Historical Medicine: Ann Shorey

I’m pleased to have Ann Shorey back with us today as she discusses some uniquie aspects of 19th century medicine with a fun quiz. Do you know the answers? Don’t fear, they’re posted.

Welcome back, Ann!

As people of the 21st Century, we’re accustomed to hearing about advanced medical tests, such as an MRI or a CAT scan, even though we may hope we never need the technology. We think of blood tests, urine samples, even DNA testing, as the norm.
But if we lived in the same time and place as the characters in my At Home in Beldon Grove series, none of those advances would be available. The series begins in 1838 with The Edge of Light and concludes in 1857 with The Dawn of a Dream. The “middle child” in the series, The Promise of Morning, is set in 1846.
Here are a few medical questions that arise in the series. The answers appear at the end of the post.
1.      Dr. Karl Spengler is a continuing character throughout the Beldon Grove series. Try to put yourself in his place when faced with a diagnosis of cholera. What was a popular treatment of the day?
2.      What was common therapy for a croupy baby?
3.      How would a doctor have cared for a serious injury to an eye?
4.      When faced with a listless infant who wouldn’t eat and whose limbs lacked any strength, what would the doctor’s diagnosis have been? And if he’d known what was wrong, would he have recognized the cause?
5.      What were the signs of acute heart failure, and with what medication would the patient have been treated? For that matter, what did the medical community call heart failure?
Here are the answers. Some were gleaned from family accounts written at the time, others from research.
1.      Cholera was commonly treated with heavy doses of calomel (mercurous chloride), which we know now is poisonous, and bloodletting via leeches or cutting. Your chances of survival were better without the treatment.
2.       A croupy baby would have had to endure a piece of flannel saturated with turpentine wrapped around its throat.
3.      For an injury to an eye, a poultice of slippery elm bark was placed on the wound. Then the head was wrapped in a bandage and the patient was made to lie flat until healing took place.
4.      The doctor would have had no idea what was wrong with the infant. Only until many years later would it be known as infant botulism, one cause being feeding honey to babies under one year of age.
5.      The signs of acute heart failure haven’t changed (shortness of breath, fluid retention), although diagnosis and treatment are much more sophisticated today. In the mid-1800’s,  the condition may have been treated with a carefully monitored digitalis decoction. In that sense, the medication was the same, although today’s compounds are far safer.
At that time the condition would possibly have been called edema of the lungs, or dropsy. The term “heart failure” wasn’t commonly used until 1895, and “heart attack” came into our vocabulary in the 1930’s.
Makes be glad to be living now. The good old days weren’t all that good, at least not if you or someone you loved was sick!
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ANN SHOREY has been a full-time writer for over twenty years. Her writing has appeared in Chicken Soup for the Grandma’s Soul, and in the Adams Media Cup of Comfort series. She made her fiction debut with The Edge of Light, Book One in the At Home in Beldon Grove series. She’s tempted to thank Peet’s coffee and Dove chocolates when she writes the acknowledgments for her books.
 She may be contacted through her website, www.annshorey.com, which also contains her blog, http://annshorey.blogspot.com/ or find her on Facebook at http://www.facebook.com/AnnShorey.

Historical Medical Question: Laudanum Dosing

I have the great pleasure of hosting Ann Shorey today and Friday. First, I’d like to give her my warmest congratulations on the release of her novel Where Wildflowers Bloom that released Jan 1, 2012. What a great New Year’s Day gift. I hope you’ll check it out.

Ann Asks:

My wip is set in 1867. One of my characters is a doctor. Here are a couple of questions:

How much laudanum would be needed to give pain control to a four-year-old? How much for an adult male? How would it be administered–diluted in water, or swallowed straight?

Jordyn Says:

First thing to understand about laudanum is that it is an opiate based pain killer. Its contemporary counterparts would be drugs like Fentanyl and Morphine. Therefore, it could have the same type of adverse reactions that these drugs have. If a patient were to receive too much, their respiratory drive could slow down and/or stop. Also, these are not uncommon drugs to have an allergic reaction to.

