Author Question: Gunshot Wounds


I’m happy to have award-winning author Jocelyn Green return to Redwood’s with a couple of questions about gunshot wounds.
Welcome back, Jocelyn!
Jocelyn asks:
I decided not to do a gunshot to my character’s shoulder because of all the bones and major things it could have hit. Too complicated for my story. Instead, I am writing that she was shot through her bicep, missing the bone, though. A year later, she raises a gun for the first time since her injury, to do target practice.
Is it possible that due to nerve injury, her aim is off, or she can’t raise the gun properly? It would be great if something doesn’t look right to her “instructor.” So, can we limit her range of motion or something, due to her injury? The year is 1863, by the way, and according to my medical textbooks from that time, the treatment of a gunshot wound was to clear out the debris and just put water dressings over it.
Jordyn says
Yes, this is possible. A gunshot wound through the bicep could injure the musculocutaneous nerve that is responsible for part of the upper arm like the flexor muscles. Flexor muscles decrease angles at joints like the elbow. So, if her arm would need to be slightly bent to shoot the weapon, she would be unable to do that. That being said—if it were needed that the opposite be true (for instance her arm would need to be straight to shoot the weapon) you could injure a nerve that supplies the extensor muscle—which decreases the angle at joints like the elbow. You can view the two links below for detailed information about flexor and extensor muscles. 
Remember, though, she would exhibit these deficiencies all the time—not just when she’s learning to shoot the weapon with her instructor so that would need to be written into the story as well.
Jocelyn asks:
I also have another character who broke his arms and legs in an accident on a ship under construction. How long would he be in slings for his arms and casts for his legs? How long would he use a wheelchair or cane?
Jordyn says:
Wow! You are really torturing your poor characters in this novel! Those are very significant injuries. Bones can take anywhere from four weeks (on the short end) to eight weeks (on the long end) to heal. In the time era your novel is set in—I’m doubtful they would have done plating, screws, etc for stabilizing fractures but likely did externally set them. 
I think he’s going to be wheelchair bound for a long time. A person quickly loses muscle mass and strength in a few short weeks of being immobile so even when he’s out of his casts (in say six to eight weeks) he would not be able to tolerate a lot of physical activity for likely several months.

These days a person who suffered these injuries might be in a rehab center for several weeks building their strength and mobility back up.  

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 A former military wife, Jocelyn Green authored, along with contributing writers, the award-winning Faith Deployed: Daily Encouragement for Military Wives and Faith Deployed . . . Again. Jocelyn also co-authored Stories of Faith and Couragefrom the Home Front, which inspired her first novel: Wedded to War. She loves Mexican food, Broadway musicals, Toblerone chocolate bars, the color red, and reading on her patio. Jocelyn lives with her husband Rob and two small children in Cedar Falls, Iowa.

Phantom Limb Pain: 2/2

Today, author and Christy Award nominee (two nominations!) Jocelyn Green concludes her two-part series on phantom limb pain. You can find Part I here

As an added bonus, Jocelyn has graciously offered to give away a personalized copy of her latest novel, Widow of Gettysburg, to one commentor. To enter, leave a comment on any of her posts WITH your e-mail address. Must live in the USA. Winner drawn midnight, Saturday, May 11th, 2013 and announced here at Redwood’s on May 12th, 2013.

Jocelyn has also graciously said she’ll send you a signed bookplate if you have any of her novels and would like one. Again, MUST have your e-mail. 

You can view Jocelyn’s previous posts at Redwood’s here and here.

Welcome back, Jocelyn!

