THE DOCTOR'S BAG

DIAGNOSTIC AIDS IN THE OLD WEST

By Keith Souter aka Clay More

The practice of medicine in the Old West would never have been easy. There were no x-ray facilities, no scanning of an sort and no laboratories to test  blood or examine tissue biopsies. Diagnosis was arrived at by taking the patient's history and performing a physical examination. Most doctors would have a stethoscope although American doctors favoured the monaural type even after the Civil War. Indeed, Harvard medical School did not possess one until 1868.

A doctor with his monaural stethoscope

While the doctor might have a thermometer (they were being used during the Civil War, although not often - there were only about twenty in the Union army), the examination of the eye and the ear had to be done by direct inspection. The  ear canal was examined by inserting a small speculum shaped like a funnel and then peering down it to see the ear drum. This either had to be done with natural light or a strong lamp at one's back. 

The ophthalmoscope was invented in 1851, allowing doctors to examine the eye indirectly by viewing through a lens with light reflected into the orifice. This started to be used during the Civil War and it is possible that a well-equipped and enthusiastic frontier doctor would have one after the war years. 

Dr Logan Munro of Wolf Creek, being a town doctor with a scientific bent, of course, has all of these!

But what about other tests that the town doctor could do? Well, of course, he could always check the urine.

A brief history of uroscopy
In medieval medicine the naked eye examination of a flask of urine was regarded as one of the most effective aids to diagnosis. Uroscopy, as the method was called was invented by Isaac Judeus (845-940 AD), an Egyptian physician at the School of Medicine at Salerno. 

The matula flask was the badge of office of a doctor before the stethoscope was invented

A special glass bulbous flask called a 'matula' was developed so the doctor could look at the urine and check for the presence of blood, discharge or any sediment. 

Isaac Judeus produced a colour wheel, a chart on which twenty different colours of urine were represented, each of which would give the doctor a different diagnosis.  This was used by doctors for many centuries.

Uroscopy gives way to urinology
In the 19th century science started to show the flaws in the empirical practice of uroscopy. The name changed to urinology, which instead of mere inspection involved an analysis of the urine for different qualities and different substances. 

William Prout (1785-1850) was an English physician, chemist and theologian who is regarded as one of the first doctors to introduce chemical analysis into medicine. His 1825 textbook  An Inquiry Into the Nature and Treatment of Diabetes, Calculus, and Other Affections of The Urinary Organs is regarded as one of the classics of medicine.

In this book he gives a list of "Tests, Apparatus, &c. required in making Experiments on the Urine." This includes litmus paper 9blue and red), turmeric paper (plant extract which exhibits colour change from yellow to reddish brown, and violet on drying, and is a test for alkalinity), a specific gravity bottle or a small or portable hydrometer that he designed, as well as a blowpipe, forceps, two small plates of glass for distinguishing mucus from pus and a watch glass for detecting urea when nitric acid was added. A strip of linen would stain yellow in the presence of bile, which appears in the urine in some types of jaundice.

             “These, with one or two small test tubes, and small stoppered phials, containing solutions of pure ammonia, potash, and nitric acid, can be readily packed into a small portable case, or pocket book, and will be sufficient, by the aid of a common taper or candle, to perform all the experiments on the urine, and urinary productions, that are commonly necessary in a practical point of view” 

Later, doctors added a spoon, to act as a tiny ladle, which when heated reveals the presence of albumin, a protein. This was one of the tests for Bright's Disease, a disorder of the kidneys.

Under the microscope

A doctor in the Old West who was scientifically minded enough to do his own bedside or side-room testing of urine may well have had a microscope. This would be powerful enough to show casts in the urine and the presence of blood. Naked eye examination does not always show it. And this would be important if a patient had sustained an injury to the kidney. 

If a doctor was trying to determine where in the urinary tract blood was coming from (especially if a calculus or stone was suspected - see my last blog), then he would want to see the urine as quickly after it was passed as possible. If the bleeding as from the bladder, the blood might only be found in the last portions of urine, whereas i

If a doctor was trying to determine where in the urinary tract blood was coming from (especially if a calculus or stone was suspected - see my last blog), then he would want to see the urine as quickly after it was passed as possible. If the bleeding was from the bladder, the blood might only be found in the last portions of urine, whereas if it was from the kidney, it would be thoroughly mixed.

Dr Logan Munro of Wolf Creek uses a microscope  like this, as does Dr George Goodfellow of Tombstone.

