Thursday, June 28, 2018


The Doctor's Bag

The blog about Medicine and Surgery in the Old West 

By Keith Souter aka CLAY MORE

Dr George Goodfellow, the famed surgeon to the gunfighters, was an innovator, a scientist, mining engineer, geologist and in his youth, a champion boxer. During his time in Tombstone he performed many post mortem examinations and reported on them, sometimes in straightforward clinical terms and sometimes with a wry sense of humour. His summation after the post mortem examination of a gambler by the name of McIntyre, who had been shot after an argument over the card table is an example of his wit:

'I performed the necessary assessment work and found the body full of lead, but not too badly punctured to hold whiskey."

Dr George Goodfellow

Lead poisoning indeed!

Plumbism and Saturnism
The medical name for lead poisoning is plumbism, from the Latin 'plumbum' for lead. Thus, in chemistry its symbol is Pb. 

Interestingly, it's archaic name is 'saturnism,' because lead was associated with the planet Saturn according to the alchemists. It is the heaviest of the base metals, which the alchemists sought to transmute into gold. 

The alchemist's goal of transmuting lead into gold

Lead poisoning can be devastating an individual. It can affect people of all ages, although children can be highly susceptible, as their organs are still developing. Lead is toxic to virtually every organ of the body and gradual exposure can result in a slow build up within the body.

It can cause acute or chronic poisoning. Acute is due to sudden accumulation and exposure. It can cause vomiting, weakness, tingling, diarrhea and weight loss. 

Chronic poisoning, as the name implies, is slow and takes a long time. It can cause colic, or severe abdominal pains. This is why it was sometimes called 'painter's colic,' as exposure to lead paint could produce it, without the individual being aware of it. It also caused kidney problems and, most alarmingly, profound damage to the brain and nervous system.

The Ancient Romans had an expression, 'as crazy as a painter.' This seems to have come from the erratic behaviour of artists, and it is possible that many had excessive exposure to lead based paints, especially if they sucked or moistened brushes dipped in lead paint. 

The Romans also essentially invented plumbing, again from plumbum, the Latin  word for lead. They used malleable lead piping. So, drinking water that travelled in lead pipes may have been a problem for the Ancient Romans. They also used lead acetate as a sweetener for food and wine, so that could be another source.

Interestingly, an analysis of ancient Roman cook-books finds that many writers, such as Marcus Gabius Apicius, a gourmand who lived in the first century during the reign of Emperor Tiberius, wrote the first great cookbook 'On the Art of Cooking.' He used vast amounts of spices and honey. It is thought that this was to disguise sometimes rancid meat, but also to give taste to the food of people who may have been suffering from chronic lea poisoning. Loss of taste is one of the symptoms of chronic plumbism.

Copy of Apicius' cook-book, 1541

During the middle ages wealthy people ate and drank from glazed earthenware dishes and analysis of skeletal remains in Denmark compared those living in rural areas and compared them with urban dwellers. They found a significantly higher amount of lead in the skeletons of city dwellers. The glaze would contain lead.

The Renaissance artist Caravaggio (1571-1610) is thought to have gone mad and possibly died from lead poisoning. Indeed, analysis of his bones showed that he had significant levels of lead in them, consistent with chronic plumbism.

Salome with the head of john the Baptist, by Carravagio, circa 1610

Caravaggio is a real example of the tortured genius.

Those at risk
Anyone exposed to lead paint, involved in the lead mining industry, or in the making of lead based medication or tonics. Also anyone drinking water from lead piping

The medical literature mentions people who had retained lead bullets in their bodies, could rarely develop lead poisoning.  As writers of western novels you might consider that as a cause of erratic behaviour or memory difficulty. 

Indeed, last year  the Centers for Disease Control and retention, CDC produced a report that suggested if anyone has a retained bullet or bullet fragments, then they could be at risk of lead poisoning effects. Memory loss would be very significant and lead blood levels should be tested and extraction of the lead should be considered. 

