Oil of Sweet Vitriol: Ether and Chloroform

Today, we’re going historical and looking at the two first common general anesthetics that were used: ether and chloroform.

Ether was discovered in 1275. It was first synthesized by German physician Valerius Cordus in 1540. He named it “oil of sweet vitriol” which likely gives a clue to its odor. Other sources report ether’s odor as pungent, sweet, nauseating and fruity.

The first use of ether as an anesthetic occurred in 1842 by Dr. Crawford Williamson Long who used it to remove tumors from the neck of patient James Venable in Jefferson, Georgia. You may also see references that ether was used at the Ether Dome by William Thomas Green Morton who was a dentist that assisted surgeon John Collins Warren who also used it to remove a neck tumor. Now, it is largely recognized that Long should be credited with its first use.

Ether’s main drawback was its flammability. When the advent of using cauterizing tools came to fruition, you can see how setting fire to one’s patient during surgery would be considered poor form on the part of the doctor.

Chloroform was discovered in 1831 by James Young Simpson, a Scottish gynecologist and obstetrician, and was found efficacious in 1847. Chloroform was used widely until it was determined to be toxic to the kidneys and liver, but I did find a short note that perhaps chloroform was the preferred anesthetic in England. Chloroform is reported to have a “pleasant, non-irritating odor and slightly sweet taste”.

These agents, most likely ether in the US, were in use until the mid 1950’s when the non-flammable anesthetic agent halothane was discovered.

Do you have a historical medical scene using ether or chloroform?

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References:

Frontier Medicine by David Dary

Chloroform

Ether

Halothane

*Originally posted February, 2011.*

Pharmacy in World War II: The Pharmacist

I’m so pleased to have Sarah Sundin back. This week, she’ll be discussing the role of the pharmacist on several different fronts during WWII. I’ve found this information absolutely fascinating!

Welcome back, Sarah.

In the 1940s, the local drug store was more than just a place to get prescriptions filled and pick up toothpaste—it was a gathering place. If you’re writing a novel set during World War II, it helps to have an understanding of this institution.

As a pharmacist, I found much about my profession has changed, but some things have not—the personal concern for patients, the difficult balance between health care and business, and the struggle to gain respect in the physician-dominated health care world. Today I’ll discuss the role of the pharmacist in the 1940s.  On February 16th I’ll describe the local drug store and how its role changed during the war, and on February 18th, I’ll review the rather shocking role—or lack thereof—of pharmacy and pharmacists in the US military.

The Profession of Pharmacy in the 1940s

Although the term of druggist has been abandoned by the profession—please do not use it in your contemporary novels—in the 1940s, the terms of pharmacist and druggist were interchangeable. The 1940 US census counted over 80,000 pharmacists. The majority worked in retail pharmacy, with only 3000 working in hospitals. In fact, less than half of hospitals had a pharmacist on staff.

A cornerstone of pharmacy had always been compounding, the practice of mixing a prescription from raw ingredients. Pharmacists made creams, ointments, elixirs, suspensions, capsules, tablets, suppositories, and powder papers. Only pharmaceutical grade ingredients could be used, approved by the USP (United States Pharmacopoeia) or the NF (National Formulary). Every pharmacist owned a copy of the USP guide—the 11th Edition (1937) or 12th Edition (1942). The USP guide provides chemical data on each substance. By the 1940s, pharmacists compounded less—about 70 percent of prescriptions were filled with manufactured dosage forms.

In the 1940s, the pharmacist was a vital member of the community. Often viewed as more accessible than physicians, pharmacists were relied upon for health information and the treatment of minor ailments.

Education and Licensing

The first four-year Bachelor’s of Science degree in pharmacy was offered by Ohio State University in 1925. The four-year program became mandatory with the incoming class of 1932. The doctor of pharmacy (Pharm. D.) degree was first offered by the University of California, San Francisco in 1955, and did not become mandatory until 2000. Therefore, in World War II, pharmacists were addressed as “Mr.” or “Mrs.” or “Miss.”

In 1942, sixty-eight colleges of pharmacy operated in the United States. In addition to general education requirements, pharmacy students also studied pharmacy, pharmaceutical chemistry, pharmacognosy (deriving pharmaceuticals from raw substances, such as plants), pharmacology (the effect of a drug on the body), and business. To increase the chance that a student would finish his degree before being drafted, most colleges of pharmacy adopted a year-round, three-year program during the war.

