Wednesday, February 26, 2014

Mending Broken Bones, c. 1769

Wednesday, February 26, 2014
Isabella reporting,

Reading about 18th medicine is not for the squeamish. In a time before antibiotics, anesthesia, transfusions, and antiseptic practices, even the most straightforward malady (by modern terms) could go fatally wrong. In my new book, A Wicked Pursuit, I have played the Cruel Author, and sent my poor hero flying off his horse and breaking his leg. (He deserved it, of course, but my reasons are in the book, not in this blog.)

Today a broken leg means a trip to the ER, x-rays, a plastic cast, and plenty of physical therapy and visits to the orthopedist. But in the 18th c., there were no x-rays, and while the wealthy were attended by a surgeon, for most people the specialist of the day was the neighborhood bone-setter who relied on common sense and experience instead of medical training. Regardless of their education (or fee), both surgeon and bone-setter alike would first need to determine if the bone were truly broken. The following description of that process comes from Dr. William Buchan's immensely popular Domestic Medicine, first published in 1769.

"The most unequivocal symptoms of fractures are, the crepitus, or grating noise distinguished on moving the limb, occasioned by the fractured ends; the separation and inequalities of the ends of the fracture, when the bone is superficial; the change in the form of the limb, and the shortening of it."

In other words, if it didn't look broken, move things around a bit and listen for the sound of the broken pieces rubbing together. Arghhh!

For most cases, the bones were pushed back into place and set, and held immobile until the fracture healed together. Then, as now, time and rest were the most important part of the healing process.  Instead of a cast, a rigid splint of wood, leather, or pasteboard was tied in place by linen bandages. Opium-based laudanum could be administered for extreme pain, but most follow-up treatment consisted of a light diet, clysters (enemas), and bleeding. For a broken leg like my hero's, the patient was confined to bed, with the splinted leg slightly raised and supported in a fracture box, like the replica, above left.

But while today an x-rays can quickly tell if there are any errant bone chips or fragments that might require surgery to remove, the 18th c. attendant was forced to rely on his own outward observations. It made for a difficult bit of guesswork, as Dr. Buchan cautions, and the wrong guess could kill the patient:

"Bone-setters ought carefully to examine whether the bone be not shattered or broken into several pieces. In this case it will sometimes be necessary to have the limb immediately taken off, otherwise a gangrene or mortification may ensue. The horror which attends the very idea of an amputation often occasions its being delayed in such cases till too late. I have known this principle operate so strongly, that a limb, where the bones were shattered into more than twenty pieces, was not amputated before the third day after the accident, when the gangrene had proceeded so far as to render the operation useless."

Aren't you grateful you live now?

Many thanks to Robin Kipps and Sharon Cotner of the Apothecary Shop, Colonial Williamsburg, for sharing their knowledge.
Above: Modern Replica of 18th c. Fracture Box, Colonial Williamsburg. Photography by Susan Holloway Scott.


Mike Rendell said...

Some of the advice given by Dr Buchan is a bit hard to understand. He states that the patient must lie still for six weeks - but also states that he must be fed a diet of prunes! It seems to me that you could not lie still for very long with that sort of diet!

athan y chilton said...

For some accurate and horrifying descriptions of late 18th and early 19th century medical practices, one can peruse Patrick O'Brian's 'Aubrey/Maturin' seafaring series... see Stephen Maturin performing amputations on a wildly pitching ship...performing surgery on his *own self* after being shot by accident... It makes for terrifying reading--and definitely shows how far the medical profession has come since those days!

Linda Collison said...

A nurse and amateur historian, I have an interest in 18th century medicine that manifested in Star-Crossed (Knopf) that became Barbados Bound, followed by Surgeon's Mate (Fireship Press). As a student nurse we were taught to feel for crepitus and to observe for shortening and outward rotation of limbs. Still handy for EMTs and paramedics in the field!

Valerie Olivia said...
This comment has been removed by the author.
Livia Ellis said...

I'm going to stop moaning about my broken wrist and fortnightly appointments to the orthopedist immediately.

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