's Bag - Then and Now. I shall certainly do that.

  8. Phrenology is an interest of mine, Meg. I collect nineteenth century phrenology books and have written about it in one of my non-fiction books, Medical Meddlers, Mediums and Magicians - the Victorian Age of Credulity, as well as having a phrenologist as a lead character in my YA mystery series, set in Victorian London. I will be writing at some stage about this amazing pseudo-science which seems so plausible. Indeed, Orson Squire Fowler, one of the most prominent 19th century phrenologists was so successful and influential that the town of Fowler, Colorado is named after him.

  9. Handsomely written. Thanks. I have read that doctors had fallen into such disrepute in the U.S. in the latter 19th century that Doc Holliday chose to study dentistry instead of medicine, which would have been his first choice.

  10. Thanks, Ron. I didn't know that Doc Holliday had considered medicine.

  11. Keith, I am SO looking forward to your blog post each month. This is a fascinating subject--medicine of those times past. Like Troy, I find your Dr. Munro to be a character that grabs my interest and makes me want to know more. I'm anxiously awaiting next month's post now that I've read this one. And I have truly enjoyed working with you on Wolf Creek-Bloody Trail.

  12. Thanks Cheryl! And it was a total pleasure to work with you on the book as well. And with Troy, Jim, Larry and James. It was quite the most enjoyable writing experience that I have ever had.

  13. Keith,what can I say but that your blog was totally fascinating.
    I have an old book, "A Minnesota Doctor's Home Remedies," that I refer to from time to time. Your doing Dr. Munro is perfect. I'll certainly be looking for your next blog.
    The best,

  14. Small bits of content which are explained in details, helps me understand the topic, thank you!

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  15. Thanks for your kind words, Jerry. I am having a great time working on Wolf Creek. I think we are all conscious of Troy's masterful touch behind the scenes. The town he created feels like home to so many characters. I must say that I really enjoy your chapter in Murder in Dogleg City. I thought the whole book worked really well as a western-mystery.

  16. Oh goodie! I'm going to love this series. Since other put in their requests, mine's for medicines. I'm fascinated with the patent medicines in the Old West. My first western historical romance features laudanum, Dr. Hostetter's Stomach Bitters, and Dr. Liebig's Lost Manhood Restorer. The ingredients in these medicines would shock our modern day sensibilities. :)

  17. You'e got it, Jacquie. I've got this in my list of to-do's. This subject is actually one of my areas of interest. And I'll also throw in some of the early quack treatments, like Perkin's tractoration, of which George Washington was an enthusiastic supporter.

    Nowadays we think of patents as being an official government protection, but the original meaning comes from a 'patent of royal favour,' which was granted to those who supplied medicines to the British royal family. And of course in the early days of actual patents it was all flouted and we saw the rise of the quacks and snake oil salesmen.

    Dr Liebig's Lost Manhood Restorer! A letter day viagra. Excellent! LOL!

  18. Keith. Thank you so much. As you know (I think) Dr. Goodfellow makes an appearance in my Road to Rimrock novel. He was the go-to doctor for abdominal wounds. Personally, I tend to go to native medicine men or women who were usually herbalists and had access (training) to centuries of experience. Could you give us some information on those, too, as we move along?
    Thanks for the great blog subject. Look forward to more.


  19. Thanks, Charlie. I will add that to my list. I would have had an eclectic approach myself and added whatever worked. Which is how Logan Munro practices.

    I very much enjoyed Road to Rimrock, by the way.

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