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 was published by Hale on 29th August.

Western Fictioneers Presents West of the Big River: The Doctor by Clay More

In Tombstone, Arizona Territory, the town too tough to die, Dr. George Goodfellow is known as the Surgeon to the Gunfighters. Friends with the Earp brothers and Doc Holliday, his services as a doctor are needed in the aftermath of the Gunfight at the O.K. Corral, but Goodfellow is handy with a gun and his fists, too, and he needs those skills to survive when he's stalked by a crazed miner and has to untangle a deadly murder mystery!

The West of the Big River series continues with THE DOCTOR, an all-new, exciting novel based on actual historical characters and incidents by acclaimed Western author Clay More, author of STAMPEDE AT RATTLESNAKE PASS and many other novels from the Western Fictioneers Library. One of the most stirring time periods in Old West history comes to vivid life in this tale of vengeance and heroism and a frontier sawbones dedicated to healing.

Excerpt:

Tombstone, Arizona Territory, 1891

Dr. George Goodfellow removed his stethoscope from the man’s bare back and went back to his roll-top desk.

“You can get dressed now, Stanley,” he said as he picked up his pen and made some notes on the record card in front of him. “You have a slight bronchial irritation, but nothing too serious. I’ll make up a cough linctus for you and drop it off at your office before lunch.”

Stanley C. Bagg, the five-foot tall owner and editor of the Tombstone Prospector and laterally, also the owner of the Tombstone Epitaph, tucked his shirt into his pants and pulled on his jacket. Then he pulled out a pair of wire-framed spectacles from his breast pocket and settled them on his thin nose.

“Thank you, George,” he said, standing and immediately provoking a coughing fit. He covered his mouth with his hand and then thumped the front of his chest, which seemed to have the desired effect in stopping the cough. “I guess it is inhaling all that darned paper dust and ink fumes that does it.”

The two men were old friends, as were their wives and daughters. Or at least, their wives had been good friends until the month before when Dr. Goodfellow’s wife Katherine died in Oakland from the tuberculosis that had plagued her for years. And both men were known to be forthright in their opinions and in their manners. Stanley was a bullish, combative newspaperman who for all his lack of height was a formidable man to cross. He had been prepared to serve a jail sentence for contempt of court when he refused to pay a fine imposed upon him by District Judge Barnes. Fortunately, several of his friends, including his friend and doctor had donated money to keep the newspaperman out of jail, while leaving his personal integrity intact.

As for Dr. George Emory Goodfellow, he had built the premier medical practice in Tombstone and garnered a considerable reputation throughout the Southwest as the surgeon to have operating on you, if you had a choice. He was prepared to push back the frontiers of his craft and perform operations that no one had tried before or even thought to be possible.

“It is probably more to do with those evil-smelling cigars that you insist on smoking. I’ve told you before, you are poisoning your system.”

Stanley guffawed. “And that is coming from a man who was advising me that a good pipe keeps a lot of diseases away when we were chatting just last week.”

George stood up. He was taller than the newspaperman. He was thirty-six years old and powerfully built, like the boxing champion he had been at the United States Naval Academy at Annapolis in his youth. He had been hotheaded back then and gotten involved in a fight at the Academy, the result being a win for George. Unfortunately, his prize was expulsion and discharge for lack of respect for discipline. That had been the time when he had chosen to make his career in medicine.

He had black hair with a central parting, a full mustache and steely eyes that could smolder with anger, twinkle with amusement or which could be reassuring in the extreme. As usual he was wearing a bow tie and a dark suit with his polished knee high boots.

He pointed to the wall above his desk upon which hung his framed medical degree beside a framed copy of the Hippocratic Oath, and in a small glass-fronted box a silver double-headed eagle medallion of Austria, which had once been the property of Emperor Maximilian of Mexico. Stanley had written an article about it when it had been presented to Doctor George Goodfellow by President Porfirio Diaz, along with a horse named El Rosillo in 1888 following the Sonora earthquake. They were given as tokens of Mexican esteem after he had loaded up his wagon with medical supplies and led a party ninety miles to Bavispe, Sonora, Mexico to treat survivors and injured. Then in the following months he had returned along with Camillus Sidney Fly, the town photographer, to study and record the effects of the earthquake. Together they travelled over seven hundred miles through the Sierra Madre Mountains. Both Camillus Fly’s photographs and George Goodfellow’s maps and reports earned national praise. The photographs of the earthquake rupture scarp were widely syndicated and George’s geological study had been praised by the united States Geological Service.

