THEY SERVED UNDER CUSTER

THE DOCTOR'S BAG

the blog about the medicine and surgery of yesteryear

Keith Souter aka Clay More

The name of George Armstrong Custer (1839-1876) is indelibly written in the history of the United States. The Battle of the Little Bighorn in which he died along with five companies that he had led was romanticised as 'Custer's Last Stand' and has been depicted in art, film and all manner of literature.

I certainly would not have the temerity to comment on his qualities as a soldier or leader, other than to say that he undoubtedly had personal charisma. In this blog I am going to talk about three men who proudly served under Custer in different capacities. And since this is a blog about medicine and surgery of yesteryear I shall begin with a doctor.

The Brave Doctor - The only Doctor to survive Little Bighorn

Dr Henry Renaldo Porter was not soldier, but a contract surgeon. As such he had served under General Cook in his Apache Campaigns in Arizona in 1872 and 1873. Cook rated him highly and cited him for conspicuous gallantry in the closing campaign in March 1873.

Dr Henry Renaldo Porter (1848-1903)

In May 1876 at the age of twenty-eight he entered a three month contract for the Sioux campaign. He was about to step into history. After the battle of the Little Bighorn, he returned to civilian life and set up a practice in Bismarck. He wrote an account of the battle in the Bismark Tribune, which they published under the heading The Brave Doctor :

At six o'clock we started. It was Custer's purpose at this time to charge the Indians in a body, he supposing that our presence had not been discovered by them. In a short time the scouts reported that we had been seen by the Indians. Custer then decided to divide the command. He sent Colonel Benteen with three companies to the left; Major Reno with three companies in the center; and he took three companies and was to go to the right, his idea being to surround the Indian camp. Captain McDougal was left in charge of the pack train. It was about ten o'clock when the command was divided. Just as we were ready to start, Custer came to me and said: 'Doctor, I would like to have you go with me, as you are younger and more robust and Dr. Lord, the chief surgeon is not feeling very well.' I replied, 'All right. I would much prefer going with you.' Custer then said, 'I will see Dr. Lord and ask him to consent.' We rode over to where Dr. Lord was, and Custer spoke to him about the contemplated arrangement. The Doctor replied: 'Not much. I am going with you.' The poor fellow in those few words saved my life and sealed his own doom. I went with Reno. We had proceeded but a short distance when Captain Cook [Lt. W.W. Cooke], Custer's adjutant, came up and said: 'The Indians are right ahead of you, and you are ordered to charge them as fast as possible.

For two days Porter was the only doctor left alive and he cared for around thirty wounded men in an improvised field hospital in the Reno-Benteen defence. All this time he was under continuous fire from Sioux and Cheyenne rifles. 

With limited medical supplies, he used laudanum, operated to remove projectiles and performed two amputations.

He was considered one of the heroes of the campaign. He was called to testify at the Reno Court of Inquiry in 1879. He died on a world tour in Agra, India at the age of 54 in 1903.

Old Neutriment

The second man to have served under Custer was John Burkman, his orderly for nine years up to the Battle of the Little Bighorn. His nickname was because of his raids on the kitchen at Fort Lincoln in his younger days.

He was devoted to both George Armstrong Custer and to his wife Libby Custer. In his own words some years after the battle, " Seems like they want no use me goin' on."

John Burkman was illiterate, but he shared his memories of living and working with the Custer's with his friend I.D. 'Bud' O'Donnell and all of this, complete with photographs, Gwendolyn Damon Wagner wrote in her book, suitably titled Old Neutriment in 1934. It gives some wonderful insight into his relationship with Custer and his personal views on the battle and the actions of the other major participants.

John Buckman (1839- 1925)

Buckman looked after Custer's two horses and his string of hunting dogs. He did so with love and meticulous care.

Like Dr Porter he had a fortunate escape from fate, albeit he bitterly regretted that he could not be at the end with Custer. This is a letter he dictated to an amanuensis to Mrs Custer in 1910:

"[Custer] turned to me with 'Burkman, saddle up my war horse, Vic: and you will have to remain with the pack train as I issued orders that there were to be no led horses in the front." 

