THE DOCTOR'S BAG - IS THERE A SURGEON IN TOWN?

CUTTING FOR STONES!

by Keith Souter aka Clay More

I've talked a bit about pain control in the 19th century. Laudanum was the great solace of many pains, as was good old whiskey in copious quantities. One of the awful causes of excruciating pain that would have sent many folks scurrying to see the surgeon was that caused by urinary stones. Sometimes you were lucky and small stones would pass with the urine. If you were unlucky there was a danger that they could get stuck and an operation might be needed.

You needed to trust that surgeon!

Famous people who suffered with stones

History is riddled with urinary stone sufferers. Napoleon Bonaparte, King Louis XIV, Sir Isaac Newton, Samuel Pepys, Benjamin Franklin and Ian Fleming. The latter, the creator of James Bond said that he had his own internal diamond making factory.

Sir Isaac Newton the discoverer of gravity

Benjamin Franklin, scientist, philosopher and statesman

The Emperor Napoleon

A little medical background

A urinary stone is called a calculus, the plural of which is calculi. This is Latin for pebble(s). As mention above, they have afflicted people throughout history. The oldest recorded one was found in an Egyptian mummy from 4,800 BC.

The Latin word calculus, for pebble only describes a smooth type. Yet many people's experience is that their stones are small, sharp and jagged, like little diamonds. There are different types of stone, you see. It depends upon what they are made of.

Around 85 per cent of stones are made of calcium oxalate crystals. About 10 per cent are uric acid crystals, 2 per cent are cystine and the rest are magnesium ammonium phosphate, or struvite.

Calcium oxalate. Struvite. Cystine. Mixed

We describe stones according to their site. Thus renal stones are kidney stones, which can form in different parts of the kidney. Ureteric stones form and may block the ureter, the tube that runs from the kidney to the bladder. Bladder stones occur in the bladder.

Stones develop if the person has a condition that increases calcium levels, which we call hypercalcaemia. This can be an inherited tendency in 50 per cent of male calculi sufferers and in 75 per cent of female calculi sufferers. Some people have a condition called hypocitruria, which means that they have low levels of urinary citrate. This promotes calcium calculi formation because citrate normally binds with calcium and prevents stone formation.  About 40 -50 per cent of stone suffered have this condition.

Another cause is hyperoxaluria, as is gout, which promotes uric acid crystal calculi.

Urinary infections can also promote mixed stone formation. 

There are other things that can do it, but there is enough information for our purposes here. Suffice it to say that staying well hydrated is one of the most important things that you can do.

Kidney stones may cause little pain. Indeed they may be asymptomatic until they produce a blockage. Once stones start to move they cause excruciating pain, referred to as renal or ureteric colic (depending where it is). Nausea and vomiting usually accompany it. 

Cutting for stone

This was how surgical treatment was referred. Hippocrates, the father of Medicine wrote in the original Hippocratic oath that 'I will not cut for stone, even in those in whom disease is manifest; I will leave this operation to be performed by practitioners.' He believed that this was something that should be left to surgeons who specialised in it.

And indeed, can you imagine such an operation performed without anaesthetic?

The operation was carried out in the lithotomy position. That is, with the patient lying on the back with the knees drawn up to expose the perineum. The word comes from the Greek lithos, meaning 'stone- and tomos, meaning 'cut.' Nowadays we still use this position (and the name for it) for other procedures, but use stirrups for the feet to get in that position.  In centuries gone by, three men would be needed to hold the patient down.

Bladder stones were removed by this perineal approach. The perineum is the area between the genitals and the anus. It was a potentially very dangerous operation, with a high risk of haemorrhage, infection and incontinence afterwards. 

A range of instruments were used for this procedure, including scalpels, dilators, forceps, cystotomes (for cutting into the bladder), urethratomes (for cutting into the urethra) and lithotomes (for cutting the stones.)

Suprapubic lithotomy was also practiced by some surgeons. That is, the operation was down through the lower abdomen. Again, in pre-anaesthetic days it was a dangerous operation.