If you are interested in reading further, follow the link in one of my replies below!

Symptoms of lead poisoning
As mentioned above, lead poisoning can either acute or chronic.

Acute poisoning
  • Abdominal pain - moderate-to-severe, usually diffuse but may be colicky.
  • Vomiting.
  • Encephalopathy or inflammation of the brain. This would be more common in children, characterized by seizures, mania, delirium and coma, death.
  • Jaundice (due to hepatitis or inflammation of the liver).
  • Lethargy (due to  anemia).
  • Black diarrhea.
Chronic poisoning
  • Mild abdominal pain.
  • Constipation.
  • Weight loss.
  • Aggression.
  • Antisocial behaviour.
  • Headaches.
  • Hearing loss.
  • Foot drop.
  • Wrist drop. 

  • Carpal tunnel syndrome.
  • Gradually developing paralysis
  • Neuritis.
  • Gout.
  • Increased perspiration and sleep disturbances

The Burton Line
Chronic lead poisoning is associated with a classic blue line on the gums. This is called the Burton Line, named after Dr Henry Burton (1799-1849), and English physician who first described it and deduced it was due to lead poisoning.  A blue line is seen when the lips are pulled back, just at the margin of the gums and the teeth.

I confess to having used lead poisoning in one of my short western crime stories, although I will not say which one!

Dr George Goodfellow (1855-1910)
I began this post with an anecdote about Doctor George Goodfellow. Undoubtedly, the surgeon to the gunfighters was a truly remarkable man. He was a  pioneering surgeon. Throughout his career he established a reputation as the foremost expert on gunshot wounds, as well as being the first surgeon to perform a perineal prostatectomy along with other ‘first’ operations. For example, he improvised and performed brain surgery when it was needed and he rebuilt a friend's nose in an early plastic surgery operation. 

In addition, he wrote and published many medical papers in the journals of the day. His work on the impenetrability of silk would lead to the actual bulletproof vests of the future.

He was also a scientist, an expert in mining and geology. His research into Gila Monsters was published in The Scientific American. And in his youth he had been the boxing champion at the United States Naval Academy at Annapolis.

In March, 1910, while in  Mexico he developed an illness, although the details about it seem to be sketchy. Over several months he became more unwell and was unable to perform surgery.  He developed wrist-drop. It seems that he developed paralysis of both arms, the right worse than the left, as well as generalized weakness. He therefore made his way to Los Angeles to let his brother-in-law investigate and look after him. Apparently, he joked that people would say he was suffering from alcoholic neuritis. He said that "some would say this because they did not like him and others because  they did not know."

His brother-in-law, Dr Charles Fish treated him in Angelus Hospital in Los Angeles for several weeks. Several specialists were consulted, but no agreement was reached on the diagnosis. 

One source suggested that he had developed 'multiple neuritis,' which is a non-specific diagnostic term meaning that several peripheral nerves seem to be affected. It was speculated that it was due to an old attack of beri-beri, that he had suffered from during the Spanish-American War. Nowadays we know that this condition is caused by a deficiency of thiamine, or vitamin B1. 

He died at 7am on the morning of December 7, 1910, having previously stated that if he could not perform surgery, he had no wish to live. 

Alcoholic neuritis is a possibility, as Doctor Goodfellow himself joked, but so too is chronic lead poisoning. 

I must emphasize that I make no claim that this actually was the cause of his illness or of his death. I have no evidence and have not researched this. I think, however,  that with his wry sense of humour, as described in the anecdote that I started this post with, he may have been amused by the irony of being poisoned by the substance that he had spent a good deal of his life digging out of his patients. 


If you are interested in reading more about medicine and surgery in the frontier days, including the work of Doctor George Goodfellow, then you may find The Doctor's bag useful. It is a collection of my blog posts, published by Sundown Press.

