You’re lying on your back, all alone in the shack you share with a few
other men here in the high Sierra, circa the mid - 1800’s. The bed upon which you are laying is simply an old burlap sack which once held a hundred pounds of beans, now stuffed with dry grass and placed across a few splintery planks held up off the floor by four rounds of a young cedar tree which serve as passable posts, leaving you more or less level and a foot or so above the floor. There’s a shirt gathered into a ball beneath your head; a flannel one which now has too many holes in it to any longer serve as clothing; a shirt whose red and black pattern has faded together into a dirty orange. A single candle visible from the corner of your eye casts gloom over the room, leaving most of it in shadow. But that really doesn’t matter to you since you had a bad accident today and now can’t move your head to look around this room even if you wanted to do so. As it is, you really can’t move anything since the pain in some parts of your body is so great that it makes you want to scream while other parts of your body are strangely numb. In fact, it would probably have been better if your friends hadn’t wadded up that old shirt and raised your head onto it, trying to make you more comfortable, since that simple action most likely put even more stress on your damaged back and neck. But they were only trying to be nice; only trying to make you rest a bit easier before they all went outside to talk about you where you couldn’t hear them. And you know that can’t be good. So now you’re stuck, all alone with your own thoughts, unable to move, wondering just how badly you’re hurt, how long you have left to live, and how painful the dying part is going to be. They might decide to try to send someone for a doctor, but since you’re this high up in the Sierra any doctor is going to be several days away. You’re up the creek without a paddle and you could almost laugh at the hopelessness of it, except that laughing hurts too. So, just what is medical care like in the mid-nineteenth century in the higher elevations of California? It’s scary. But before we return to our patient who is patiently waiting for either recovery or death, perhaps it might be interesting to sample what medical treatment consisted of when a logger or a miner or a trapper got sick or injured when he was up in the mountains; when doctors were too many miles and too many days away to be of help. And perusing some helpful medical literature of the day may just prove enlightening. So pour yourself a tumbler full of laudanum and sit back. Or, if you don’t happen to have any of that liquid opium laying around, whiskey will do almost as well. Let’s start with a simple problem – say, a fist fight. Two men trade punches until one of them lands a lucky shot and his opponent’s nose is broken. Blood flows freely and the fight stops. What advice is then offered to the fighter’s friends who must apply medical treatment? “When the bones of the nose are broken in they may be raised to their place by means of a quill introduced into the nostril.” This sounds potentially painful as a quill is the hard, pointed end of a feather, so tough that it had been used as a durable writing instrument for centuries. Or perhaps the men fought more violently and drew knives against each other. Every logging and mining camp had its source of contention - usually drinking or gambling – and the men involved would sometimes choose to settle the issue permanently, just between themselves. But what if a man didn’t die in that knife fight but was only wounded? “The most effectual treatment of a deep stab is to enlarge the wound. If painful swelling takes place relief must then be afforded by even further enlarging the wound. If a deep stab wound causes violent inflammation, blood must be taken from the arm.” So, the theory here seems to be that losing some blood in a knife fight can be cured by losing a lot more blood under subsequent medical care from another part of the body. But what if the two disputing men instead picked up guns? Then the following advice is offered: “Should a ball have passed into the belly or chest, there is little hope of recovery. Supply cooling drinks of barley water or gruel with additions of lemon juice or cream of tartar. The sufferer will often bleed to death in a few hours.” But it is not explained - since the poor man was going to die anyway in just a few hours - just why his last few hours should be spent sipping barley, gruel or cream of tartar. If the patient with the bullet in his belly were asked and able to respond, it would seem fairly certain that he would have opted for something a bit more alcoholic than cream of tartar for his last moments on this planet. “When a ball has struck the head, the head should be shaved and covered with a linseed poultice. Give salts to keep the bowels open. Avoid drawing blood unless he has a fever. Return of the senses is a favorable sign, otherwise death is to be apprehended.” Yes, removing blood always helps a man with a fever and a bullet in his head. And it was apparently considered of utmost importance to begin the journey into the Afterlife with open bowels. “When a ball passes through fleshy parts the chief danger arises from wounding some large blood vessel or nerve. If there is much pain, the patient should be bled and freely purged." So, if a large blood vessel is damaged, it helps to bleed the victim even more? “When the end of a limb is carried away by a cannon ball the loss of blood is seldom alarming. But you must not depend on this and wounded arteries may thus prove fatal.” Hmmm. Cannon ball wounds may prove fatal. Do you think? Yet, although bullets often flew freely, there weren’t many cannon ball injuries in the mountain camps of California. The men here were generally not looking for a fight. However, other things sometimes plagued those who were new to the mountains, especially the high altitude and thinner air which often brought on headaches. For those who were prone to migraines the brightness of the sun, especially reflecting off the snow, could trigger a migraine. But a migraine, unfortunately, was not recognized as a type of headache. It was something worse – it was Brain Fever. “The symptoms are very severe pain in the head, extreme sensitivity to light and sound, hard and rapid pulse, flushed face, wildness of talk. Firm but temperate restraint must be used to prevent mischief.” Most migraine sufferers then, as they would today, probably objected to that part about firm but temperate restraint. “From one to two pints of blood should be taken at the first bleeding, repeating this operation at intervals of a few hours till the delirium is overcome. Active inflammation of the brain usually terminates fatally within four days. In few instances it ends favorably.” Let’s see: one to two pints of blood every few hours would result in eight to sixteen pints of blood being drained from the patient the first day. If that were to be continued for four days, no wonder the patient died – the human body doesn’t hold that much blood! The only curious part of that medical instruction are the words, “usually terminates fatally”. As bad as the migraines may have been, it would seem doubtful that anyone survived the cure. The men in the Sierra were, to a man, all very hard