Transurethral lithotripsy was the greatest advance. The French surgeon Jean Civiale (1792-1867) developed this method by introducing instruments through the urethra, that is directly through the tube leading into the bladder. He invented an instrument called a lithotrite, which bored holes in the stone, then broke the stone up. It would have required great skill, since it was all done without the aid of imaging techniques, but since it did not require cutting into the bladder, it reduced complications.

Dr George Goodfellow

The great Tombstone doctor was known as the surgeon to the gunfighters. He was a surgical innovator. Among his achievements he was the first American surgeon to perform the perineal prostatectomy. Afterwards he travelled the USA demonstrating the operation.

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:

THE DOCTOR by CLAY MORE

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

Available at Amazon.com:

ADVENTURES FROM THE CASEBOOK OF DR MARCUS QUIGLEY

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

THE DOCTOR'S BAG

I THINK IT'S BUSTED, DOC!

By Keith Souter  aka CLAY MORE

It is a dangerous business being a character in a western novel. You can get shot at, tossed off a horse, hurled through a saloon window or be pushed over a ravine. You have seen it on the movies, read it in the novels or written about it yourself. Any of them can have fatal consequences, but more often than not in this fictional world that we love so much the result is a broken bone somewhere. And then the Doc comes along just in time to hear that speculative diagnosis - "I think it's busted, Doc!"

                                           A Dash for the Timber by Frederic Remington

And of course, an examination reveals all, a splint is manufactured, a dose or two of laudanum and "You'll be up and about in no time at all."

But in real life it is often more complex than that.

 

                                             The BroncoBuster by Frederic Remington

The birth of orthopaedics
We know that doctors have been setting bones since the days of the ancient Egyptians. We have surgical papyri outlining treatments and mummies have been found with splints made of bamboo, reeds, wood or bark, padded with linen.

The roman physician Galen (129-199 AD) treated gladiators and recorded his treatments in his medical and surgical encyclopaedias. His treatments were used as the basis for treatments all the way up the the Renaissance.

The name orthopaedics was first used  in 1741 in France, when Nicholas Andry, a professor of medicine at the University of Paris coined it from the Green words 'orthos,' meaning 'bone' and 'paideia' meaning 'rearing of children'. His book Orthopédie was about the prevention and correction of musculoskeletal deformities in children. There was a real need for this since there were many diseases that could cause problems like scoliosis (curvature of the spine), abnormalities in the growth of bones (e.g., tuberculosis), various infections (osteomyelitis), vitamin disorders (e.g. vitamin D deficiency causing rickets or bowed legs), and conditions that could cause paralysis, such as poliomyelitis.

                                                     Professor Nicholas Andry (1658-1742)

So, the specialty of orthopaedics was originally all about treating children to prevent problems. The treatment of fractures became added along the way.

The frontispiece for his book showed a sapling supported by a staff. This has been taken as the logo of orthopaedic institutions and organisations across the world ever since.

In   Jean-Andre Venel established the first orthopaedic institute in 1781 for the treatment of children.

Splints and supports
As mentioned above, splints of various forms have been used from the times of antiquity. The purpose of them is simply to support the leg and prevent movement of the broken ends of the broken bone.

In medieval times surgeons knew that fractures bones had to be kept in place. One method of doing this was to soak bandages in horses' urine. As the bandage dried it would stiffen into a splint.

Plaster of Paris casts
This was a fantastic addition to the surgeon's armamentarium of treatments. It was the invention of Antonius Mathysen, a Dutch military surgeon in 1851. Essentially, a continuous bandage is wound round and round the limb then soaked in Plaster of Paris. It is called this because it was first used extensively in Paris in medicine and in building.

Essentially, it is made from gypsum, which is heated to produce anhydrous calcium sulphate. When water is added to this it forms gypsum again and hardens.  Hardening takes place very quickly, but it has to dry out. The larger the cast, the longer it takes. An arm cast will dry out in 3-6 hours and a leg cast may take up to 6 hours.Yet full drying may not be complete for 72 hours.

Diagnosis of fractures
Nowadays we are very dependent on x-rays, but in the old West there was no such thing. William Roentgen discovered them in 1895. Only a year later, Dr John Hall-Edwards in Birmingham, England started to use the so-called X-rays in medical diagnosis.