What We Know Today

The study of PLP continues with today’s generation of amputee veterans. Most contemporary studies confirm what Mitchell found, but add to it some new information. Most recent studies report PLP at rates of 50% to 80%. A few of these are in constant pain, but for most, the episodes can last a few seconds or one to two hours.
Since the beginning of the conflicts in Iraq and Afghanistan more than 1000 amputees have been treated at Walter Reed Army Medical Center in Washington, DC. Almost all experience PLP, either within the first 24 hours of amputation, or within two weeks. The following insight comes from an article in a 2010 issue of The Neurologist:
“As part of routine treatment efforts, the patients are asked to describe their experience with phantom sensation and phantom pain. There have been a plethora of responses regarding the onset, duration, description, and location of phantom sensations and phantom pains from those queried. Furthermore, some explain they have volitional control over their phantom, and can move their phantom at will, while others report their phantoms being fixed in a specific position. Some even report the inability to make movements with the phantom, despite the presence of a strong sensation or pain emanating from their residual limb. For example, one service member reported that his phantom hand was in a distinct position: he felt he was pulling the trigger on his rifle with his index finger, and was unable to move his hand to a different position. He also felt cramping pains in his hand muscles. Another service member, a bilateral, above knee amputee, described the feeling of heavy legs, asserting that the feeling was similar to weights attached to his calf muscles. He also described that it felt as though his combat boots were on too tightly.”
There are multiple theories as to the cause of PLP, all of which can be read in this online article [http://sunburst.usd.edu/~cliff/Courses/Advanced%20Seminars%20in%20Neuroendocrinology/Pain/Weeks10.pdf]. 
The most successful treatments have been with opioids and mirror therapy, the latter considered the most promising treatment plan.
In this treatment, the patient views the reflection of their intact limb moving in a mirror placed between the arms or legs while simultaneously moving the phantom hand or foot in a manner similar to what they are observing. The virtual limb in the mirror appears to be the missing limb.
Patients have reported a relief of cramping and “frozen limb” phantom pains as a result of even one session with the mirror. In one study in which patients used mirror therapy for 15 minutes each weekday for four weeks, significant decreases in pain were reported. More about mirror therapy can also be found in the online article hyperlinked above.
For further reading:
Mitchell, Silas Weir. The Case of George Dedlow. (fictional account of quad amputee) New York: The Century Co., 1900. Read it online at Google Books here, and begin on page 115. http://bit.ly/ZixtJd
 
Gunshot Wounds and other Injuries of Nerves. Philadelphia: J.B. Lippincott, & Co., 1864. Read it online at Google Books here: http://bit.ly/17hhuvf
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 A former military wife, Jocelyn Green authored, along with contributing writers, the award-winning Faith Deployed: Daily Encouragement for Military Wives and Faith Deployed . . . Again. Jocelyn also co-authored Stories of Faith and Couragefrom the Home Front, which inspired her first novel: Wedded to War. She loves Mexican food, Broadway musicals, Toblerone chocolate bars, the color red, and reading on her patio. Jocelyn lives with her husband Rob and two small children in Cedar Falls, Iowa.

 

Phantom Limb Pain: 1/2

Author and Christy Award nominee (two nominations!) Jocelyn Green joins us again this week for a two-part series on phantom limb pain.

As an added bonus, Jocelyn has graciously offered to give away a personalized copy of her latest novel, Widow of Gettysburg, to one commentor. To enter, leave a comment on any of her posts WITH your e-mail address. Must live in the USA. Winner drawn midnight, Saturday, May 11th, 2013 and announced here at Redwood’s on May 12th, 2013.

Jocelyn has also graciously said she’ll send you a signed bookplate if you have any of her novels and would like one. Again, MUST have your e-mail. 

You can view Jocelyn’s previous posts at Redwood’s here and here.

Welcome back, Jocelyn!

Though the phenomenon of phantom limb pain had been recorded long before the Civil War, it was Silas Weir Mitchell, a Philadelphia physician specializing in nerve injuries during the Civil War, who coined the term. Phantom limb pain, or PLP, occurs when a patient feels pain in an arm or leg that has been amputated. Mitchell studied PLP (or sensory hallucinations, as he also called them) in depth at the Turner’s Lane hospital in Philadelphia, dubbed the Stump Hospital because it focused on caring for amputees.

