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Category Archives: Medical History

Q and A: Could Death From Bleeding Be Delayed For Several Days After a Frontier Wagon Wheel Accident?

Q: My story takes place in a wagon train in the late 1800’s. My character is dragged by a horse while crossing a river. He hits rocks and is bounced off the back wheel of a wagon. Of course the horse’s hooves do damage as well. Three days later he dies from massive bleeding from his internal injuries. This three day delay followed by the sudden loss of blood is important to the story’s timing, but is it realistic?

wagon_train-2

A: The answer to your question is yes.

This type of accident could, as you can imagine, result in all types of injuries. Broken bones, skull fractures, neck fractures, cracked ribs, punctured lungs, and intra-abdominal injuries (injuries inside the abdominal cavity). This last type of injury might serve you well.

A ruptured spleen or lacerated liver or fractured kidney would bleed into the abdominal cavity. Death could be quick or take days if the bleed was slow. There would be great pain, especially with movement or breathing, and the abdomen would swell. Also a bluish, bruise like discoloration could appear around the umbilicus (belly button) and along the flanks. This usually takes 24 to 48 hours or more to appear. This occurs as the blood seeps between the “fascial planes.” The fascia are the tough white tissues that separate muscles from one another. The blood seeps along these divisions and reaches the deeper layers of the skin causing the discoloration. But, these injuries wouldn’t lead to external bleeding since the blood has no exit from the abdominal cavity.

However, if the injury was to the bowel, then external bleeding could occur. For blood to pass from the bowel, the bleeding would have to be within the bowel itself and not just in the abdomen somewhere. If the bowel were ruptured or torn so that bleeding occurred within the bowel, the blood would flow out rectally. But, blood in the bowel acts like a laxative so the bleeding would likely occur almost immediately and continue off and on until death, which in this situation would be minutes to hours to a day, two at the most. It would be less realistic for the bleeding to wait three days before appearing in this case. With one exception.

The bowel could bruised and not ruptured or torn, and a hematoma (blood mass or clot) could form in the bowel wall. As the hematoma expanded it could compromise the blood supply to that section of the bowel. Over a day or two the bowel segment might die. We call this an “ischemic bowel.” Ischemia is a term that means interruption of blood flow to an organ. If the bowel segment dies, bleeding would follow. This could allow a 3 day delay in the appearance of blood.

In your scenario, the injuries would likely be multiple and so abdominal swelling, the discolorations I described, great pain, fevers, chills, even delirium toward the end, and finally bleeding could all occur. Not a pleasant way to die, but I would imagine this happened not infrequently in frontier days.

The victim would be placed in the bed of one of the wagons and comforted as best they could. He might be sponged with water to ease his fevers, offered water or soup, which he would likely vomit, and prayers would be said. They could have tincture of opium (a liquid) available and give him some. This would lessen the pain since it is a narcotic and would also slow the motility (movement) of the bowel and thus lessen the pain and maybe the bleeding.

Of course, during the time period of your story, your characters wouldn’t know any of the internal workings of the injury as I have described. They would only know that he was severely injured and in danger of dying. Some members of the wagon train may have seen similar injuries in the past and may know just how serious the victim’s condition is, but they wouldn’t understand the physiology behind it. They might even believe that after he survived the first two days that he was going live and then be very shocked when he eventually bleed to death. Or they might understand that the bouncing of the wagon over the rough terrain was not only painful but also dangerous for someone in his condition. They train may be halted for the three days he lived or several wagons might stay behind to tend to him while the rest of the column moved on.

 

Murder By Meme: Slender Man and the Wakefield Anti-Vaccine Hoax

Slender Man

We all know that viral illnesses can kill. Ebola would be an example. So would small pox and the 1918 Flu.

But can an internet viral hoax kill? An interesting article titled “Murder By Meme: Slender Man and the Wakefield Anti-Vax Hoax” by Travis Langley, Ph.D. in Psychology Today looks at this issue.

In June, 2009, Eric Knudsen (aka Victor Surge) posted a pair of black & white photos of groups of children in which he had inserted a thin figure in a black suit into the background. This was the birth of the Slender Man hysteria. It led to the attempted murder of a 12-year-old girl by two of her classmates, also 12. Why would they stab their classmate 19 times? Apparently to serve as “proxies” for The Slender Man and to show that he really existed.

Crazy is as crazy does.