In the Old West doctors relied on physical examination to diagnose fractures. Then, and now fractures would be divided into two broad types:

• Closed or simple fractures - when the skin is intact.
• Open or compound or - when the broken bone protrudes through the skin.

The type of fracture can vary immensely. We talk about a 'clean break' meaning a simple transverse fracture. But it can also be oblique, as can happen with a torsion injury. Or it can be comminuted, meaning fragmented, It can be complicated by causing blood vessel or nerve damage. And it can be a 'greenstick' (as happens in youngsters, when a bone gets bent and only partially fractures).

The principles of treatment of fractures was relatively simple then. If moving the part of the body distal to (furthest away from the site of the pain) caused extreme pain or if  grating could be felt, then a fracture would be diagnosed. 

The bone had to be set. That is, the limb had to be stretched in order to make sure it was the same length as the other. This would give the best chance to get the two broken ends in position against one another to allow healing to take place.

Without the use of x-rays it is very likely that all manner of injuries would end up being diagnosed as a fracture. The treatment would involve immobilising the part and hopefully, the injured part would just 'knit together' and be whole again after a few weeks. Remember, that nature actually does the healing, not the doctor, surgeon or nurse. All that they do is create the best circumstances for nature to do its job.

And of course if the 'broken bone' healed up all right, it would bring nothing but kudos to the doctor, whether it actually had been a fracture or not.


Bone healing
What actually happens when the bone ends are back in opposition is that a large haematoma, or blood clot forms around the ends. This is rather like jelly. After a few days blood vessels grow into it and cells called phagocytes start digesting any debris and tissue that won't heal. Then other cells called fibroblasts start to lay down collagen, that forms a frameworks around the bone ends. This secures the  one ends and new bone is laid down. As a rule of thumb, most bones will have knitted in about 6 weeks.

Some fractures worth knowing about
There are lots of different fractures, many of which are named after the doctors or surgeons who first described them. Some of the ones which our western doctors would have known about are as follows:

Colles fracture
A fracture of the distal radius one inch (2.5 cm) above the wrist. It was described by Abraham Colles an Irish professor of anatomy in 1814. It is sustained by falling on the outstretched hand as when you try to break your fall. The problem is that the broken bone gets displaced and causes a dinner-form abnormality if it is not replaced in posit and immobilised. It takes 4- 6 weeks to heal.

Bennett's fracture 
This is one that could occur in saloon brawls, or whenever a really hard surface was punched. If you swing at someone and they duck, causing you to punch the wall, you may end up with a Bennett's fracture. It can also occur if someone punches someone else's skull! It is a fracture of the first metacarpal, the big bone at the base of the thumb. It is also common in people who have never learned how to punch correctly - which is most people! It was described by Edward Hallaran Bennett, professor of surgery at Trinity College Dublin in Ireland in 1882. It needs immobilisation of for 4-6 weeks.

Scaphoid fracture
This is not named after anyone, but is the name of one of the bones of the wrist. It also occurs when you try to break your fall. It causes pain in the 'anatomical snuffbox.'  This is an area at the base of the thumb. It is called this because in days of yore when folk took snuff, they placed a pinch in the lilt depression on the ice of the wrist formed when you elevate the thumb perpendicular to the hand. The problem with this fracture is that the scaphoid has a variable blood supply and in many people the blood supply comes distally. That is, blood vessels do a U-turn to supply the bone from its far end. If they do not also have a blood supply going directly into the base of the bone (that is, from the top and bottom) then non-union of the bone can occur and the piece without the blood supply can die.

Monteggia fracture
This is a fracture of the proximal third of the ulna (the larger bow in the forearm) with dislocation of the head of the radius (the smaller bone). It was named after Giovanni Monteggi, (1762-1815) an Italian professor of anatomy and surgery. It occurs with a fall and a twist. It is a difficult one to treat because the breaks and the two bones are hard to get in the right positions.  Nowadays it may necessitate operation.

Clavicle fracture
The collar bone is commonly injured in contact sports and fights. A direct blow to the upper chest can  fracture it, most usually at the junction between the middle and outer thirds. They heal up very well generally. We used to use figure of eight bandages and a sling, but really they generally just heal without any intervention.