I found a great resource for Ann. It’s an old medical text written by Dr. Chase, a physician during this time period. I was able to link to the exact information she needed. You can view it here:

http://www.archive.org/stream/drchasesrecipes01chas#page/132/mode/2up. The text gives a recipe on how to mix the drug and states: “From 10-30 drops for an adult, according to the strength of the patient or the severity of the pain.” So for children, I would imagine you would start with single drops.
I also wanted to point to this post written by historical author Ann Love (who I think has the best historical author name ever!) over at Anne’s Love Notes. She writes a more in-depth piece concerning Dr. Chase that will be of interest for historical authors. You can find it here: http://anneslovenotes.blogspot.com/2011/11/researching-19th-century-primary-source.html.
Any other thoughts for Ann?
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ANN SHOREY has been a full-time writer for over twenty years. Her writing has appeared in Chicken Soup for the Grandma’s Soul, and in the Adams Media Cup of Comfort series. She made her fiction debut with The Edge of Light, Book One in the At Home in Beldon Grove series. She’s tempted to thank Peet’s coffee and Dove chocolates when she writes the acknowledgments for her books.

 She may be contacted through her website, www.annshorey.com, which also contains her blog, http://annshorey.blogspot.com/ or find her on Facebook at http://www.facebook.com/AnnShorey.

Historical Overview of 19th Century Medicine

I ran across these guest posts by Eleanor Sullivan over at The Writer’s Forensic Blog which were excellent and a good resource for the historical authors that follow here. They are must read as I learned a lot of fascinating facts.

To supplement, I thought I’d add a few words to her list of terms that were used then and what they mean. These are referenced from Frontier Medicine by David Dary which is another excellent resource.

Acute Indigestion: listed as a cause of death. Probably a heart attack. This is interesting as in modern medicine, women can present quite differently from their male counterparts when they are suffering from heart attack. One of these symptoms can be indigestion.

Bad Blood: syphilis

Barber’s Itch: infection of the hair follicles of the face.

Black Fever: Rocky Mountain spotted fever.

Camp Colic: appendicitis

Domestic Illness: polite label for mental breakdown, depression, or the aftereffects of a stroke where a person was housebound and in need of regular nursing.

Dry Bellyache: lead poisoning

Grip/Gripe: influenza

Quinsy: tonsillitis

Scrivener’s Palsy: writer’s cramp

For an outstanding generalized overview of 19th century medicine, check out these links to Eleanor’s Guest Posts:

1. http://writersforensicsblog.wordpress.com/2011/10/09/guest-blogger-eleanor-sullivan-19th-century-medicine-part-1/

2. http://writersforensicsblog.wordpress.com/?s=Eleanor+Sullivan

Old versus New Medicine: Blistering

Prior to the birth of modern medical theory, the pervading thought for illness was that disease was caused by an imbalance of body fluids. To right this, common medical practices included purging, starving, blistering or blood-letting to place things back in order.

Maybe you think we don’t use any of these practices anymore. Think again.

Let’s consider blistering a patient.

In historical medicine, blistering used a caustic substance on a portion of the patient’s skin to induce a burn or blister. The goal was to create infection as physicians of the day thought that the subsequent puss draining from the wound would be beneficial for the patient.



Blister Beetle



 
Blistering is still used as a medical treatment. Molluscum is a wart-like virus that is very common in pediatrics. Cantharone is a blistering agent made from beetles. Some physicians will refer to it lovingly as “bug juice”. A very minute amount (this stuff is powerful) is applied to the lesion with a wooden stick. Over the next several hours, it will cause a water blister to form over the lesion. The goal is that when the blister forms, it will pull up the viral core, to resolve the lesion more quickly.



You can read more about that here: http://www.childrensmemorial.org/depts/dermatology/mollus.aspx

Does it surprise you that a blistering agent is still used as a medical treatment?

Western Medicine Circa 1890: Part 4/4

Lacy concludes her four-part Friday series today on western medicine during the 1890’s. It’s been a pleasure to have her and I hope you’ll check out her novel. Lacy, best of luck and many blessings on your writing career. I hope you’ll stop in again.

I hope you’ve enjoyed the excerpts from Marrying Miss Marshal that I’ve shared the last three weeks. This week, I thought I’d talk a little bit about my current project, which is now on my editor’s desk (hopefully soon to be bought!).