Each state had its own licensing requirements and examinations, and there was no reciprocity between states. For example, a pharmacist licensed in California had to take a new set of examinations if he moved to Michigan.

Manpower Shortage

In a nation of 130 million, over 11 million would serve in the armed forces during the course of the war. This produced a manpower shortage on the home front, and pharmacy was not immune. As a class, pharmacists were not exempt from the draft, but local draft boards could declare individuals as “necessary men” if their enlistment would negatively affect the health of the community. During World War II between 10,000-14,000 pharmacists served in the military. Due to this loss, approximately 15 percent of drug stores closed during the war. The west coast was hard hit when all Japanese-American pharmacists were forcibly interned.

However, more opportunities opened for women as colleges and employers actively recruited them. While less than 5 percent of pharmacists in 1940 were female, the percentage of female pharmacy students rose above 15 percent during the war.

Effects of the War

Due to store closures, the average store filled 13 percent more prescriptions than before the war. This increase in workload was balanced by depletion of other goods due to rationing and shortages. In addition, citizens were encouraged to take better care of their health so they could contribute to the war effort, which led to an increase in physician visits. Overworked physicians dispensed fewer drugs from their offices and sent more patients to pharmacies. As a result, the average drug store enjoyed an 80 percent increase in sales during the war.

Pharmacists dealt with shortages of ingredients and medications. A serious shortage of quinine, used to treat malaria, led the military to collect the majority of the nation’s quinine stock. Also, shortages of alcohol, sugar, and glycerin taxed the ability of pharmacists to compound. Each pharmacy received a ration of ten pounds of sugar a week for compounding purposes.

Resources

My main source was this excellent, comprehensive, and well-researched book: Worthen, Dennis B. Pharmacy in World War II. New York: Pharmaceutical Products Press, 2004.

http://www.lloydlibrary.org (Website of the Lloyd Library and Museum, which has many articles and resources on the history of pharmacy).

United States Pharmacopoeial Convention. The Pharmacopoeia of the United States of America, Twelfth Edition. Easton PA: Mack Printing Company, 1 November 1942.
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Sarah Sundin is the author of the Waves of Freedom series (Through Waters Deep, 2015, Anchor in the Storm, 2016, and When Tides Turn, March 2017), the Wings of the Nightingale series, and the Wings of Glory series, all from Revell. In addition she has a novella in Where Treetops Glisten (WaterBrook).

Her novel Through Waters Deep was a 2016 Carol Award Finalist, won the 2016 INSPY Award, and was named to Booklist’s “101 Best Romance Novels of the Last 10 Years.” Her novella “I’ll Be Home for Christmas” in Where Treetops Glisten was a finalist for the 2015 Carol Award. In 2014, On Distant Shores was a double finalist for the Golden Scroll Awards from both AWSA and the Christian Authors Network. In 2011, Sarah received the Writer of the Year Award at the Mount Hermon Christian Writers Conference.

A mother of three, Sarah lives in northern California, works on-call as a hospital pharmacist, and teaches Sunday school and women’s Bible studies. She enjoys speaking to community, church, and writers’ groups, and has been well received.

Civil War Medicine: Part 4/4

Today, we’re finishing up with Erin Rainwater’s amazing series on Civil War medicine. You can find Part I, Part II, and Part III by clicking the links.

Civil War Medicine: Hapless or Heroic in Retrospect? 

History has not always been kind to Civil War practitioners of medicine. The methods discussed in the previous posts seem barbaric to us now, and the lack of medical knowledge regarding foundational principles such as asepsis, infection, and sanitation is regarded as tragically antiquated. Their twenty per cent mortality rate is unacceptable by today’s standards. More horror stories abound. From our retrospective and often condescending viewpoint, we smugly judge one century’s standards by the current set. This is not only an unfair but a flawed verdict. The inadequacies of those medical care deliverers have received considerably more attention than their accomplishments, which were many.

If judged by the standards of their day, Civil War doctors and nurses should be hailed as remarkably successful.  With the existence of bacteria still only theoretical, with the available instruments and anesthesia, and with the indescribable numbers of patients inflicted upon them, the fact they saved lives in such unhoped-for numbers is a credit to their skill, creativity, and tenacity.