Fracture of neck of femur
The femur is the thighbone. The two main parts are the neck of the femur, where it forms the hip joint and the shaft, the main part of the thigh.  This is the sort of fracture that happens in older people who may have osteoporosis, or thinning of the bone. This is nowadays treated by internal reduction and fixation. It is probably not going to occur to your hero or heroine in the western novel, but could to another character. It classically causes a great deal of pain after a fall or twist, and the leg will show external rotation due to the weight of the limb.

Fracture of the shaft of the femur
This can occur with any large trauma, either directly from a blow or from a fall. Depending upon which part of the shaft is affected the muscles will move the two parts ion different directions. The first aid treatment would be to strap the two legs together, so that the good leg acts as a splint.

Skull fracture
The big thing here is the possibility of a hemorrhage inside the skull or into the brain. In terms of the novel, the big question would be whether to trephine or not. That is, whether to make a hole in the skull to release blood.

This just happens to be one of the questions that Doc Logan Munro is forced to consider in Wolf Creek 8: Night of the Assassins. But you will find no spoilers here!

And it is also a question posed to Doc Marcus Quigley in Dead Man's Game.
______________________________________________________________________________
 Clay More's character of Dr Logan Munro, the town doctor is appearing in several of the Wolf Creek novels

And his other new character, Doc Marcus Quigley, dentist, gambler and occasional bounty hunter continues in his quest to bring a murderer to justice, in DEAD MAN'S GAME the last in his  ebook short stories THE ADVENTURES OF DOCTOR MARCUS QUIGLEY published by High Noon Press.

THE DOCTOR'S BAG

THE PILL AND THE SYRINGE 

- pushing back the frontiers of Medicine

If you are a Gunsmoke fan you will doubtless have been amazed at how many medicines Doc Galen Adams crammed into that old black bag of his. He was prepared for any eventuality and would always have something that he could give to relieve the sick or injured.

Back in Wolf Creek Doc Logan Munro tries his best to stay up to date with modern medicine and surgery. He makes up all of his own medicines, often using herbs or traditional remedies that he has picked up along the way or been alerted to by Charlie Blackfeather.

But the way that the medicines were given is interesting, because in medicine you want to present a drug to the body in the most effective way that you can. 


The invention of the pill
We must go back into the mists of time to look at a great boon to mankind, the development of the pill as a means of delivering medicine. 

The ancient Egyptians seem to have been the first to come up with the idea. There are ten medical and surgical papyri, which detail treatments used in the days of the pharaohs. The Ebers papyrus, written about 1550 BC contains recipes for all manner of enemas, lozenges and pills. These early pills were hard compressed balls of clay or bread. In addition, they sometimes used the faeces of various creatures.

Now I guess you may have turned your nose up in disgust at that last sentence. But consider the times they lived in, with a pantheon of over 400 gods and goddesses. The world was a mystical place organised by the deities, and the priesthoods had rituals that covered just about every activity that could be undertaken. 

The scarab, the dung beetle rolled a ball of dung in order to lay its eggs inside it. This the Egyptians believed was symbolic of the god Khepri, the scarab-headed god, who rolled the sun across the heavens each day. 

The dung beetle rolling the ball was thought to be symbolic of the god Khepri

The scarab was the ancient Egyptian symbol of birth, regeneration and renewal as well as being used as a powerful talisman for health. It has been suggested that priest physicians invoked Khepri when they made their remedies, which they did as these crude pills, like the dung beetle.

Coating the pill

The basic design for the pill lasted almost 2,500 years until the Persian physician Rhazes (865-925 AD) improved upon it by giving it a coating. By using a psyllium-seed mucilage the solved the problem of the nauseating or bitter tasting pill.

                                                                 Rhazes (865-925 AD)

A  century later another Persian polymath, known as Avicenna (980-1037 AD) further improved it by coating his pills in silver or gold leaf. In an age of alchemy, precious metals were thought to enhance the effectiveness of medicines. An interesting boost to the placebo effect.

                                                           Avicenna (980-1037 AD)

The first London Pharmacopoeia
A Pharmacopoeia is a book of drugs with all of their ingredients, actions and side effects. The first London Pharmacopoeia of 1618 contained recipes for 38 pills. Of these, 23 were derived from medical works written in Arabic. Two were from Avicenna and one from Rhazes. 