If a character in your story is an amputee, like one of my characters in Widow of Gettysburg, the following will be helpful to you.
What Mitchell Found
·         Almost every amputee at Turner’s Lane Hospital experienced PLP. 
·         Most of them came out of anesthesia feeling the presence of the amputated limb.
·         Those who did not immediately feel PLP usually felt it within three weeks.
·         Usually, the patients felt the missing hand/foot but not the section of limb directly beyond the stump.
       Mitchell wrote: “The patients describe themselves as knowing that they have a hand which is connected to a stump, and feel able to move it, but of the rest of the limb they are unconscious, and the subjective sensations which are so common are always referred to the hand or foot, and rarely to the continuity of the member.”
·         In about one-third of the leg cases, and in one-half of the arm amputations, the patient felt that the foot or hand is nearer to the trunk than the extremity of the limb.
·         The type of pain could be burning, itching, stabbing, or cramping.
·         Missing legs usually felt as though they are hanging straight down, while missing arms felt as though they were bent at the elbow or locked in the last position they were in prior to the operation.
·         Treatment of water dressings on the stump helped with burning sensations in some cases, but most efforts to relieve PLP were ineffectual.
·         Amputee veterans wrote to Mitchell decades after their operations and shared that in their dreams, they had all their limbs perfectly whole.
    
      Return Friday as Jocelyn finishes up her Civil War medical series.

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A former military wife, Jocelyn Green authored, along with contributing writers, the award-winning Faith Deployed: Daily Encouragement for Military Wives and Faith Deployed . . . Again. Jocelyn also co-authored Stories of Faith and Couragefrom the Home Front, which inspired her first novel: Wedded to War. She loves Mexican food, Broadway musicals, Toblerone chocolate bars, the color red, and reading on her patio. Jocelyn lives with her husband Rob and two small children in Cedar Falls, Iowa.

              
       


Opium Abuse during the Civil War Era: 2/2

Author Jocelyn Green returns with another installment in her series of posts on Civil War Medicine. Jocelyn was here last week discussing amputees and prosthetics. You can Part I and Part II by following the links.

As an added bonus, Jocelyn has graciously offered to give away a personalized copy of her latest novel, Widow of Gettysburg, to one commentor. To enter, leave a comment on any of her posts over the next three weeks WITH your e-mail address. Must live in the USA. Winner drawn midnight, Saturday, May 11th, 2013 and announced here at Redwood’s on May 12th, 2013.


Jocelyn has also graciously said she’ll send you a signed bookplate if you have any of her novels and would like one. Again, MUST have your e-mail. 

Good Luck!

Today, Jocelyn continues her discussion on opium abuse during the Civil War. Here is Part I.


In severe cases, the individual may have a weak pulse, lower blood pressure, reduced heart rate, difficulty or labored breathing, and changes in the color of lips and fingertips. Seizures, convulsions, hallucinations, confusion and psychomotor retardation also take place.

Common Opium Abuse Withdrawal Symptoms

If the patient suddenly stops taking opium, either by choice or from lack of supply, which often happened among Confederate soldiers especially, the following symptoms could be present.

§  emotional instability
§  depression
§  feeling shaky
§  nightmares
§  exhaustion
§  general body weakness
§  lethargy
§  mental fogginess
§  anxiety
§  nervousness

Signs of Opium Abuse Withdrawal

§  trouble sleeping
§  nausea and vomiting
§  heart palpitations
§  headaches
§  clammy
§  sweaty skin
§  decreased appetite
§  unusual movements
§  hand tremors
§  alterations of the pupils
§  pale skin

Severe Opium Withdrawal Symptoms

In extreme cases, the following might present themselves.

§  irrational thoughts
§  irritability
§  anger
§  confusion
§  fever
§  seizures
§  convulsions
§  hallucinations

Treatment

So what did doctors do when a patient was overdosed on opium? The following case study from the archives of the University of Virginia offers some answers. Though this example took place a decade before the Civil War broke out, we can imagine many doctors may have used similar methods.