Stanley knew that his friend was proud of the award, yet he was far prouder of the fact that the townsfolk of Bavispe had called him El Santo Doctor, the sainted doctor. His fluency in Spanish had helped, since he could communicate, explain and reassure the injured in their own tongue. It was typical of the man that he cared more about what his patients thought of him as a doctor than he did for all the accolades and prestige that he seemed to accumulate with little effort. He was just a natural subject for newspaper coverage, one of those characters that the frontier seemed to throw up every now and then.

But it was to the framed Oath that George directed his attention. “See that Hippocratic Oath, Stanley?” he asked rhetorically. “You know as well as I do that I live by it, as best I can. If I take someone on as a patient I’ll give him or her the best treatment I can and advise them to the best of my ability. You have to accept that sometimes, like when we were chatting last week, my best may be impaired. If you recall we were playing poker at the time in the Crystal Palace saloon and we had both drunk four or five whiskies. I actually said that a good pipe kept some diseases away, on account of pipe tobacco’s natural ability to keep pesky flies and bluebottles away from the vicinity. And as you well know, the good Lord blessed us here in Tombstone with more than our fair share of the creatures.”

His hands went up to grasp the lapels of his coat, a slightly pompous mannerism of his that many folks found intimidating, because it was usually accompanied by a slight raising of his jaw and a triumphant twinkle in his eye that signaled, at least in his mind, that he had either won, or was about to win an argument.

“So, my friend, you can see that the advice I gave you was the best I could give under the circumstances.”

Stanley opened his mouth to protest when there was a sudden commotion from the waiting room outside. Voices were raised and there were exclamations of amazement. Then there was the noise of heavy boots racing across the wood floor and a beating on the door was followed by it being immediately thrown open.

“Doc Goodfellow! You’ve got to come over to Campbell and Hatch’s Pool Parlor. There’s a guy dying there.”

George recognized the messenger as Walt Harper, one of the ushers from the Schieffelin Hall. He could see the panic in his face.

“I didn’t hear any shooting. What is it, a knifing?”

“It’s Red Douglas. He’s choking and seems to be having some kind of fit.”

The doctor had already sprung into action. He had grabbed his black bag then dashed to a cupboard from which he took out a couple of small wooden cases which he threw into the bag.

“Stanley, don’t you come. That cough will start up if you try to run. Get going, Walt, I’m right behind you.”

“And miss a story?” Stanley rejoined him. “Not on your life. I’ll just take the stairs nice and easy and I’ll meet you there.”

But the town doctor had already gone. As he charged through the waiting room he barked a quick, “Emergency call, folks. I should be back in half an hour.”

Then he was out the door and dashing down the outer steps of the Crystal Palace Saloon from his office.

As was often the case when folks saw Dr. Goodfellow racing someplace he attracted a number of followers who tagged on behind him. Tombstone was that sort of place. It had a lot of folks who seemed to have an unhealthy interest in sudden death. As long as it wasn’t their own.

Clay More is the western pen-name of Keith Souter, a part time doctor, medical journalist and novelist. He lives and works within arrowshot of the ruins of a medieval castle in England. In 2014 he was elected as Vice President of Western Fictioneers and he is also a member of Western Writers of America, The Crime Writers’ Association, International Thriller Writers and several other writers organizations. 

He writes novels in four genres – crime as Keith Moray, Westerns as Clay More, Historical crime and YA as Keith Souter. His medical background finds its way into a lot of his writing, as can be seen in this novel about Doctor George Goodfellow as well as in most of his western novels and short stories. His character in Wolf Creek is Doctor Logan Munro, the town doctor, who is gradually revealing more about himself with each book he appears in. Another of his characters is Doctor Marcus Quigley, dentist, gambler and bounty hunter. He has recently published a collection of short stories about him in Adventures from the Casebook of D Marcus Quigley, published by High Noon Press.

If you care to find out more about him visit his website: http://www.keithsouter.co.uk

Or his blog http://moreontherange.blogspot.co.uk

Or check out his regular contribution about 19th Century Medicine here on the WF blog.

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THE DOCTOR'S BAG - DIG THOSE BULLETS OUT, DOC!