workers. And, to a man, when they weren't working, they (almost) all sought the company of the opposite sex. But that could also lead to problems, and venereal disease often came back home with the men as an unexpected bonus of a romantic encounter with an attractive stranger. The symptoms were always unpleasant and usually quite painful. “When there is much inflammation draw blood from the arm pretty freely and open the bowels with Epsom salts. Local bloodletting is not advisable.” ‘Local’ bloodletting?!?!? “After bloodletting it will be necessary to immerse the yard in warm water.” (‘Yard’ was a term for male genitalia. An overly optimistic term, perhaps.) “Add laudanum to a pint of hot water, afterwards applying linseed oil and an oatmeal poultice.” All such patients most likely welcomed the appearance of laudanum. Oatmeal and linseed oil probably were not greeted with an overabundance of enthusiasm. “If the patient is obliged to move about he should support the yard up to the belly by means of any bandage.” (Tie a yellow ribbon around the old oak tree?) Unfortunately, the above problems also seemed to frequently led to a neighboring issue. “The swelled testicle frequently happens, particularly when the running has been unseasonably checked.” That is indeed an eloquent description, even poetic. “In the inflammatory stage the patient should lie on his back and a dozen leeches should be applied.” Perhaps a comment is not really necessary here, rather just a pause to allow the mental images to form clearly. Yet what about other non-violent injuries; the kind of unexpected event which might befall any man without the slightest warning? Such as a kidney or bladder stone; a stone big enough to block the flow of urine? Under the heading of ‘Gravel & Stone’, this advice is offered: “When an obstinate case of retention of urine takes place it will be necessary to make use of a catheter made of silver or elastic gum. Elastic gum catheters are safest for inexperienced hands – there is a wire inside for keeping it stiff during insertion.” Squirming yet? Crossing your legs, perhaps? “Place the patient on his back. The catheter should be well oiled. Hold the Yard in one hand and pass the instrument into the orifice, keeping the urethra stretched. The forefinger, passed into the fundament (anus), will sometimes guide the instrument.” Sometimes? What does that finger do all the other times? Returning to our friend who still lays quietly on his cot in his shack in the mountains with the feeling in his limbs fading away and his mind contemplating all the myriad possibilities while slowly accepting the inevitable, we see his friends frantically flipping through the well-worn pages of the only medical book in camp to see what advice, what hope, it may have to offer their companion. Because that advice is all they have. Doctors in California are relatively few and, like their professional compatriots in the eastern and southern states, they have so far mostly settled in the cities where the trade will provide them with a multitude of patients complaining of mostly common ailments requiring little effort and resulting in quick payment. After all, isn’t it far more desirable to treat Miss Scarlett for a case of the Vapors and get paid in gold coin rather than to treat a trapper with venereal disease and get paid with a couple of dead squirrels? And so, as our friends leaf through the faded pages in the dim light they determine what they must do: “Severe contusion of the spine is generally known by the loss of sensation and motion below the injured part. The patient may be unable to expel his own stools, or they may escape from him unconsciously.” The men pause in their reading, their eyes meet, and they nod in a knowing way. Yes, this is the correct diagnosis. “Apply a large poultice of Jalap and Cream of Tartar along the backbone until a purge of the bowels is obtained.” The men nod sagely. It is apparently well known that empty bowels help to heal just about everything, including a broken back. “Recovery may not take place.” It would seem that is a somewhat conservative statement. “But while there is life there is hope, and every attention and kindness should be paid to all sufferers from this accident.” Actually, there is no hope; not for this patient in this place at this time. His destiny is pretty much confined to the shallow grave which is already being prepared for him by the wiser members of the community, and our friend is comfortable with his fate. Because he knows that there are far worse fates which could have befallen him. And as his spirit floats away to greet whatever awaits him in the approaching Afterlife he smiles, for he is happy to have escaped without leeches being applied to his testicles or that Fundamental Finger making its entrance into his backside to (sometimes) guide his treatment. There are far worse fates than that of having to navigate between Heaven and Hell, and medical treatment in the California of a century and a half ago was one of them. Finally, there is care given to describe the symptoms of determining death should it be deemed necessary to execute a man by hanging. “From the return of the venous blood being stopped by the action of the rope around the neck the face is rendered black, the eyeballs start from their sockets, and the nostrils are wider than in a natural death.” This sounds pretty final. However, if there is still some doubt: “After the rope has been removed, the taking of blood from the jugular is advisable.” Or, if the hanging party sobers up and realizes a mistake may have been made: “The bellows may be considered the most important agent.” Well, perhaps not. If his face has gone black and his eyes are bugging out then pushing a bellows down his throat and pumping madly probably wouldn’t have helped too much. So if you were one of those adventurous men of a century and a half ago who determined that being a pioneer in the Sierra Nevada Mountains of California was just the career hinted at by your high school guidance counselor, then it would have indeed been best for you if you’d been born with elastic bones, a stout genetic foundation, and an enviable resistance to all things which crawl, fly, and bite. Otherwise, in most cases, those friendly care givers who offered you medical help would probably only have succeeded in speeding your journey into the Afterlife as they probed the boundaries of known medicine with one eagerly exploring forefinger. But at least they would have made certain that you would have had very clean bowels with which to begin that journey. You would also have had a fervent wish never to be jump-started back to life with a pumping bellows only to open your eyes and find your testicles being sucked by a sack full of thirsty leeches who are slowly making their way up to that “Yard” of which you were once so justly proud. Kind of makes Medicare look good, doesn’t it?
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AuthorWith a degree in Anthropology and an avid interest in history, Tim Christensen has lived in the Sierra Nevada Mountains for many years. He has no cell phone or television, but manages, when not chopping firewood or shoveling snow, to keep himself entertained with a library of several thousand books. Archives
July 2017
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