In the war that preceded this one, the Mexican-American War, ten men died of disease for every one killed in combat. During the Civil War, that ratio was reduced to 2:1. That alone is measurable evidence of an enormous advancement in medical care in the span of under two decades, much of which came about as a result of the war. The creation of frontline field hospitals, ambulance services, and the utilization of female nurses should cause modern historians to conclude that the maligned medical practitioners during the Civil War should be reckoned as heroic, not hapless. Their crude system of triage, setting aside men wounded through the head, chest or abdomen because they would most likely die seems brutal, but with the knowledge and little time available, it allowed surgeons to save those who could be saved. Modern mass casualty triage is not so far removed from this practice.

Aside from medical care administered to the living, advancements in post mortem measures took place as well. Prior to the war, embalming was usually only done to preserve specimens for scientific study. Because many families of killed soldiers desired to bring them home for burial, embalming became more commonplace.

I have only skimmed the surface in relating how the War Between the States necessitated numerous adaptations in the delivery of medical care, and how we benefit even today from some of those changes. These are just some examples of not only medical but also the many moral and social advancements that came as a result of the American Civil War. I truly hope these four posts have been educational and entertaining, and that perhaps this information will help you gain a greater appreciation of our sesquicentennial commemorations over the course of the next four years.

REFERENCES:

Burns, Stanley B., MD, FACS, “The Naldecon Gallery of Medial History,” Bristol Laboratories, © 1987.

Civil War Manuscripts, Library of Congress.

Downs, Robert B., Books That Changed Amercia.

Miller, Francis Trevelyan, ed., The Photographic History of the Civil War, Prisons and Hospitals

Ward, Geoffrey C., Burns, Ric, and Burns, Ken, The Civil War, An Illustrated History. Alfred A. Knopf, Inc., © 1990.

The Day Richmond Died.

www.civilwarhome.com/medicinehistory

www.civilwarsurgeons.org

www.members.cox.net/cwsurgn/civilwar

http://home.nc.rr.com/fieldhospcsa

*********************************************************************************************Erin Rainwater is a Pennsylvania native whose trip to Gettysburg when she was twelve enhanced her already deep interest in the Civil War. She attended Duquesne University in Pittsburgh, and entered the Army Nurse Corps upon graduation.  Serving during the Vietnam War era, she cared for the bodies and spirits of soldiers and veterans, including repatriated POWs and MIAs. Now living in Colorado, she is a member of a Disaster Medical Assistance Team, and has been deployed to disaster areas around the country. True Colors is partly based on her military and nursing experiences as well as extensive research. She also authored The Arrow That Flieth By Day, a historical love story set in 1860s Colorado, and Refining Fires, a uniquely written love story that was released in July, 2010. Erin invites you to visit her “virtual fireside”.

***Content reposted from January 31, 2011.***

Civil War Medicine: Part 3/4

We’re continuing Erin Rainwater’s four part series on Civil War Medicine. You can find Part I and Part II by clicking the links.

Conditions and Treatment

Unlike today, the majority of soldier deaths during the Civil War were attributed to disease. Unsanitary and close-quarter living conditions in the camps led to outbreaks of dysentery, typhoid, measles, smallpox, chicken pox, throat distemper (diphtheria), and other diseases. Scurvy and other nutritional disorders were prevalent, as was typhus from lice and fleas.

Mosquito-borne illnesses such as yellow fever and “ague” (malaria) also posed a threat, although they were believed due to “miasmic vapors” from stagnant waters. Minor wounds such as from a splinter, a scratched mosquito bite, or the rub of a boot could become infected and ultimately lead to septicemia and death. Lacking scientific knowledge regarding the causes of disease, physicians depended on a few standard remedies, such as quinine, calomel, ipecac and opium to cure most symptoms. Mercury was used to treat venereal disease, although it only cleared the symptoms and was not a cure. Nitric acid was poured on open wounds to kill infection. It also seared the flesh.

The physiology of some conditions, such as the gastrointestinal system, was surprisingly well known back then. The digestive process was understood, as well as the length of time for various foods to be digested. Much of this knowledge came from Dr. William Beaumont’s experiments and studies, including the observation of an open stomach wound in a man who’d been shot.

Gastrostomy tubes were used for feeding patients with such wounds, and drains were placed to remove infectious drainage and gastric juices. Cardiopulmonary-wise, physicians used stethoscopes to discern crepitant rales and rhonchi, heart murmurs, and friction rubs. They used percussion techniques in the physical exam to appreciate dullness and diminished resonance of the chest and abdomen. Mercury thermometers were available but rarely used. Fever was considered a disease, and temperatures were taken only to investigate unusual maladies or those of special concern. Doctors then were faced with some of the same frustrations of today: addicts pilfering drugs and alcohol, and well-intentioned family members offering food to patients with serious stomach and intestinal ailments and wounds.