“On May 7, 1850, Dr. John William Ogilvie traveled eight miles to a plantation in Barnwell County, SC in response to a reported overdose of Laudanum, or a tincture of opium. The patient had attempted suicide, swallowing the tincture at 4:15 that morning. Arriving at 7:15 AM, Dr. Ogilvie found him still alive. Apparently in a state of melancholy, the patient was conscious and calm, but expressed regret that the doctor had come as he still wished to die. Dr. Ogilvie, however, proceeded to treat the patient without any apparent difficulty. Initially, he administered ten doses of zinc sulphate solution, five minutes apart. The patient began to vomit fifteen minutes after the last dose, and Dr. Ogilvie smelled and saw the drug in his regurgitated fluids. The doctor then proceeded to put a tube down his patient’s throat and forced four pints of warm water into the man’s stomach. Dr. Ogilvie left at 10:45 AM, his patient stabilized and quickly recovering.”

Historically, southern whites were the most susceptible to opium addiction, and prior to 1900, the addiction primarily affected the middle- and upper-class. Country physicians actually had the highest rate of addiction among nineteenth-century professions, so it was not a big leap for me to give an opium addiction to a Confederate surgeon in my novel.

Dependency on the drug during the Civil War was likely magnified by soldiers’ traumatic experiences. Opium helped calm frayed nerves and brought sleep to those who otherwise may not have been able to rest. Not only did it numb physical pain, but it numbed emotional pain, as well.

Up until the Civil War, opium use and abuse was so widespread it was not frowned upon. It was not until the significant abuse during and after the Civil War that doctors began to take drug abuse seriously and medical opiate addiction finally began to disappear.

For further reading:

Courtwright, David T. Dark Paradise: Opiate Addictionin America Before 1940. Cambridge: Harvard University Press, 1982.

Hodgson, Barbara. In the Arms of Morpheus: The Tragic History of Laudanum, Morphine, and Patent Medicines. Buffalo: Firefly Books, 2001.

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A former military wife, Jocelyn Green authored, along with contributing writers, the award-winning Faith Deployed: Daily Encouragement for Military Wives and Faith Deployed . . . Again. Jocelyn also co-authored Stories of Faith and Couragefrom the Home Front, which inspired her first novel: Wedded to War. She loves Mexican food, Broadway musicals, Toblerone chocolate bars, the color red, and reading on her patio. Jocelyn lives with her husband Rob and two small children in Cedar Falls, Iowa.

Opium Abuse during the Civil War Era: 1/2

Author Jocelyn Green returns with another installment in her series of posts on Civil War Medicine. Jocelyn was here last week discussing amputees and prosthetics. You can Part I and Part II by following the links.

As an added bonus, Jocelyn has graciously offered to give away a personalized copy of her latest novel, Widow of Gettysburg, to one commentor. To enter, leave a comment on any of her posts over the next three weeks WITH your e-mail address. Must live in the USA. Winner drawn midnight, Saturday, May 11th, 2013 and announced here at Redwood’s on May 12th, 2013.

Jocelyn has also graciously said she’ll send you a signed bookplate if you have any of her novels and would like one. Again, MUST have your e-mail. 

Good Luck!

As you can image by the title of my novel, Widow of Gettysburg, writing it required extensive research into the condition of wounded soldiers and their treatment. I soon discovered that opium was considered a wonder drug by battlefield surgeons. It was sprinkled on wounds to help slow blood loss, and taken orally to relieve pain and induce sleep. Opium and morphine were the most popular painkillers—but they were also used in the treatment of cholera and sometimes dysentery.

The most significant incidence of opium abuse in the United States occurred during the Civil War, when an estimated 400,000 soldiers became addicted to the drug. Two of my characters in Widow of Gettysburg struggle with it. The following signs and symptoms helped guide those storylines.
Opium Abuse Side Effects
These side-effects depend on factors such as the dose, how the drug is taken, and the individual’s metabolism. In addition, these side-effects depend on the duration of time in which the drug has been taken. Opium abuse brings about side-effects such as:

  • Drowsiness
  • Sedation
  • Depressed or slowed breathing
  • Glazed or red eyes
  • Slurred speech
  • Headaches
  • Confusion
  • Dizziness
  • Small pupils
  • Nausea
  • Sleeping disorders
  • A runny nose
  • Sinus irritation
  • Excessive energy
  • Rapid speed
  • Mania
  • Loss of appetite
  • Mood swings
  • Depression
  • Apathy
  • Slowed reflexes
  • Vomiting
  • Constipation and other gastrointestinal problems
  • Extreme anxiety
  • Restlessness and tension


In most cases, side-effects are experienced at the early stages of abuse and decrease as time goes by.