This photograph shows a sample page detailing a purgative pill devised by Avicenna - Pilule Pestilentiales Ruffi.


The problem of bioavailability
Bioavailability means the readiness with which a drug can be absorbed and allowed to reach its target organs. The pills that had been in use for centuries often had poor bioavailability because the material they were encased in didn't break down in the intestines. In many cases it would be like swallowing and trying to absorb buckshot.

In 1834 the French pharmacist Mothes devised the gelatin capsule, which could be used to contain liquids or powders.These are still used today.

A real breakthrough came in 1884 when Dr William Upjohn (1853-1932) patented a 'friable pill,' which was made by compressing powder into a pill shape. This would then dissolve in the stomach and be absorbed quickly. It had good bioavailability. 

Dr Upjohn lived, qualified and practiced in Michigan. He knew that his invention was a winner, the problem being to persuade other doctors to use his friable pills rather than their own hard pellets. He did it by sending thousands of pine boards along with traditionally made pills and his own friable pills to doctors all over the country, inviting them to  try to hammer the traditional pills into the board. They often did so without breaking, showing how hard it was for the body to absorb. In comparison, one of his friable pills could be turned into powder, ready to be absorbed, merely with the pressure of the thumb. It was a brilliant and persuasive image which became the logo of The Upjohn  Pill and Granule Company that he and his brother formed in Kalamazoo in 1886. It was to become one of the pharmaceutical giants of the 20th Century.

It changed the face of medicine.



The hypodermic syringe
We now come to a relatively recent invention, the hypodermic syringe. Being the sort of man that he is, Dr Logan Munro would certainly grasp its potential and soon be giving the citizens of Wolf Creek the benefits of the latest science.

Hypodermic comes from the Greek hypo, meaning 'under' and derma, meaning 'skin'. It therefore means syringing under the skin into the body.

This is one of the most important inventions in medicine, for it gave doctors a means of delivering drugs into the patient's system, by-passing the gastro-intestinal tract. That is often a good thing to do, especially if the person has an inflamed stomach or if they are vomiting and unable to keep anything down. But it wasn't invented until the mid-nineteenth century.

Syringes had been used in medicine for centuries, but for introducing fluid into bodily orifices, or to suck out fluids or pus. Some attempts to give drugs by injecting them into the body were made in the early seventeenth century, but they were not successful and fatalities did occur. In those days it would be highly likely that infections would have been directly introduced to the tissues.

The first necessity was to produce a hollow needle. This was done by Dr Francis Rynd (1801-1861) an Irish surgeon in 1843. He successfully develop a technique with a hollow needle for injecting opiates to treat neuralgia.

Dr Thomas Wood (1817-1884) a Scottish physician invented the first hypodermic syringe in 1853. Apparently he tried to copy the cation of a bee sting, so he used a hollow needle that could be attached to a metal syringe.  He used t to inject morphine and other opiates in the treatment of neuralgia, which was at that time  an umbrella label for all manner of painful conditions.

             
                                                      Dr Thomas Wood (1817-1884)

During the Civil War most surgeons simply dusted morphine into wounds or gave opium pills. Dr John Billings (1838-1913), a Lieutenant Colonel in the Union Army was the first doctor to use a hypodermic syringe in the field. Despite his advocacy of it, however, probably less than a dozen were used during the war.

                                                          Dr John Billings (1838-1913)

Dr Billings would go on to become one of the most prominent physicians and librarians in American medicine.

                                                 A mid-19th century hypodermic syringe

Syringes are used to inject subcutaneously (just under the skin), intra-muscularly (into the muscle) and intra-venously (directly into the blood stream through a vein). It is important to expel any air when giving an intra-venous injection, sine an air bubble can travel throughout the circulation as an air embolism. It can have the same effect as  a blood clot and could produce a heart attack, stroke or chest pain. They can be rapidly fatal. It is for this reason that you see doctors invert a syringe, as in the position in the photograph, tap it to get any air to the top of the syringe, below the aperture of the needle, then squirt some fluid out. This is to get rid of air bubbles to prevent an embolism.

