High Sierra House Calls

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?