The story is set in the same time period and area as Marrying Miss Marshal but with different characters. In it, the hero has several adopted children and one of them falls off a ladder in the barn and breaks his leg. Because of this, the hero has to rely on the heroine’s help or he risks losing the hay he needs to put up to make it through the winter.
FRACTURES
In the reference Family Physician: A manual of domestic medicine, it is recommended that only medical doctors be allowed to treat fractures, otherwise the results could be lost of use of the affected area (finger, limb, etc.).
However, according to Bleed, Blister and Purge, if there was no doctor available, the only choice was for the homesteader or whoever it was to do their best to repair the broken bone. Treatment included splinting and then wrapping with surgeon’s plaster to put the limb in a cast. I would assume that sometimes in this case, the fracture would not be set exactly right and probably resulted in loss of some functionality of the arm or leg. However, in my story, I did choose to make a doctor available to help.
Here’s an unedited excerpt from my current project. Enjoy!
Penny found the house dark, and a bent-shouldered Jonas sitting on the porch steps. The lightening sky provided enough light to see his head was between his hands. Was he sleeping?
“Jonas?” she called softly and his head jerked up. Not sleeping, then. “Everyone all right?”
He stood and raised a hand to the back of his neck, half-turning from her so she couldn’t see his face.
“Yes. The doctor arrived just after you left—”
“After you made me leave.”
“—and set Maxwell’s leg. It’s splinted now with a plaster cast. He’s supposed to stay off it for a few days—or as long as I can keep him down.”
“Did he get any sleep last night?”
“Doc gave him some pain medication, knocked him right out.”
She couldn’t resist reaching out to touch his arm. He jumped at the contact but didn’t pull away.
“And you?”
He shook his head, ran his other hand down his face. “Couldn’t get my mind to quiet. We’re already behind on the haying, and with the Sumners’ fields to cut, too—without a driver—without Maxwell, I don’t see how we’ll finish.”
“Can you hire someone else?”
He was shaking his head by the time she’d finished her question. “Everyone’s hired out for the season. It’s not likely.”
“Well, what about Poppy?” As she said the words, she thought about her grandfather’s continuing exhaustion, though he’d been trying to hide it from her. “No, he probably shouldn’t be out in the sun all day.”
“There’s no one…”
She’d never heard Jonas so disheartened before. She knew part of his defeated attitude was because of his worry for Maxwell and loss of sleep. Maybe that’s why he’d overlooked the last obvious answer.
“What about me?”
Copyright © 2011 by Lacy Williams.
REFERENCES:
Family Physician: A manual of domestic medicine (1886) is available in the public domain on Googlebooks:
(Treatment of fractures begins page 717)
Bleed, Blister and Purge by Volney Steele, M.D. (2005)
CONTEST REMINDER
Don’t forget to leave a comment to be entered to win a copy of Marrying Miss Marshal and three other Love Inspired Historical books. You’ve have until 11:59pm EST to comment and I’ll be drawing a winner tomorrow! Full contest details were posted June 30th.
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As a child, Lacy Williams wanted to become a veterinarian “when she grew up”. However, the sight of blood often made her squeamish so she gave up that dream before her teen years. As a college student, Lacy was a physical therapy major for approximately two weeks—until she found out she’d have to take a cadaver lab to complete that degree plan. As a writer, Lacy has finally found a way she can handle blood and gore—fictionally. 
A wife and mom from Oklahoma, Lacy is a member of the American Christian Fiction Writers and is active in her local chapter, including a mentorship program she helped to start. She writes to give her readers happily-ever-afters guaranteed and mostly reads the end of the book first. You can find out more about Lacy at her website http://www.lacywilliams.net/. She is also active on Facebook (www.facebook.com/lacywilliamsbooks) and Twitter (www.twitter.com/lacy_williams).

Western Medicine Circa 1890: Part 3/4

Lacy continues her four part Friday series today on western medicine. I think her posts have been quite thought provoking! Don’t forget, she’s running a great contest for a chance to win four historical novels so be sure to leave a comment and check out full contest details as posted on June 30th. I echo Lacy’s thankfullness at giving birth with today’s medical techniques.