And then there’s the 14-year-old who read about Slender Man and decided she needed to burn down her home—-with her mother and brother inside. Fortunately there were no injuries but the house and family car took a hit.

But such internet hoaxes aren’t confined to the world on teen angst. It has also entered the world of legitimate medicine. And has done great harm.

MMR

Ever seen a case of Whooping Cough? Diphtheria? Probably not. I’ve never seen diphtheria and whooping cough (pertussis) only a couple of times way back during my pediatrics rotation as a junior medical student. The reason these and other childhood diseases such a rubella and mumps are now not so common is a robust and widespread immunization program that has done a stellar job in keeping these illnesses at bay.

Enter Dr. Andrew Wakefield. He apparently created an entirely fraudulent research study that suggested that the MMR (Measles, Mumps, and Rubella) vaccine caused Autism. Based on this scam, allegedly funded by an “ambulance-chasing” law firm, many well-meaning and fearful parents refused to vaccinate their children. This led to outbreaks of these uncommon diseases. Here in my own backyard, Orange County, CA, we had an outbreak of pertussis that could be traced for the most part to a single pediatrician who bought into this “bad science.”

The truth? There is not a single piece of legitimate evidence to suggest that MMR is in any way related to autism.

And Slender Man does not exist.

 
3 Comments

Posted by on October 16, 2014 in Medical History, Medical Issues

 

Guest Blogger: Daphne Holmes: How DNA Testing Helps Determine Paternity

DNA

 

How DNA Testing Helps Determine Paternity

The impetus for determining the paternity of a child likely dates back to the most primitive tribal cultures. Particularly in patriarchal cultures where females were regarded as the property of males, it was deemed important to ensure that a man’s “property” had not been shared, and that the virtue of the female was beyond question. As societies became more sophisticated, the need to establish paternity became as much an economic issue as a moral one. In modern cultures, paternity testing is used primarily to establish whether or not a man is responsible for providing financial support to a child, as well as determining whether the child carries any of the father’s genetic predispositions for health challenges.

Physical appearance – In more primitive cultures (some of which continue to flourish), the objectives behind determining the paternity of a child were culturally and/or emotionally based. If a child was born who lacked identifying characteristics of either parent, it was frequently assumed that the father was someone other than the woman’s mate. The repercussions to the mother were quite severe, often culminating in her death. Unfortunately – especially for the women – the comparison of obvious physical traits was highly subjective, and many women suffered dire consequences, even if their husband/mate was indeed the biological father.

Blood typing – With the early 20th century discovery that different individuals had different blood types, and the recognition in the 1920s that those blood types were genetically inherited, a more accurate means of determining paternity came into common use. It was discovered that by comparing the parents’ blood types, it was possible to determine the most likely blood type of the child. While this was admittedly a step above the “he has his father’s eyes” paternity test, it was still only about 30% accurate.

Serological testing – It was discovered in the 1930s that specific proteins not considered during blood typing could establish the presence of genetically inherited antigens that would more accurately identify the child’s biological father. Unfortunately, serological testing only improved the accuracy of paternity testing to about 40%. Hardly conclusive evidence.

Tissue typing – In the 1970s, the human leukocyte antigen (HLA) was discovered in abundance within white blood cells. When samples of this genetically inherited antigen taken from the mother and child were compared to the sample taken from the father, paternity could be established with roughly 80% accuracy. While this was a significant improvement over previous methods, the collection procedure itself was unpleasant, and the size of the sample required made it hazardous to the child, particularly if the child was less than six months old. Obviously, more work needed to be done.

DNA testing (RFLP) – In the 1980s, the technique called restriction fragment length polymorphism (RFLP) was discovered that looked at a significantly wider spectrum of variables in the blood than had been analyzed with earlier techniques. It was discovered that the offspring of two parents would have half the unique characteristics of each parent. This technique elevated the accuracy of paternity testing to the level of statistical certainty. Unfortunately, the amount of blood required for accurate sampling was, like tissue sampling, large, posing potential problems for the child. In addition, the potential for genetic mutations in the child could render a false negative, indicating that neither the woman or the man was the child’s biological parents. For these reasons, RFLP testing has been all but abandoned.