Hell on the Prairie, the sixth Wolf Creek book features Keith (Clay More's) character Dr Logan Munro, the town doctor in THE OATH, a story about a spectre from his past. 

Logan has been in Books 1, 4 and 6, and 8 and appears in the second Christmas anthology O DEADLY NIGHT in the story THE SPIRIT OF HOGMANAY 

And his other new character, Doc Marcus Quigley, dentist, gambler and occasional bounty hunter continues in his quest to bring a murderer to justice, in RATTLER'S NEST in his  ebook short stories THE ADVENTURES OF DOCTOR MARCUS QUIGLEY published by High Noon Press.

DOUBLE-DEALING AT DIRTVILLE was originally published by Hale as a Black Horse Western, but is now available as an ebook from Western Fictioneers Library.

THE DOCTOR'S BAG

ELECTROTHERAPY - the shocking treatment

By Keith Souter aka CLAY MORE

In my first western novel Raw Deal at Pasco Springs, believe it or not, one of the main characters is a doctor. He considered himself to be an up-to-date doctor and used electrotherapy in his practice. He was not alone in that, for doctors in Europe and America were adding it to their range of treatments. 

Here is a snippet:

Lucinda squeezed Tom’s hand while Doc Hawkins deftly sutured the wound on her shoulder.

‘You were lucky my girl,’ the doctor remarked, peering through wire framed spectacles perched on the tip of his nose. ‘A few inches East and …’

‘Don’t even think of that, Doc,’ Lucinda said with a shiver. ‘It’s bad enough that they murdered poor Curly.’

The doctor straightened up and sucked air between his teeth. ‘Your arm’s going to feel real numb for a few days, unless I stimulate the nerves and muscle.’ He  crossed his consulting room to a table on the far side of his roll-top desk. It was bedecked with strange looking glass jars full of liquids, rods and copper coils. He selected one with long wires leading from it and returned to the couch.

‘The very latest in medicine from back East,’ he explained. ‘This is a galvanic battery for giving what they call Faradic Stimulation.’ He handed Lucinda a rod to hold while he strapped a paddle gently over her upper arm.

‘This’ll tickle a bit,’ he informed her as he twisted wires together on top of the battery. Immediately the muscles on her arm started to twitch so that despite herself, Lucinda giggled.

‘Why it’s making my arm move all by itself,’ she uttered in amazement.

‘This is the future, folks,’ said the doctor. ‘Copper! These wires transmit electric currents. Back East they have buildings illuminated with electric light.’ His  eyes twinkled almost reverently, as if he could see this vision of the future. ‘One day we’ll laugh at our primitive kerosene lamps and simple electric batteries like these.’

Lucinda giggled again. ‘I think you’d better turn this tickling machine of yours off now Doc, or I’m going to pee myself with laughing.’

 Electricity was definitely in the air in the nineteenth century. That is to say that the discoveries about electricity that had been made in the previous century had opened up whole new areas of research. The Italian Luigi Galvani (1737-1798) an anatomist and professor of obstetrics at Bologna University had performed experiments on frogs’ legs and discovered that electricity could make them twitch. Then Alessandro Volta (1745-1827), a professor of physics at Pavia University invented the first battery, the voltaic pile.

It seemed that this was a power that could have immense benefit in medicine – and all sorts of folk started using it.

John Wesley and Ethereal Fire

The name of John Wesley (1703-1791) is forever associated with Methodism, which he founded along with his younger brother Charles Wesley. He was an Anglican minister but found himself banned from many pulpits because his religious views were considered radical. He therefore travelled extensively, both in England and America, preaching in open areas to the poor whom he often found to be excluded from churches. In America he railed against the practice of slavery.

            Not only did he believe that he was called to help people with their spiritual needs, but he also wrote about medicine and how people could use self-help techniques when they were ill. His book Primitive Physick was published in 1747 and was widely sold and used.

In that same year he saw for the first time an exhibition of Galvanism, or the use of electric batteries called Leyden jars to create shocks. Wesley was quick to grasp the opportunities that this amazing power, which he called ‘ethereal fire’, could hold. He became a devotee of electrotherapy and began using it to treat the poor on his travels and in a special free dispensary that he established. In 1759 he wrote The Desideratum, or Electricity made plain and useful.