Experiments in bullet-proofing

By Keith Souter aka Clay More

In the Doctor's Bag this month I want to draw your attention to a little of the work of Dr George Emory Goodfellow, famously known as the surgeon to the gunfighters.  He was without doubt one of the most remarkable characters ever to practice medicine and surgery. He was a polymath, a man who would have made an impact anywhere, any time. He just happened to be practising as a doctor in Tombstone, Arizona during one of its most violent epochs.

Dr George Emory Goodfellow (1855-1910)

Among his many achievements, he was the first doctor to perform a laparotomy (the operation to open the abdomen) to treat abdominal gunshot wounds. He was the first surgeon to perform a perineal prostatectomy and he was an early advocate of aseptic surgery and of spinal anaesthesia. He was a geologist (his father was a mining engineer), an expert on Gila Monsters, a boxing champion in his youth and a man that you didn't cross (he carried and was prepared to use a concealed Italian poniard dagger).

He operated on Virgil Earp after an assassination attempt on him in the aftermath to the Gunfight at the OK Corral, he performed sterling innovative reconstructive surgery on the nose of his friend 

George Whitwell Parsons and he led an emergency relief operation to treat the injured after the  devastating Sonora earthquake of 1887.

For this he was called El Santo Doctor, the sainted doctor, by the people of Bavispe and he was given a horse, El Rosillo, by President  Diaz.

Eureka - The Impenetrability of Silk
An interesting area of research that Dr Goodfellow undertook was into the possibility of making bulletproof vests. Indeed, his research was of fundamental importance in this.

Many of the greatest discoveries in medicine and science come about because someone sees something that others may also have seen, yet only that person understands its significance.  They are the Eureka moments of science. George Goodfellow had his when he was digging out bullets!

In 1887 he wrote a paper in the Southern California Practitioner, entitled Notes on the Impenetrability of Silk to Bullets. In it he outlined three instances of gunshot wounds wherein bullets either did not go where they should have, or what should have been a fatality was not. It was the fact that the victims all had silk in one form or another, through which the bullets could not penetrate.

The paper is fascinating, but it is written in the dispassionate clinical manner of all scientific and medical papers. The tales behind them are fascinating and indeed apocryphal anecdotes of Tombstone during those violent days of the Wild West.

He begins the paper thus:

   ‘A somewhat extensive experience in the gunshot wounds of civil life, during the past few years, has brought to my attention the following instances illustrative of the remarkable tenacity of silk fibre and its resistance power of a bullet:’

I propose to describe these tales in more detail in another work, so for now it is enough to mention that in one case a fatal chest wound showed no blood loss, which was remarkable. The reason was that the bullet had hit a silk handkerchief and driven it into the chest cavity, but it had failed to penetrate the silk. In his post mortem examination he pulled the silk out and the bullet came out all wrapped up.

In another, that was not fatal, a man was  shot in the neck. He was wearing a silk neckerchief, which once again did not allow the bullet to pass through it, the result being that he did not sustain injury to the great blood vessels in his neck.

            ‘He subsequently told me, for I never saw him to speak to but twice, that all the liquids he took passed out of the wound of entrance for some weeks. He is now, I presume, pursuing his trade (cattle-stealing) on the border – if not in peace, at least in prosperity.'

           

Doctor Goodfellow went on to experiment with this, using layers of silk, rather like the medieval protective, quilted gambesons that had been used to protect against arrows. Others followed him and by the century's end bulletproof vests made from silk were being produced. They were extremely expensive, of course, yet offered some protection against bullets of low power.

Indeed, Archduke Franz Ferdinand of Austria was wearing one on the 28th June, 1914 when he was assassinated. His assassin shot him through his unprotected neck. And of course, it his assassination - the shot heard round the world - that is considered to be one of the triggers for the outbreak of World War I. *


[This famous phrase is also used in reference, of course, to the first shot fired in the American Revolutionary War.]

**********

My later ego Clay More has a couple of recent releases.  
Redemption Trail published by Western Trail Blazer
- a novelette- novella

Sam Gibson used to be a lawman, until the day he made a terrible mistake that could never be taken back. Since then, he has alternated between wishing there were a way he could redeem himself and believing he deserved punishment. 

He’s about to get both… 

Adventures from the Casebook of Dr Marcus Quigley published by High Noon Press
- seven interconnected short stories.

Doctor Marcus Quigley, qualified dental surgeon, gambler and sometime bounty hunter has gradually been working his way west. His reasons for choosing such a lifestyle are personal and pressing, as well as expedient, for there is someone he means to track down and hold to account for a murder committed some years previously.