The novel about Dr George Goodfellow, the Tombstone surgeon to the gunfighters

The novel about Ned Buntline, the King of the Dime Novelists

Buy The Dime Novelist


  1. Educational and interesting. I was aware of the hazzards of lead poisoninig but not all the symptoms. While I can't say it was true, but when I was working with juveniles in my early career, some of their actions may have been the result of lead in their systems. It's a thought I shall ponder.

    Thank you again for adding to my knowledge of the medical aspect for future writing. Doris

    1. Thanks, Doris. Nowadays, blood tests would determine whether lead levels were raised. Back on the frontier doctors would have to go on clinical acumen. I think that a lot of these skills have been lost, as we rely more and more upon the lab, radiology and ever more sophisticated scans. There is an inevitability about this, but I think doctors should maintain the traditional examination skills and look out for clinical signs such as the Burton Line.

  2. Among the many safety warnings I heard in school during my early elementary years in the 1960s, one of them was not to eat paint (as in chips of paint from windowsills). I recall wondering why anyone had to be warned NOT to eat paint, as it never occurred to me that paint was something one wanted in their mouth. *grin* Thank you for another interesting and helpful article.

    1. Thanks, Kaye. The thing is that youngsters are inquisitive and explore. They tend to put things in their mouths and if they had tasted lead paint flakes they would find them sweet. That is the problem.

    2. Oh my gosh. I had no idea that lead paint is sweet. *smacking forehead* That makes perfect sense. Thank you for that tidbit.

  3. I wonder, if someone like a gunfighter was shot often enough, could they get lead poisoning from the lead in the bullets?

    Like the "mad hatters" who were poisoned as they worked with mercury, I see here that painters went nuts with lead in the paint. What a shame people did not know this early on.

    My mother had rheumatic heart disease she contracted in her childhood after having strep throat. She was on a diuretic that contained mercury. When I was about eight, I remember the day we had trouble waking her up. After an urgent visit to the doctor, they discovered high levels of mercury in her blood. She was taken off that diuretic immediately and managed to overcome the mercury that had built up in her system. That was in the late 1950's...amazingly.

    The scariest thing to me is the number of old houses with lead pipes that people buy without replacing the plumbing.

    What an interesting physician Goodfellow was and so varied in his skills. Now all doctors have a specialty, but Dr. Goodfellow did it all! I can't imagine him performing brain surgery and, apparently, he was successful. What a shame his life ended the way it did.

    As always, you have written a most informative and interesting post. I am always eager to read them. Happy Birthday, Keith.

    1. Absolutely, it could, Sarah.

      The Centers for Disease Control and Prevention, CDC, last year produced a report. If anyone has a retained bullet (they do not always have to be removed) then there is a risk of lead poisoning and it has to be considered.

      Have a look at this link and follow it through if you are interested.

      Thank you for your birthday wishes!

    2. Interesting. My oldest brother was shot (accidental misfire), the round was never removed, he died relatively young (70) but of lymphoma.

      My father suffered multiple gunshot wounds in 1945, several fragments remained in his body, he developed Alzheimer's in his 60's and died at age 88.

    3. Dang. Accidental *discharge.*

    4. Thank you for stopping by, Shay. Whether lead was a factor in your brother and father's cases, no one can say, but I think there is good reason for a serious large scale retrospective study to be done. It could have huge implications.

  4. Fascinating stuff, as always, Keith! The drop wrist symptom is really interesting to me -- odd, for sure, isn't it? Happy birthday today! Hope you are having a wonderful day today!

  5. Thanks, Cheryl.

    Yes, you can get foot drop and wrist drop. Memory problems would be highly significant.

  6. Happy Birthday Keith - another highly interesting post. I love your medical posts - always something fascinating to tuck into one's stories.

  7. Thanks, J.E.S. There are all sorts of possibilities for stories involving lead.

  8. Very interesting, Keith. I cringe at the thought of blue gums.

    1. Thanks, Jerry. You are right, plumbism is definitely something to avoid.

  9. Nice and unique collection of western wear. Keep sharing..!!