When I was getting to know my heroine, I met a really tough, independent woman. She has to be, to be able to do her job as town marshal. But what most of the other townspeople don’t know is that she does have a softer side… and she desperately wants a family of her own. Her best friend is pregnant and Danna ends up having to help during the delivery… and it is a really poignant moment for her because of her secret desire for a family of her own.
Also, as a mom who gave birth in a lovely hospital with several nurses and my obstetrician attending, I was still plenty scared. Imagining what it would have been like to deliver a baby back in the 1890s makes me shudder…
CHILDBIRTH
During the 1890s, most women gave birth at home. Hospitals existed in the East, but in the West there weren’t a lot of towns big enough to support one. So the best most women could expect was for a doctor to be present. More common was a midwife or even a neighbor to be present. Or sometimes it was just the husband (my husband pretended to be calm during my first delivery but I later found out it was all an act—I can’t imagine what he would have been like if he had been the only person in that room with me…)
According to Bleed, Blister and Purge (2005) a lot of women could have a normal delivery at home with very minimal help. The problems came when there were complications. Because doctors were often far away, sometimes the mother and/or child would suffer or even die because the doctor couldn’t get there in time. Luckily for my heroine, her best friend was a second-time mom and didn’t suffer any complications.
Here’s an excerpt from Marrying Miss Marshal chapter 13:
“Danna!”
“I’m here!” Rushing to her friend’s side, Danna saw the face creased in pain, the sweat on Corrine’s brow, the marks where she’d obviously clutched the sheets in her fists. “What can I do?”
Corrine let out a long breath, muscles easing. “Nothing yet. I think we have a bit to go, even though the pains have been coming all day.”
“Should I get the doctor?”
“He’s tied up at his office. The young man from the robbery took a turn for the worse. He’s in surgery.”
That wasn’t good. The “young man” was quite possibly the only lead Danna had to find out anything about where the outlaws were going with the bank’s money.
“What about your neighbor…” And why had she rushed out like that?
Corrine clasped Danna’s hand as another pain came. Her lips pinched white. “She doesn’t…she thinks…Brent killed…your husband.” The words came out in spurts and gasps as Corrine panted through the contraction.
Danna found a clean cloth on the end of the bed—someone had prepared things at least—and dabbed at her friend’s forehead. “Ssh. Ssh. It’s okay.”
The contraction eased and Corrine relaxed again. “I don’t suppose there’s any news…?”
Danna wished she had something positive to tell her friend, but there was nothing. “I’m sorry.”
“And Mrs. Burnett,” the preacher’s wife, “is visiting her sister out of town,” Corrine spoke as if the question about her husband hadn’t been asked. “So I sent the neighbor boy to fetch you. Will you stay with me? Help me labor this baby?”
Tears sparkled in Corrine’s eyes.
A lump of responding tears formed in Danna’s throat. “You don’t even have to ask,” she told her dearest friend.
Copyright © 2011 by Lacy Williams. Permission to reproduce text granted by Harlequin Books.
REFERENCES:
The Modern Family Physician (1915) is available in the public domain on Googlebooks.
Volume 1 (Childbirth information starts page 370):
Bleed, Blister and Purge by Volney Steele, M.D. (2005)
***********************************************************************
As a child, Lacy Williams wanted to become a veterinarian “when she grew up”. However, the sight of blood often made her squeamish so she gave up that dream before her teen years. As a college student, Lacy was a physical therapy major for approximately two weeks—until she found out she’d have to take a cadaver lab to complete that degree plan. As a writer, Lacy has finally found a way she can handle blood and gore—fictionally.
A wife and mom from Oklahoma, Lacy is a member of the American Christian Fiction Writers and is active in her local chapter, including a mentorship program she helped to start. She writes to give her readers and mostly reads the end of the book first. You can find out more about Lacy at her website http://www.lacywilliams.net/. She is also active on Facebook (www.facebook.com/lacywilliamsbooks) and Twitter (www.twitter.com/lacy_williams).

Western Medicine Circa 1890: Part 2/4

Lacy Williams is back with part two of her four part Friday series on western medicine during the 1890’s. She is running a fantastic contest so be sure to leave a comment and check out the full details posted on June 30th. Nothing like a chance to win four books!