Wounds, of course, were the other consideration in this war of inconceivable casualties. As bullet manufacturing changed during the war so did the wounds they left. The small- caliber round balls shot from a smooth bore musket often produced a different type of wound than the newer, faster velocity, conical-shaped slugs later produced. All had the capacity to incur catastrophic injuries beyond repair. In battlefront hospitals, there were few alternatives to amputation of limb wounds, and an experienced surgeon could perform the procedure in under ten minutes.

Later in the war, some surgeons experimented with blood vessel resection, but amputation remained far more common. Soldiers with head and chest wounds were given a poor prognosis, and often not considered treatable. Bullet wounds were the most common by far, but those from canister, cannonballs, shells, sword and saber had to be reckoned with as well.

It was considered routine that combat wounds become infected. Pus was considered “laudable” because the body was discharging poisons, a necessary adjunct to proper healing. In the rare instances pus did not appear, it was called “union by first intention” and considered an utter mystery. Yet there were five types of infections acknowledged as abnormal.

A triad of infections referred to as “hospitalism” included gangrene, erysipelas (a skin infection we now know is caused by strep), and pyemia (septicemia, or “blood poisoning.”) The mortality rate from these hospital-acquired infections reached ninety-five per cent. The survivor of a “routine” infection often became the victim of osteomyelitis, a chronic bone infection, and was doomed to a slow and painful death from a festering wound where entire sections of bone would be eaten away. Tetanus was present, though less common than other diseases, because most battles were fought on virgin soil unfouled by the manure that carries the tetanus spores.

Wet dressings could be applied utilizing a siphoning technique. One end of a strip of cotton or linen was placed in a container of water suspended over a wound. The other end of the material hung just above the wound but below the level of the water, thus providing a continuous drip. The nurse was freed up from having to return for frequent remoistening of the bandage. Oilcloths were placed to catch the excess water and drain it into a vessel on the floor.

With flies rampant, so were their eggs, or maggots. Although the critters caused no pain, female nurses were disgusted by them and their wiggling bothered the wounded men. Yet some discerning surgeons detected that wounds infested by maggots healed more rapidly, and that the little vermin actually cleansed wounds, digesting and removing dead tissue while leaving healthy tissue uninjured. Rats reportedly tendered similar results. Some modern day physicians have accepted maggot therapy as useful for debridement, although I’ve yet to see where rat therapy has become part of standard treatment.

Without the benefit of x-ray equipment, sometimes the only way to hit upon the location of a bullet was to take “soundings.” In my novel True Colors Cassie Golden, who at this point thinks she’s seen everything, watches in awe as a Confederate surgeon inserts a porcelain-tipped probe into a wound and taps it against various obstacles. She observes that the sound of tapping bone versus lead is distinguishable. Additionally, when the doctor rubs the white-tipped probe against lead it comes out streaked with gray—a sign it has detected its quarry. Like all nurses, she realizes that the learning process is never over.

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Erin Rainwater is a Pennsylvania native whose trip to Gettysburg when she was twelve enhanced her already deep interest in the Civil War. She attended Duquesne University in Pittsburgh, and entered the Army Nurse Corps upon graduation.  Serving during the Vietnam War era, she cared for the bodies and spirits of soldiers and veterans, including repatriated POWs and MIAs. Now living in Colorado, she is a member of a Disaster Medical Assistance Team, and has been deployed to disaster areas around the country. True Colors is partly based on her military and nursing experiences as well as extensive research. She also authored The Arrow That Flieth By Day, a historical love story set in 1860s Colorado, and Refining Fires, a uniquely written love story that was released in July, 2010. Erin invites you to visit her “virtual fireside”.

***Content reposted from January 24, 2011.***

Civil War Medicine: Part 2/4

We’re continuing our four part series with Erin Rainwater and her research into Civil War Medicine. You can find Part I here.

Changes in delivery of medical care resulting from the war.

When you look at the casualties wrought by the Civil War it is mind-boggling. The Battle of Antietam in Maryland was the single bloodiest day of the war. There were over 20,000 American casualties in a single day (North and South combined). The Battle of Gettysburg was fought over three days, and 51,000 men were killed, wounded or missing. In all, more than 620,000 men died during the four-year conflict.

