The second book, AN OUTLAW IN WONDERLAND, in my western historical romance series “Once Upon a Time in the West” was released on June 4th. This series is set in the post-Civil War period. However the incidents that set the heroes and heroines on their path occurred during the war. This second book begins at Gettysburg in 1864 and moves to Chimborazo Hospital and Castle Thunder Prison in Richmond.
As the hero of OUTLAW is a physician, and the heroine a matron at the hospital (when they aren’t spying for opposite sides) I did a lot of research about Civil War era medicine and became fascinated by it. They knew a lot more than we thought they did back then, or at least a lot more than I thought they did.
The casualties of the Civil War were the greatest in our history. Most estimates put the death toll at 620,000, though some go as high as 700,000. For the Union, over twice as many died of disease as died in battle. The names of the diseases were as colorful as their symptoms–the King’s evil, a strangery, erysipelas, pyemia, paroxysms.
Most physicians were aware of the connection between filth and infection, however they had no idea how to sterilize equipment. Because of the conditions–an overabundance of wounded, tents and barns used as field hospitals, a lack of any water, let alone clean water– doctors often went days without washing their hands, thus transferring bacteria from one man to another. A small cut on a hand could result in a “surgical fever” for the doctor himself. And penicillin wouldn’t be discovered for another seventy odd years.
In AN OUTLAW IN WONDERLAND, Ethan Walsh believes that putrefaction is a result of invisible particles in the air. If they entered an open wound, infection set in. The particles could travel on the instruments used, the sutures, even the surgeon’s, the nurse’s, or the patient’s hands. Therefore, Ethan washes everything that touches his patients, including the doctor, with a mixture of alcohol and water. Fewer of his patients die than any of the other physicians’. Most think him insane. Annabeth Phelan sees him as both beautiful and brilliant.
While the concept of “biting the bullet” has become legend, in truth most operations were performed after the administration of ether or chloroform. Reports of screaming from the operating tents were most likely the screams of men who’d just learned they would lose a limb rather than their screams as they were losing it.
Chloroform and ether was administered by dripping the liquid onto cloth then holding the cloth over the patient’s nose. When he went limp, the operation commenced. Not the best technique, but better than the alternative. Many soldiers were only half asleep when the operation began. Stonewall Jackson was said to have remembered the sound of the saw cutting off his arm. In the Civil War, speed was often a surgeon’s best technique.
If a soldier survived surgery and escaped fever, pain might be alleviated by laudanum or morphine, which was made from the opium poppy. Often the drug was rubbed directly onto the wound in powder form. The liquid form could also be injected. As laudanum, the drug could be added to water and made more palatable with sugar. The drug in either form was highly addictive. Such addiction, its symptoms and cure, also plays an important part in OUTLAW.
In this trilogy, brain injuries play a significant role. During the Civil War, as now, the brain is a mystery. Injuries to it–be they from a Minié ball, or a knock on the noggin–are treated with a combination of guesswork and hope.
I became fascinated with Civil War era medicine, and enjoyed filtering it through the “Once Upon a Time in the West” series.
Do you enjoy learning about other time periods? What’s your favorite time period? What’s the most interesting thing you’ve learned about it?
I’ll be giving away a copy of the first book in the “Once Upon a Time in the West” series, the RITA nominated, BEAUTY AND THE BOUNTY HUNTER to three of today’s commenters, chosen at random.