Thursday, September 25, 2014

Dr JULIAN CHISOLM - A GREAT INNOVATOR DURING AND AFTER THE CIVIL WAR



THE DOCTOR'S BAG

Keith Souter aka Clay More


Medicine and surgery have always advanced during times of war. Surgical techniques are developed to deal with the wounds and injuries that weaponry cause. And medical  innovations are often also introduced on order to make scant resources stretch further. In the Doctor's Bag this month I am going to focus on a doctor who contributed to medicine and surgery both during and after the Civil War. His invention of the Chisolm inhaler was one of the most significant medical inventions of the 19th century.

Dr Julian John Chisolm (1830-1903)
Julian John Chisolm, often referred to as john Julian Chisolm or as J.J. Chisolm was born in Charleston, South Carolina in 1830. He obtained his MD medical degree from the Medical College of South Carolina in 1850 then travelled to Europe to study medicine and surgery in Paris and London.


He returned to Charleston in 1860 and took up the post of Professor of Surgery at the Medical College. He  kept the position throughout the War and in 1861 published the first edition of his textbook A Manual of Military Surgery for the Use of Surgeons in the Confederate States Army.


He was one of the few competent surgeons at the start of the War (it was the steepest of learning curves for surgeons on both sides), but his book gave detailed instructions. His experience was based on personal observations of many wounds  treated in both civilian and military hospitals admitted form the battlefields of Europe. The book was updated twice during the War.

He also indicated his views on the practice of venesection (blood-letting) in chest wounds.


"Where the heart and pulse are both weak--a common condition after severe wounds--in our experience the abstraction of blood will occasion a complete prostration of strength, and may be fatal. There is no reason for changing the plan of treatment already discussed in detail, for combating inflammation following gunshot wounds, and which is equally applicable to chest, wounds. Even when the lung is inflamed, we prefer the mild antiphlogistic and expectant treatment to the spoliative. The large success in the treatment of perforating chest wounds in the Confederate hospitals puts forth, in a strong light, the powers of nature to heal all wounds when least interfered with by meddlesome surgery. Absolute rest, cooling beverages, moderate nourishment, avoiding over stimulation, with small doses of tartar emetic, veratrum, or digitalis, the liberal use of opium, and attention to the intestinal secretions, will be required in all cases, and in most will compose the entire treatment."

The Chisolm Inhaler
During the war chloroform took over from ether as the anaesthetic of choice. It was administered by using a piece of cloth, which was fashioned into a cone, onto which the chloroform was administered. This was found to be wasteful, since much of the chloroform evaporated. Hence it was unscientifically and crudely given and could also affect anyone see in the enclosed space used as an operating theatre. In a field hospital that may have been a tent.

With the Union Naval blockade the supplies of chloroform were drastically reduced. Stimulated by that, and by the wasteful and hazardous way it was traditionally given he invented  his inhaler. It consisted of a flattened cylinder, measuring 2.5  by one inch, with two tubes which could be inserted into the nostrils. The chloroform was dripped into a perforated disc onto a cloth inside the inhaler. It reduced the amount needed to a mere ten per cent.



Surgeon, Scientist and Medical Purveyor
On the September 20, 1861 he was appointed as Surgeon in the Confederate Army and set up a hospital in Manchester, Virginia.  Then in November of that year he was ordered to set up a medical purveyor's office, which received and distributed medical supplies and surgical instruments to surgeons and doctors in the field.

The purveyors office was later moved to Columbia, where he established a laboratory. There he developed medicines that were also in  scarce supply because of the Union Naval blockade. The drugs were made from indigenous plants

Members of the public were asked to help the war effort and grow plants:

In obedience to an order of the Surgeon General, I … request … ladies of the South to extend the sphere of their usefulness, by interesting themselves in the culture of the garden Poppy; by which they will administer to the relief of our sick and wounded soldiers and render essential service to our Confederacy. The seed of the Poppy should be planted in rich ground, and the largest pods or capsules selected for use. To obtain the gun, the pods or capsules – a few days after the (illegible), should be cut longitudinally through the skin. This would be done later in the afternoon, the hardened gum being scraped off in the morning by means of a dull knife, then wrapped up carefully, and should be sent to the nearest Purveyor. Persons having seed of the poppy, will be paid a liberal price for them at this office. R. Kidder Taylor, Surg. And Med. Purveyor, CS Army.


Dr Chisolm had in his laboratory 'a series of copper kettles for evaporating.' He recommended  staffing other laboratories with chemists from Europe, skilled in extracting alkaloids from plants. In particular, he gave the example of finding a substitute for  quinine, which was in extremely short supply and which was needed to treat malaria. The normal source of quinine was the  cinchona trees, which do not grow in  the south.  A tincture could be made of willow, dogwood and poplar bark as a substitute.




With the ultimate Union advance in June 1865, Dr Chisolm turned over to a Union officer 'all machinery, injured by fire formerly used at the Confederate States laboratory & Distillery located at the Fair Grounds on the outskirts of the town of Columbia.' This included about 80 pounds of gum opium and 340 ounces of morphine.

Professor or Eye and Ear Surgery
After the War, Dr Chisolm moved to the University of Maryland in Baltimore  and accepted the chair of Eye and Ear Surgery created for him. Once in post he founded the Baltimore Eye and Ear Hospital and the Presbyterian Charity Eye, Ear and That Hospital.  He is considered to be the founding father of American Ophthalmology.

He wrote over a hundred medical papers and continued to be innovative in his surgery and in his research. In 1888, for example, he grafted a rabbit cornea onto a human. He also made significant advances in cataract surgery.