Over half perished from disease, not battle wounds. These numbers are inconceivable, both in terms of lives lost and in the challenge of delivering medical care in a day prior to asepsis (germ-free), antibiotics, and helicopter aerovacs. As a result of the enormous casualties, many of whom were brought into nearby towns where churches, hotels, barns and even citizens’ homes were requisitioned by the armies and made into makeshift hospitals, a new system of medical care delivery was born of necessity.

Both governments ordered the swift construction of general hospitals to treat the injured and ill. Additionally, frontline hospitals were born of necessity. Initially, the ambulance service was maintained and run by the Quartermaster Corps. Around 1862, the medical director of the Union army, Jonathan Letterman (for whom the Army hospital in San Francisco was named) developed a system whereby ambulances and trained attendants were assigned to and moved with a division.

This provided for more immediate collection of the wounded from the battlefield and transport to dressing stations and on to field hospitals. The current system of rapid response and ambulance conveyance was conceived due to the necessities brought on by the Civil War. It is interesting to note that casualties from both sides were treated at the frontline hospitals.

When (unsterile) silk, cotton or catgut ligatures were at a premium, horse hair was boiled to soften the texture to make it pliable for use as suture material. It was noted by some that the infection rate dropped significantly when this was used. The same was true when a lack of reusable sponges led to the utilization of one-time use rags for cleansing wounds. Applying iodine to wounds and wiping instruments with chlorine between surgeries brought similar results, but without scientific data to prove a correlation, some physicians saw no sense in these procedures.

The surgeon general remained opposed to the use of civilians and women in the hospitals, but the lack of males to perform the required duties forced the issue. Dorothea Dix, highly respected as a crusader for improving conditions in prisons and hospital for the mentally ill, managed to convince skeptical military and government officials that certain women were capable of dealing with what the war did to men.

With the news of her appointment as Superintendent of Women Nurses in June, 1861 came torrents of applications from women offering their services. Working for no pay, Miss Dix personally looked after the well-being of the female nurses she hired as well as the soldiers to whom they ministered. However, in her attempt to weed out those merely looking for a husband, she would only hire women over thirty or married, strong, and plain of face and dress. Some hospitals’ chief surgeons rejected the hiring authority given Miss Dix, and in a show of defiance, refused to accept her nurses on their wards.

It took a literal Act of Congress to allow the surgeons to bypass her authority and hire nurses on their own. This is what happens to the heroine in my novel, True Colors, who is considered unacceptable by Miss Dix because she is under thirty, unmarried, and not so plain. Disappointed yet undaunted, Cassie follows in the footsteps of many of her fellow rejects and marches straightway to an Army hospital and applies directly to the surgeon-in-charge. She is fortunate in that this doctor had worked alongside British Army surgeons in the Crimean War a decade earlier, and was appreciative of the role of female nurses. He hires her on the spot.

The significance of the contribution of women nurses during this conflict should not be understated. Rather than being seen as mere helpers of the main players—interesting but insubstantial—available evidence indicates their activities had important ramifications in both the immediate medical sense and the broader social sense. Truly they were the forerunners of female nurses of our generation.

*********************************************************************************************Erin Rainwater is a Pennsylvania native whose trip to Gettysburg when she was twelve enhanced her already deep interest in the Civil War. She attended Duquesne University in Pittsburgh, and entered the Army Nurse Corps upon graduation.  Serving during the Vietnam War era, she cared for the bodies and spirits of soldiers and veterans, including repatriated POWs and MIAs. Now living in Colorado, she is a member of a Disaster Medical Assistance Team, and has been deployed to disaster areas around the country. True Colors is partly based on her military and nursing experiences as well as extensive research. She also authored The Arrow That Flieth By Day, a historical love story set in 1860s Colorado, and Refining Fires, a uniquely written love story that was released in July, 2010. Erin invites you to visit her “virtual fireside”.

***Content originally posted January 17, 2011.***

Civil War Medicine: Part 1/4

I’m pleased to host Erin Rainwater as she shares her expertise concerning Civil War Medicine.

Welcome, Erin!

Pre-war medical system.

This year marks the Sesquicentennial (150-year anniversary) of the beginning of the Civil War. If you’ve never studied it much, I recommend you use these four commemorative years as an incentive to expand your knowledge of it.