I know I’m not alone in the fact that Janette Oke really inspired me to want to read and write inspirational fiction (waaaay back when it was just a dream for me). The next inspirational author that I fell in love with was Al Lacy, who writes westerns/western romance (I liked that his last name was the same as my first name…).
One problem that Mr. Lacy’s characters (a lot of times it was the bad guys) ran into was gunshot wounds. Mostly they didn’t survive, which I think is realistic. My issue when writing MARRYING MISS MARSHAL was that I had a main character, a marshal, who found herself trading bullets with some outlaws… What if she got shot? How bad could I make her injury and still reasonably expect her to go about her duties?
GUNSHOT WOUNDS
Difficult enough to treat with today’s modern medicines, I imagine treating gunshot wounds was probably something that Wild West doctors dreaded. Part of the problem was the damage that a bullet could do to a person’s insides—not pretty to put back together. Another problem was the threat of infection. If any foreign object (a piece of bullet, fabric remnant, dirt, etc.) remained in the wound after cleansing, it could cause major problems, which might lead to amputation or death for the wounded person.
Family Physician: A manual of domestic medicine (1886) suggests that serious wounds requiring surgery only be treated by a doctor, and doesn’t go into explicit detail about the treatment of these wounds, which would probably include gunshot wounds. It does share some information on treating “lighter” types of wounds. Here’s an excerpt:
The after-treatment of a wound cannot be of too simple a character. Where there is no pain or discomfort about the wounded part, there can be no object in disturbing the first dressing applied, and this should be left undisturbed for from two to four days, according to the severity of the injury. If all has gone well, it is quite possible that a skin wound may heal at once, and merely require the application of a piece of plaster over it, to protect it for a few additional days. If, however, it is found on carefully soaking off the original dressing that the wound is open and discharging, the best application will be the ” water-dressing.”…
Because I needed my heroine to be able to be active, not laid up by a gunshot wound, I chose to give her a “flesh wound”, more of a scrape. The bullet that hit her did not pierce her skin, per se. Here’s an excerpt from Marrying Miss Marshal chapter 16 that shows the hero (her husband) helping her treat the wound:
“Do you need help?” He waited for her answer before he turned around.
Danna sighed, a little huff of air to let him know she wasn’t happy about it. “Yes. It’s difficult for me to reach the wound.”
He faced her, and had to swallow hard. She wore an undershirt and had the quilt from the bed wrapped around her; only her shoulder and injured arm emerged. It was her hair that unmanned him, the dark locks falling in waves down her back. She must’ve loosed them from the braid so they would dry.
His knees threatened to knock together as he approached her. She flushed under his gaze and averted her face, pointing to the array of doctoring supplies she’d laid out across the bed.
“You’ll need to clean it out first,” she said. “The wound isn’t bad, but if infection sets in…”
“Yes, I know.” And he did know how bad infection could get. He’d met plenty of men missing limbs or on the brink of dying because of infection from injuries. “I can’t believe you went all morning with a bullet wound and didn’t tell me.”
He located an antiseptic and some clean cloths and moved in front of Danna so her crown was at his chin. He began by wiping the blood off of the inside of her arm. He was entirely too conscious of how soft her skin felt against his palm, and how she smelled sweet, even though the rain must’ve washed away any scent of soap or perfume.
“There wasn’t anything you could do, even if I did tell you.”
“You would’ve told your first husband.”
“Fred—” She bit out the one word. That was it.
He kept his gaze on what he was doing, but he could see her jaw flex from the corner of his eye, as if she’d chomped down on what she really wanted to say.
He leaned away so he could look her in the face. He didn’t release his hold on her upper arm. “Say it.”
Her gaze didn’t waver from his. “Fred would’ve known without me telling him.”
Well. Chas looked down to apply the antiseptic to a rag, pretending her words didn’t sting. He dabbed the rag against the bloody furrow in her skin—she was lucky the bullet hadn’t entered her flesh—and heard her soft intake of breath.
He hated that she was injured. Hated that they hadn’t been able to capture the outlaws. Hated that he had no control over any of this.
Copyright © 2011 by Lacy Williams. Permission to reproduce text granted by Harlequin Books.
REFERENCE:
Family Physician: A manual of domestic medicine (1886) is available in the public domain on Googlebooks:
(Treatment of Wounds begins page 712)
***********************************************************************
As a child, Lacy Williams wanted to become a veterinarian “when she grew up”. However, the sight of blood often made her squeamish so she gave up that dream before her teen years. As a college student, Lacy was a physical therapy major for approximately two weeks—until she found out she’d have to take a cadaver lab to complete that degree plan. As a writer, Lacy has finally found a way she can handle blood and gore—fictionally. 
A wife and mom from Oklahoma, Lacy is a member of the American Christian Fiction Writers and is active in her local chapter, including a mentorship program she helped to start. She writes to give her readers happily-ever-afters guaranteed and mostly reads the end of the book first. You can find out more about Lacy at her website www.lacywilliams.net. She is also active on Facebook (www.facebook.com/lacywilliamsbooks) and Twitter (www.twitter.com/lacy_williams).


Western Medicine Circa 1890: Part 1/4

I’m very pleased to host Lacy Williams as a guest blogger this month. She is doing a four-part Friday series on western medicine during the 1890’s. Lacy has developed a great contest so check yesterday’s post for details. Though, I’m not sure I’m pleased with her reading the end of books first. I might have to chat with her about that….

Welcome Lacy!