Depression was one of the most serious side effects of long-term users, and could lead to suicide.

In severe cases, the individual may have a weak pulse, lower blood pressure, reduced heart rate, difficulty or labored breathing, and changes in the color of lips and fingertips. Seizures, convulsions, hallucinations, confusion and psychomotor retardation also take place.


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 A former military wife, Jocelyn Green authored, along with contributing writers, the award-winning Faith Deployed: Daily Encouragement for Military Wives and Faith Deployed . . . Again. Jocelyn also co-authored Stories of Faith and Couragefrom the Home Front, which inspired her first novel: Wedded to War. She loves Mexican food, Broadway musicals, Toblerone chocolate bars, the color red, and reading on her patio. Jocelyn lives with her husband Rob and two small children in Cedar Falls, Iowa.

The Civil War and Prosthetic Limbs: 2/2

Jocelyn has returned for Part II in this series on Civil War medicine and amputees. Check out Part I here.

As an added bonus, Jocelyn has graciously offered to give away a personalized copy of her latest novel, Widow of Gettysburg, to one commentor. To enter, leave a comment on any of her posts over the next three weeks WITH your e-mail address. Must live in the USA. Winner drawn midnight, Saturday, May 11th, 2013 and announced here at Redwood’s on May 12th, 2013.

Jocelyn has also graciously said she’ll send you a signed bookplate if you have any of her novels and would like one. Again, MUST have your e-mail. 

Good Luck!

Jocelyn appeared before at Redwood’s and you can read those posts here and here.

Welcome back, Jocelyn!


Many entrepreneurs who developed artificial limbs were Civil War veteran amputees themselves. In fact, one of the most successful pioneers in prosthetics was Confederate veteran James Edward Hanger, whose amputation in West Virginia was the first recorded amputation of the Civil War. He was 18 years old at the time. Union surgeons discovered him wounded and performed the amputation, giving him a standard issue replacement leg: a solid piece of wood that made walking clunky and difficult. 
Hanger’s adjustments included better hinging and flexing abilities using rust-proof levers and rubber pads. He also used whittled barrel staves to make the limb lighter-weight. He won the Confederate contract to produce limbs, and by 1890, had moved his headquarters to Washington, D.C., and opened satellite offices in four other cities. The company he founded – Hanger, Inc. – remains a key player in prosthetics and orthotics today.
One of James Hanger’s early patents from 1891. Courtesy of Hanger.com.

The Civil War-era commitment to support veterans continues today through programs of the VA and the Defense Advanced Research Projects Agency (DARPA) to ensure ongoing progress in prosthetics design. The war set the prosthetics industry on a course that would ultimately lead to today’s quasi-bionic limbs that look like the real thing and can often perform some tasks even better.

To see just how far we’ve come in the realm of prosthetic limbs, I invite you to take a look at the video below. This is a brief look at the story of Taylor Morris, the fifth quad amputee veteran in the U.S. Army. You will see Taylor, who is from my hometown of Cedar Falls, Iowa, go from the hospital bed shortly after his surgeries, to dancing with his girlfriend again at the end of the video. (Have a Kleenex handy!)



For further reading:
Hasegawa, Guy R. MendingBroken Soldiers: The Union and Confederate Programs to Supply Artificial Limbs. Southern Illinois University Press, 2012.
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A former military wife, Jocelyn Green authored, along with contributing writers, the award-winning Faith Deployed: Daily Encouragement for Military Wives and Faith Deployed . . . Again. Jocelyn also co-authored Stories of Faith and Couragefrom the Home Front, which inspired her first novel: Wedded to War. She loves Mexican food, Broadway musicals, Toblerone chocolate bars, the color red, and reading on her patio. Jocelyn lives with her husband Rob and two small children in Cedar Falls, Iowa.