The men were all in good spirits when they passed me. Then was the time I begged his nephew, Arthur Reed, to remain back with me for i would rather have taken my chances in the front, but you know, I had to over orders. I could tell you word for word, Mrs Custer, if I were beside you. That was the last I saw of the General as they left the pack train."

Of Dr Henry Porter, John Buckman had only good things to say.

"Don't git me wrong, Bud. We want all cowards. A lot o' gallantry was showed that day. Some men volunteered to go down right in the face o' Indian fire, to rescue the wounded that was strung here and thar 'long the side o' the cliff. We was all cravin' water. The wounded suffered most.Doctor Porter - he was a good one and a brave fellow -- he worked like a beaver, easin' the sufferin' best he could. What with the heat, blood pizen set in quick. I seen him, one time in partic'lar, amputize a fellow's leg. I seen the man lay thar, his face white's a sheet, his lips set tight, not a moan out o' him, nothin' but his eyes tellin' how it hurt. Doctor Porter says, `My wounded has got to have water! Who'll volunteer to go arter it?'

"Bud, thar was the river jist below us, millions o' gallons of water a-ripplin' and a-sparklin' along, but betwixt us and it was the Indians, shootin' any one that made toward it. A deep ravine led from our hill and men could crawl down through it almost to the river but then there was a short stretch of open space and to dash across it to the water meant death, sure's sartain. Our hankerin' fur a drink got terrible. We sucked raw potatoes. We held pebbles in our mouths. Nothin' helped much. We'd all of us, horses and men, 've sold our souls fur a drink o' that water we could see flowin' along; but the wounded, o' course, was in the worst fix. When Doctor Porter spoke up some men volunteered and crept down the ravine carryin' buckets and kettles and canteens. I started with them. My horse got hit in the flank and I come back, figgerin' I'd jist as soon die of thirst as an Indian bullet. Some of 'em made it. One fellow was hit jist as he stooped over to fill his bucket and the pail was shot away and his leg was shattered. He hung on to another fellow's stirrup and was dragged back up the hill. Arterwards that leg had to be amputized. Most o' them that went down brung back a leetle water, jist enough so' the doctor could trickle it into the mouths of the wounded. Arter that from time to time men kept slippin' down through the ravine to the river, but I didn't try it agin.

Sadly, in 1925, having lived long after the battle he was found dead on the porch of his boarding house in Bilings, Montana, a gun in one hand and a bag of candy in the other. 

Dog Kelley

The third man to have served under Custer had left the 7th Cavalry before Little Bighorn, but had also been an orderly under George Armstrong Custer. His name was James H (Dog) Kelley, who was the mayor of Dodge City from 1867 to 1871. As such, he worked with and supervised several of the most famous lawmen of the Old west, including Bat, Ed and James Masterson and Wyatt and Morgan Earp. His name is also linked with one of the most infamous episodes in the Old West, the tragic death of Dora Hand.


James Kelly was born in Manchester, England in 1834. He was Custer's orderly and served under him until they came to Fort Dodge in 1872. Like Custer he loved horses, hunting and racing dogs, especially greyhounds. He was honourably discharged in 1872. As a parting gift Custer gave him a dozen greyhounds, hence the name 'Dog Kelley.'

James H (Dog) Kelley (1834-1912)

Dodge City was a place that many people drifted into. One person who had apparently travelled west because of her consumption (Tuberculosis), was the dance hall singer and actress Dora Hand. She went to Dodge City in 1878 and became extremely popular. She was romantically linked to Dog Kelley. 

Dora Hand (1844-1878)

Sadly, she was shot to death when a cowboy named Spike Kenedy fired into the cabin she was sleeping in, because he believed that the mayor, 'Dog' Kelley was sleeping there. A posse was formed, the members including Wyatt Earp, Bat Masterson and Charlie Bassett. They caught him, wounding him in the process, but he was later acquitted, because there was deemed to be insufficient evidence. His father, Mifflin Kenedy had come to the young cowboy's rescue, as he had done before.


