Dr LEWIS SAYRE's 1862 TREATMENT FOR GUNSHOT WOUNDS

The Doctor's Bag

The blog about Medicine and Surgery in the Old West 

By Keith Souter aka CLAY MORE

Dr George Goodfellow, the surgeon to the gunfighters is famed as the doctor to treat your gunshot wound in the Old West. He developed his expertise during his practice in Tombstone and later on in Tucson in the 1880s and wrote a major paper on the subject in 1889. He was practising in the early days of antiseptic surgery and adopted Joseph Lister's methods of sterilizing instruments in carbolic acid and cleansing wounds with it. 

A hand-operated carbolic spray, such as Dr Goodfellow may have used

As western writers we often set out stories before the Lister era of aseptic surgery. I thought it might be useful to consider how earlier doctors might treat gunshot wounds, so here is a short paper from the American Medical Times of 1862, by Dr Lewis Sayre. He was a leading orthopaedic surgeon of the nineteenth century. 


Oakum as a Substitute for Lint, in Gunshot and other Suppurating Wounds

Dr LEWIS A. SAYRE recommends (Am Med Times, Aug 9, 1862) picked oakum as a substitute for lint, in all cases of suppurating wounds, particularly in connection with opened joints where the suppuration is excessive. The oakum, he says, is more of an absorbent than lint, and therefore fulfills one of the objects of dressing better, and another advantage is its cheapness.

"It is necessary," he says , "to place under the wound a piece of India-rubber cloth, or oiled muslin, for the sake f cleanliness; and in case of much inflammation, by simply wetting the oakum in cold water, and wrapping the oiled muslin around the limb, or wounded part, so as to exclude the air, you have at once the neatest and most comfortable poultice that can be applied to it. In gunshot wounds, which go through an through a limb, particularly if made with the 'Minié ball,' the whirl or screw of the ball entangles in its thread the muscular fibres and cellular tissue, and separates them from their attachments for a long distance from the real track of the ball itself.

"As the muscle and tegumentary tissues are more freely supplied with blood vessels than the the fat and cellular tissue, the consequence is that they begin to granulate more readily than those other tissues, and will thus often close up the wound, and prevent the free escape of pus, before those parts have perfectly healed, and thus lead to the formation of extensive secondary abscesses. I, therefore, in all cases where no blood vessels prevent it, pass an eyed probe through the wound and draw through it a few fibres of the oakum or tarred rope, which keeps it perfectly free, and the tar is a very excellent antiseptic, and removes all unpleasant odour.

"A few fresh fibres are twisted on the end of the seton *at every dressing and drawn into the wound, and the soiled piece cut off and removed with the dressings."


[* seton - a thread of gauze or other suture material threaded through tissue and used to keep a wound open.]

A three ring Minié ball, as invented by Claude-Etienne  Minié

Oakum

This was loose hemp or jute fiber, sometimes treated with tar, creosote, or asphalt, used chiefly for caulking seams in woodenships and packing pipe joints.

Oakum

In Victorian prisons and workhouses inmates were made to pick old ropes apart to produce oakum.


Tarred rope and oakum may be the answer in your stories of the really Old West

Hemp rope required tarring to prevent rot. So there you have it. 

If you are treating a gunshot in the 'really Old West,'  that is before aseptic surgery as advocated by Joseph Lister from 1865 (the date when he started using carbolic acid dressings and 1867 when he developed and started using his carbolic acid spray - picture above), then consider using  tarred rope strands as outlined above and wound dressing with oakum.

Dr Lewis A. Sayre (1820-1900)

To round off, you may be interested in a little background on this doctor. Lewis Albert Sayre, MD was a leading orthopaedic surgeon of the nineteenth century, who was a surgical innovator and a prolific medical writer. He was a founder of the Bellevue Hospital Medical College in 1861. This institution merged with University Medical College in New York in 1898 to become New York University School of Medicine. He was also a founding member of the American Medical Association, and was elected its president in 1880.

Dr Lewis Albert Sayre

He is most famous for being the first surgeon to operate to cure hip ankylosis (stiffness) and for his treatment of scoliosis, by suspending the patient to allow gravity to straighten the spine and then to put the body in a plaster cast. This treatment made a huge difference to many thousands of people. 

Although this may look alarming, the patient was actually in control and suspended herself prior to having the Plaster of Paris bandage applied to the torso to maintain the straight spinal position. He described this fully in his 1877 text Spinal disease and spinal curvature: their treatment by suspension and the use of the plaster of Paris bandage.

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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 past blog posts, published by Sundown Press.

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

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

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