The Civil War and Prosthetic Limbs: 1/2

I’m so pleased to host author Jocelyn Green again. She’s an amazing woman and author of inspirational fiction surrounding the Civil War.  Jocelyn will be here over the next three weeks sharing wonderful information about her research. Often times, during war, there is a lot of advancement in medical technology which is why I’m giving her so many days.

Plus, I just love her.

As an added bonus, Jocelyn has graciously offered to give away a personalized copy of her latest novel, Widow of Gettysburg, to one commentor. To enter, leave a comment on any of her posts over the next three weeks WITH your e-mail address. Must live in the USA. Winner drawn midnight, Saturday, May 11th, 2013 and announced here at Redwood’s on May 12th, 2013.

Jocelyn has also graciously said she’ll send you a signed bookplate if you have any of her novels and would like one. Again, MUST have your e-mail. 

Good Luck!

Jocelyn appeared before at Redwood’s and you can read those posts here and here.

Welcome back, Jocelyn!


“It is not two years since the sight of a person who had lost one of his lower limbs was an infrequent occurrence. Now, alas! There are few of us who have not a cripple among our friends, if not in our own families. A mechanical art which provided for an occasional and exceptional want has become a great and active branch of industry. War unmakes legs, and human skill must supply their places as it best may.”
~Oliver Wendell Holms, M.D., “The Human Wheel, Its Spokes and Felloes,” 1863
If necessity is the mother of invention, it should come as no surprise that the Civil War, which produced some 45,000 amputee veterans, also prompted major progress in the development and production of artificial limbs. One of the characters in my novel Widow of Gettysburg is the recipient of one of these limbs. Let’s take a closer look at what was involved in this rehabilitation of amputee veterans. (You can see more on amputations from a previous blog I wrote for Jordyn, here: http://jordynredwood.blogspot.com/2012/08/civil-war-amputations-and-anesthesia_31.html
Double Amputees of the Civil War
Once the stump was healed after amputation and the patient able to do without dressings, the surgeons’ work was finished, and the patient was left to shift for himself in securing the best apparatus. But not everyone was a good candidate for a prosthetic. If the limb was taken off at the joint, such as the hip or shoulder, there was no stump to which an artificial limb could be attached. The surgeon may have performed the operation too high or too low on the limb for a good fit to be possible. Also, if the stump was prone to frequent infection, it would have been too painful to attach an artificial limb to it.
For those who could pursue a prosthetic, in the North, the most popular artificial leg was a “Palmer” leg, named for Benjamin Franklin Palmer, who patented the design. A previous design by James Potts was made of wood, leather, and cat-gut tendons hinging the knee and ankle joints, and dubbed “The Clapper” for the clicking sound of its motion. Palmer improved upon this design with a heel spring in 1846, and his “American leg” was produced continuously through World War 1.
Palmer’s leg cost about $150, a prohibitive amount for the average private, whose pay was about $13 per month. Add to that the cost of travel and lodging expenses to see a specialist, and the number of amputees who could afford it went down even further. The cost of an artificial limb for Confederate veterans was between $300-$500, due to the soaring inflation.
Since the majority of veterans had been farmers, planters, or skilled laborers before the war, the need for artificial limbs was, indeed, a crippling problem. To help address it, the U.S. government appropriated $15,000 in 1862 to pay for limbs for maimed soldiers and sailors. In January 1864, a civilian association in Richmond was established to pay for artificial limbs for Confederate amputees.
After the war in 1866, North Carolina became the first state to start a program for thousands
of amputees to receive artificial limbs. The program offered veterans free accommodations and transportation by rail; 1,550 veterans contacted the program by mail. During the same year, the State of Mississippi spent more than half its yearly budget providing veterans with artificial limbs.
 Return for Part II on Friday.
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 A former military wife, Jocelyn Green authored, along with contributing writers, the award-winning Faith Deployed: Daily Encouragement for Military Wives and Faith Deployed . . . Again. Jocelyn also co-authored Stories of Faith and Couragefrom the Home Front, which inspired her first novel: Wedded to War. She loves Mexican food, Broadway musicals, Toblerone chocolate bars, the color red, and reading on her patio. Jocelyn lives with her husband Rob and two small children in Cedar Falls, Iowa.