The story of this whole tragic episode is told in Howard Kazanjian and Chris Enss's excellent book Thunder Over the Prairie.

Dora Hand was interred in Boot Hill.

As for Dog Kelley, his fortune came and went. He ran the Kelley Opera House in Dodge for several years, but lost his property in the Panic of 1884. He saw his last years in Fort Dodge, and himself died from consumption in 1912. He was buried in Fort Dodge cemetery.

Ned Buntline

The famous King of the Dime Novelists, Edward Zane Carroll Judson (1821-1886) was a fascinating character. He was a prodigious writer of popular literature who had clearly led an adventurous and very full life, and who saw no problem in aggrandizing himself and his achievements. He has been described by as The Great Rascal, which is not far off the mark, in my opinion. Yet that is not to denigrate him, for he produced a body of work that influenced and entertained millions of people. He introduced Buffalo Bill and Wild Bill Hickok to the wider world.

One of the fascinating things about him was the fact that not only did he create his own history (for example, he bestowed the rank of Colonel upon himself, although he had never been more than sergeant), but myths followed him.

He wrote hundreds of dime novels and is credited with having more or less created the mythic Wild West. Most western enthusiasts know about the Buntline Special, the extra long Colt revolvers that he allegedly had made for Wyatt Earp, Bat Masterson and a few other famous lawmen who were involved in the posse that tracked down Spike Kenedy. Yet the historical records of the Colt Manufacturing Company fail to record their order, let alone their manufacture. It seems that this myth may have been created by Stuart N Lake, in his novel Wyatt Earp: Frontier Marshal, published in USA by Houghton Mifflin in 1931 (and published as He Carried A Six-Shooter in the UK in 1952). William Shillingberg wrote a detailed, scholarly paper debunking this in 1976.

My own short biographical novel The Dime Novelist about Ned Buntline, published in the West of the Big River series by Western Fictioneers includes, with some poetic licence, the episode about Dora Hand and the fabled Buntline Specials.

 

I THINK IT'S BUSTED, DOC!

The Doctor's Bag

The blog about Medicine and Surgery in the Old West 

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!"

Aiding a comrade by Frederic Remington

And of course, an examination reveals all, a splint is manufactured, a snort of whiskey or 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 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 encyclopedias. 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.

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 organizations 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.

                  The Hodgen splint was invented in 1863 by John T Hodgen, a surgeon from St Louis. It was a suspension leg splint for fractures of the middle or lower femur.

                             

                         

Plaster of Paris casts

This was a fantastic addition to the surgeon's armamentarium of treatments. It was the invention of Antonius Mathijsen, 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.

                             

                  Nikolai Pirogov is credited as the first surgeon to use them to treat casualties in the Crimean War in the1850s, so of course, Dr Logan Munro was aware of the method and would use it in his practice in Wolf Creek!


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 fractures - 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 or twisting  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 immobilizing 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 framework 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 immobilized. It takes 4- 6 weeks to heal. 

Smith's fracture
By contrast, a Smith's fracture, also known as a Groyland-Smith fracture is a 'reverse' Colles fracture. It was described by the Irish orthopaedic surgeon Robert Smith in his 1847 book,  Treatise on Fractures in the Vicinity of Joints, and on certain forms of Accidents and Congenital Dislocations.  

 It is a fracture  of the distal (bottommost) part of the radius, caused by a blow to the back of the forearm, or a fall on the flex wrist. 

Thus, a Colles fracture is an extension injury and the Smith's fracture is a flexion injury. 

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.

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 immobilization 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 little depression on the back of the wrist formed when you elevate the thumb perpendicular to the hand. 

The anatomical snuffbox outlined

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 bone 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. 

Monteggia fracture, by Jane Agnes

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!

***

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

The Doctor's Bag

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

The Doctor

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

The Dime Novelist