Wesley subscribed to the theory that ethereal fire, as they knew electricity, caused capillaries to dilate and that it released all manner of blockages that were causing disease.

Soon ‘ethereal fire’ was being used to give shocks to people to cure them of arthritis and rheumatism, epilepsy, blindness, paralysis, back pain, sciatica and that cursed affliction of the spirits, melancholia or depression. So successful were his treatments that other dispensaries were established and Wesley’s reputation as a healer soared.

            Many of the conditions that he treated may have been amenable to electrical shocks. Certainly his use of it in depression may have been one of the only effective treatments at that time.

Nineteenth century electrotherapy

The Victorians were ingenious at constructing machines and gadgets. There was something awe-inspiring about medical machines with wires, rotating parts and cylinders and flasks that sparked and produced shocks. Doctors all over Europe and America invested in electrotherapy machines to treat everything from headaches to piles. Indeed a common treatment for piles was called ‘anal Faradism’, which involved the insertion of a rod into the rectum, followed by an electrical discharge to singe the piles. It must have been excruciating.

            All manner of belts, straps, rings and supports, which could be ‘charged’ were devised. They all had a dramatic effect, since they would produce a sensation that people could feel, and since they felt it so strongly it would be likely to produce a strong placebo effect. This is not to say, however, that any beneficial effect would be purely placebic, since we know today that various types of electrical stimulation can be helpful in the management of pain. Transcutaneous Electrical nerve Stimulation, or TNS is such a method commonly used today.

              And the belt had an internal attachment to help with other problems!

            Of less certain effect, however, would be the Galvanic Spectacles, which were invented and patented by Judah Moses of Hartford, USA in 1868. A British patent for a similar invention was granted to John Leighton in 1888. These consisted of a spectacles frame with a zinc plate and a chrome plate which settled over the bridge of the nose, with leads that attached to a small galvanic battery. A discharge of electricity was thought to stimulate the optic nerve, which they proposed would improve the eyesight. Some users of the galvanic spectacles even suggested that it would clear sinusitis and cure the common cold.

            In Paris in 1853 Dr Guillaume Duchenne published an account of his success with electricity in various conditions.  His work A Treatise on Localised Electrization and its Application to Pathology and Therapeutics was to prove influential in medical circles.

            Doctors working in the medical asylums of the day had virtually no effective treatments. Patients were physically restrained and there was no drug that could help psychotic states or the harrowing condition of depression. Electrotherapy seemed to offer some help, even if no-one knew how it worked. There were three types of electricity that they could use. Galvanism, which produced a direct current. Faradism or an induced current. And Static electricity given directly or charged in a Leyden jar. However, despite initial promise and continued use during the Victorian era the results were quite disappointing and eventually it fell into disuse. It was not reintroduced until 1938 when Cerletti and Bini introduced a very specific therapeutic use of electricity in the technique of Electro-Convulsive Therapy, or ECT, in which electricity was applied to one or both hemispheres of the brain in order to induce a convulsion.

            Other doctors were not to rigid and thought that electrotherapy had a legitimate place in the treatment of rheumatic and arthritic conditions. Indeed, it was in this area that its use would thrive all through the Victorian era and well into the twentieth century. Even today in the twenty-first century it has a place in many painful conditions, when used under the guidance of appropriately trained practitioners. 

Hell on the Prairie, the sixth Wolf Creek book features Keith (Clay More's) character Dr Logan Munro, the town doctor in THE OATH, a story about a spectre from his past. 

Logan has been in Books 1, 4 and 6, and 8 and is scheduled for more.

And his other new character, Doc Marcus Quigley, dentist, gambler and occasional bounty hunter continues in his quest to bring a murderer to justice, in RATTLER'S NEST in his  ebook short stories THE ADVENTURES OF DOCTOR MARCUS QUIGLEY published by High Noon Press.

Raw Deal at Pasco Springs, featuring that electrotherapy-toting doctor was originally published by Hale as a Black Horse Western, but is now available as an ebook from Western Fictioneers Library.