Just want to say a quick thank you to Jordyn for hosting me on her blog this month! I’m really excited to be here and I plan to share some book excerpts and do a book giveaway that you won’t find anywhere else, so stay tuned the next few Fridays.
 I did a considerable amount of historical medical research for my novel, Marrying Miss Marshal, mostly because it seemed my heroine (a town marshal) kept getting into scrapes! Some of the basic research indicated that folks in the Wild West didn’t always have access to a doctor, mostly because there was a shortage of doctors in the less-populated areas. So they tended to doctor themselves. My heroine, Danna Carpenter, is the widow of the former town marshal and often had to doctor him up, so she does have some experience with tending injuries. She also grew up on a ranch, so in my mind, she would have also seen treatment of animals, which was often done by common sense.
DISLOCATED SHOULDER
In the first chapter of Marrying Miss Marshal, the hero falls down a ravine and dislocates his shoulder. One of the sources I used in my research, The Modern Family Physician (1915), gives two methods for treating a dislocated shoulder. One, Stimson’s method, wouldn’t work for my story because both hero and heroine are stranded outdoors in the dark. Here’s an excerpt that tells about the second method of treatment:
The more ordinary method consists in putting the patient on his back on the floor, the operator also sitting on the floor with his stockinged foot against the patient’s side under the armpit of the injured shoulder and grasping the injured arm at the elbow, he pulls the arm directly outward (i. e., with the arm at right angles with the body) and away from the trunk. An assistant may at the same time aid by lifting the head of the arm bone upward with his fingers in the patient’s armpit and his thumbs over the injured shoulder.
Although this isn’t exactly how it happened in Marrying Miss Marshal, this information is what I based my scene on. My brother-in-law (shout out to Ben!) dislocated his shoulder several times during high school, and had either a family member or friend put the joint back into place on the spot, so I know it’s possible for a layman to do it.
How do you think my scene turned out?
From Marrying Miss Marshal chapter 1:
When she reached him, Danna knelt at his head and studied the man. His hat had slipped to one side, and his sweat-matted hair was dark next to his fair skin.
“Mister, you’ve sure got a way of getting into some pretty good scrapes,” she muttered. She probed his scalp and neck gently with her fingertips, searching for injury. Though obscured by a few days growth stubble, he had a strong jawline.
He gasped when her palm brushed his right shoulder. Keeping her touch as light as she could, Danna ran her fingers over the arm and shoulder, and he moaned again. “Hurts.”
“I know. Looks like you’ve knocked it out of place.” She prodded his torso and legs, but found no additional trauma. She did find a gun belt and weapon at his hip, but ignored it for now. “I can reset it for you.”
She smoothed a hand over his forehead, as if she was comforting her almost-niece, Ellie. “Tell me your name.”
“Chas.” A breath. “O’Grady.”
She filed the name away. O’Grady sounded Irish. She nodded absently and murmured, “I’m Danna Carpenter,” as she considered the best way to get his shoulder back into the socket. “What brings you to Wyoming?”
“Job.”
“Not cattle.”
One corner of his mouth quirked upward. “How’d you know?”
“Lawyer?”
He snorted a laugh, then grimaced as if the movement pained him.
“Railroad surveyor?” she guessed, and gave a mighty tug.
O’Grady’s upper arm and the shoulder slid into place with an audible click. She was impressed when he didn’t cry out, just rolled his head and looked at her with those blue eyes.
“Thanks. You’re a doll.”
Then he passed out.
Copyright © 2011 by Lacy Williams. Permission to reproduce text granted by Harlequin Books.
REFERENCE:
The Modern Family Physician (1915) is available in the public domain on Googlebooks:
Volume 1
Volume 2 (dislocated shoulder information starts on page 412 of this volume)
***********************************************************************
As a child, Lacy Williams wanted to become a veterinarian “when she grew up”. However, the sight of blood often made her squeamish so she gave up that dream before her teen years. As a college student, Lacy was a physical therapy major for approximately two weeks—until she found out she’d have to take a cadaver lab to complete that degree plan. As a writer, Lacy has finally found a way she can handle blood and gore—fictionally. 
A wife and mom from Oklahoma, Lacy is a member of the American Christian Fiction Writers and is active in her local chapter, including a mentorship program she helped to start. She writes to give her readers happily-ever-afters guaranteed and mostly reads the end of the book first. You can find out more about Lacy at her website http://www.lacywilliams.net/. She is also active on Facebook (www.facebook.com/lacywilliamsbooks) and Twitter (www.twitter.com/lacy_williams).