Helen Keller, Charles Dickens and Alexander Graham Bell
Helen Keller (1880-1968), the famous American activist, author and lecturer had been taken to see Dr Chisolm as a child, after she had gone deaf and blind following a childhood illness. It is possible that the illness was scarlet fever or meningitis.  He advised her to be seen by Alexander Graham Bell, who was working with deaf people at the time. His parents had both been deaf, which had led him to try to develop a range of hearing instruments for the deaf. As a result, in 1876, he had patented the first useable telephone!

Interestingly, Helen Keller's parents had been inspired after reading Charles Dickens American Notes, about his travels in America. In it he mentioned visiting the Perkins School in Boston,where he had been impressed at the work of Dr Stanley Howe, the director of the Perkins Institution for the Blind, with Laura Bridgman, who would become the first blind-deaf person in America to gain a significant education in English. It was Laura Bridgman who advised seeing Dr Chisolm.

Dr Chisolm had a stroke in 1894, from which he made a partial recovery. He died in 1903 in Petersburg, Virginia.
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Clay More's novel about Dr George Goodfellow is published in the West of the Big River series by Western Fictioneers. 



Available at Amazon.com:



And his collection of short stories about Doc Marcus Quigley is published by High Noon Press


Available at Amazon.com:


And his latest western  novel Dry Gulch Revenge was published by Hale on 29th August.


20 comments:

  1. What an amazing man and an impressive body of work. I wonder how he became interested in ophthalmology in the first place. He'd been dealing with wounds during the war--did he publish any papers on eye wounds and care?

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    1. Hi Jacquie, yes he was an amazing man. He studied eye and ear surgery in Paris and London and he wrote over a hundred papers.

      Doc Logan Munro uses a Chisolm inhaler all the time.

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  2. Fascinating article, Keith.Whenever I think of chloroform, I've always had the image of someone sneaking up behind another person and slapping a handkerchief over the victim's mouth. I was surprised to learn that image actually paralled how it was administered--without the sneaking, of course. Thanks for the insight.

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    1. Thanks, Tom. Chloroform made surgery a far less horrific prospect for people, but overdose was certainly possible when administered in an ad hoc manner. It was used in various other ways, including internal dosing in conditions like cholera and gonorrhoea! Not sure how successfully, though

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  3. As always, good stuff, Keith. And I cannot recommend The Doctor highly enough. Of course, Dr. Goodfellow shows up in Chuck Tyrell novels, too, so I may be a tad prejudiced.

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    1. Thanks, Charlie. You have every right to be prejudiced, you wrote about him first.

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  4. Keith, I always enjoy your medical posts. Anything about the Civil War gets my attention because, of necessity, that was an innovative period in many ways. Particularly in medicine, the war brought about some big changes, and it appears Dr. Chisolm was responsible for several of those changes.

    I can't thank you enough for sharing your knowledge with the rest of us. You, sir, are a kind, generous person.

    (I agree with Chuck about The Doctor, BTW.)

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  5. Thank you, Kathleen. It is amazing to think that people could qualify in medicine in such a short time back then. Starting out as a doctor at the age of 20 seems so daunting!

    And thank you about The Doctor. I appreciate it.

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  6. Dr. Keith,

    Just read WEST OF THE BIG RIVER: THE DOCTOR and posted a review on Amazon.com about that wonderful book and Dr. Goodfellow.

    As always you have written another fascinating blog about real doctors and procedures of the past.

    We ALL admire your writing and your studied work.

    Charlie

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  7. Thanks, Charlie. Dr George Goodfellow made a huge contribution to surgery and was a larger than life character. But so too was Dr Chisolm. I enjoyed researching and writ in about them both.

    And thank you for your very kind review.

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  8. Keith,
    Your continued posts on these innovative people of medicine are so fascinating. The learning curve is getting small enough that I can truly follow what they are saying. For me that is priceless. You allow the lay reader to understand the importance of the contributions these people were making. Thank You. Doris

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  9. Thank you, Doris. Doing the research is fascinating. Especially tracking down and looking at some of Dr Goodfellow's papers. He wrote in the standard dispassionate clinical manner needed in the professional literature, yet you still get a sense of how he as a man actually talked.

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  10. Dr. Chisolm was truly a man for his time. His inhaler was brilliant. Had a little MacGuyver in him!

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    1. Hi Vonn, yes cometh the hour cometh the man. I agree, his inhaler was utterly ingenious.

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  11. Wow, the research you do is so impressive! almost as much as the subject matter!! and that's a LOT of morphine at the end of the war -- or is it? and here I thought the poor Reb soldiers had to suffer through when the docs cut off limbs, etc. Or was that due to the Gone With The Wind film? hmm...

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    1. Thanks, Meg. The Confederate Laboratories, as I understand it, were set up because their supply lines were disrupted and because of the Union Naval blockade. Clearly, they had clever men operating them.

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  12. Keith, I'm always so fascinated by your posts, and want to thank you so much for sharing your knowledge and love of medicine and medical history with the rest of us.

    The inhaler. Who would have thought it had been around that long? What a fantastic invention that was--especially for those times!

    I love your posts and always look forward to reading them.
    Cheryl

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    1. Thanks, Cheryl. The inhaler made anaesthesia safer, but still hazardous, of course. Nowadays we have more effective anaesthetic drugs, muscle relaxants, endotracheal intubation and gases. Yet the amazing thing is that even now we still do not know the actual mechanism of anaesthesia.

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  13. Always a great read from you - I love learning about the medical treatments that would have been available to my characters. Might never use them ... but you never know what might pop up out West, right?

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    1. Thanks JES, as you say, anything could happen. Doctors had to be innovative.

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