That war was a watershed time in our nation’s history like no other event before or since, in war or peacetime. It even changed the way citizens referred to their nation. From the time of the Revolution until then the country was thought of as a collection of independent states. Shelby Foote, the Civil War historian who made you feel like you were there, said that prior to the war people would say, “The United States are…” As a result of the war, it was grammatically spoken as “The United States is…” That’s what that war accomplished, Foote said. It made us an is.

There are many interesting facets regarding the standards of medical care and how it was delivered back when we were still an are. Some of what we read about seems barbaric to us now, yet American surgeons were up to international standards of medical science of the time. Furthermore, as often happens in time of war, this conflict quickly propelled physicians into the role of leaders in medical and surgical breakthroughs.

Prior to the war, cleanliness was regarded as insignificant except in respect to gross contamination by foreign matter. Surgeons operated in street clothes or donned a surgical apron. They might wipe bloody and pus-laden instruments on their aprons or a rag, but washing them wasn’t routine. Clean linens and washed hands were statistically proven to be of value but rejected as non-scientific.

Medical school in the 1860s was normally two years long. Microscopy was taught, as was the cell theory of tissue structure. Tissue samples were stained and analyzed, urinalyses and stool studies were performed.

The primary anesthetics available were ether and chloroform, each having its pros and cons. Chloroform was non-flammable, which made it preferable during the war when gunpowder was lying about and bullets flying about. It was also faster acting. On the down side, it was easier to overdose a patient with chloroform, and anesthesia-related fatalities were higher. Surgeons and attendants, however, were more easily overcome by the vapors of ether while performing surgery.

At the outbreak of hostilities, there were few military physicians, fewer military hospitals, and lack of a hospital corps. Nursing and other duties were performed by soldiers temporarily assigned to hospital detail, and who were not necessarily qualified nor of upstanding character. After the fighting began, civilian doctors flooded into the military system. Others chose not to join up but worked as contract physicians. Doctors not only were required to be skilled but were expected to organize, equip, supply and administrate their hospitals. The enlisting, training and disciplining of subordinates was also in their job description.

Female nurses were rarely tolerated. They were believed to lack the physical strength to help wounded men, and especially in the South they were considered too delicate and refined to assist a rough soldier in bathing and tending to personal hygiene. It was generally conceded, however, that women were more attuned to the emotional needs of the sick and more skilled at “sanitary domestic economy.”

As word of Florence Nightingale’s notable work in the Crimean War spread, women’s abilities in the field of nursing became more widely acknowledged. Some American physicians who had gone to the Crimea to assist the British came home reporting that the female nurses were undeniably competent and able to care for soldiers with war-related wounds and illnesses. It was finally becoming more seemly for females to care for male patients. Their pay, however, was half of what civilian male nurses received to care for military patients. In my novel, True Colors, Cassie Golden receives the standard pay for civilian female nurses working in a government hospital—twelve dollars a month plus meals. That is for twelve-hour shifts, usually five days per week but often more. And she was glad to have it.

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Erin Rainwater is a Pennsylvania native whose trip to Gettysburg when she was twelve enhanced her already deep interest in the Civil War. She attended Duquesne University in Pittsburgh, and entered the Army Nurse Corps upon graduation.  Serving during the Vietnam War era, she cared for the bodies and spirits of soldiers and veterans, including repatriated POWs and MIAs. Now living in Colorado, she is a member of a Disaster Medical Assistance Team, and has been deployed to disaster areas around the country. True Colors is partly based on her military and nursing experiences as well as extensive research. She also authored The Arrow That Flieth By Day, a historical love story set in 1860s Colorado, and Refining Fires, a uniquely written love story that was released in July, 2010. Erin invites you to visit her “virtual fireside”.

***Contest reposted from January 10th, 2011.***

 

Cost of Medical Care on the Frontier

I’ve been reading through David Dary’s book Frontier Medicine as research for this blog and came across an interesting list of what it might cost for certain medical treatments. I found these to be fairly expensive in light of what a family might earn. Take a look.

For $0.50

Traveling more than 18 miles
Cathartic
Emetic
Tincture per oz
Blisters to ankles and wrists
Bleeding
$1

A visit
Tooth Extraction
$2

Administration fee for therapy

$5-20

Infant Delivery
Curing gonorrhea/venereal disease
Reducing Fracture
Reducing Kneecap Dislocation

$50
Amputation
Trepanning (skull-boring)

What do you think of these costs and what a family might make?