DNA Testing (PCR) – By the 1990s, the RFLP testing was replaced by the polymerase chain reaction (PCR) technique. This technique involves the computerized replication of DNA collected from even a minuscule sample that is collected anywhere on the individual’s body, then comparing the subjects’ profiles. In addition to requiring a very small sample (typically via an oral swab), the subject is not submitted to discomfort as in earlier test techniques, and the computerized analysis takes far less time, while still providing accuracy at the level of statistical certainty, 99.99%.

Author: Daphne Holmes contributed this guest post. She is a writer from www.ArrestRecords.com and you can reach her at daphneholmes9@gmail.com.

 

 

Snake Venom For Treating Seizures? On Second Thought

rattlesnake

 

In the dark ages of medicine, meaning anything before 50 to 100 years ago, those afflicted with epilepsy were treated, how shall we say, less than compassionately. They were often thought to be infected by some evil miasma, or possessed by a lurking devil or witch or warlock, or were afflicted with some contagious process. They were isolated from society, feared and shunned by all, and often subjected to horrific treatments – everything from freezing water to cutting holes in the skull to let out the evil spirits (trepanning).

 

trepan

 

This is not an uncommon reaction when people are faced with things that they don’t understand. And 100 years ago the medical profession actually understood very little.

A case in point would be Philadelphia physician Dr. Ralph Spangler who suggested that rattlesnake venom, which interestingly he had been using to treat tuberculosis (go figure), might be useful in treating epilepsy. He published an article about a Texas man who had been bitten by a rattlesnake and subsequently the epileptic seizures that had plagued him suddenly ceased. In this empirical observation of a single case he jumped to the profound conclusion that snake venom cures seizures. Thankfully cooler heads prevailed and other physicians pointed out that snake venom not only didn’t, and couldn’t, help epilepsy but rather frequently caused allergic reactions as well as hemolytic destruction of the blood. Not pretty.

The history of medicine is replete with such examples.

 

Is “Real” Artificial Blood On the Horizon?

red-blood-cells

 

Blood is indeed the river of life. It carries oxygen and nutrients to all the cells of the body and removes toxic byproducts to keep everything clean and healthy. The cardiovascular system is a closed system in that it constantly recirculates, and like submarines, leaks from the system can be disastrous, and deadly. Blood is also a living, biological material and this makes it very difficult to handle. It must be taken from a living person, treated to prevent clotting, and stored in a manner that prevents decay. The logistics of this are very difficult, particularly when blood is needed in places such as war zones, very remote areas, and even in space. If someone is severely injured and in danger of exsanguinating – – the $10 word for “bleeding to death” – – then rapidly replacing this loss blood is essential. IV fluids and plasma expanders and other assorted intravenous materials can be given to buy time, to keep the volume in the system to an adequate level, and to keep everything circulating, but these materials have a major drawback – – they don’t carry oxygen. So the only life-saving remedy is to replace the blood.

Over the years there have been many attempts to develop artificial blood, a product that would carry oxygen and be logistically more friendly. Something that did not require anticoagulation, refrigeration, and care in its transport and storage. Something that could be carried and stored like a bottle of water. Many of these endeavors have proven to be unsuccessful.

Blood substitutes have traditionally been based on hemoglobin, the oxygen-carrying molecule within the red blood cells (RBCs). Products such as HemoPure (made from bovine hemoglobin), PolyHeme (made from outdated human blood), and HemAssist (based on cross-linked hemoglobin) all seemed promising but safety issues arose with each and these have not been completely resolved.

Other forms of “artificial blood” have been based on perfluorocarbon emulsions. These too have faced many problems.

Another problem with blood therapy is keeping a steady and safe supply. There are only so many donors and the blood’s shelf-life is not all that long. If blood could be manufactured so that an adequate and steady supply could be maintained, this would be a giant step forward.

Well, now it seems that manufactured truly artificial blood might be on the horizon. A group at the University of Edinburgh is beginning clinical trials on a process for making red blood cells from stem cells. Since these would be “real” RBCs, the technique holds promise.

 
2 Comments

Posted by on April 30, 2014 in Medical History, Medical Issues

 

Guest Blogger: Eleanor Sullivan: Herbalism: Scientific or Sorcery?

Ever wonder what people used to cure old-fashioned ills? Before penicillin?

Plants, that’s what.

 

plant-images4-150x150[1]

 

Recently, I had the opportunity to meet a practicing herbalist in Minneapolis, a young woman with a quick smile and quicker wit. Lise Wolff opened my eyes to a different health care world. (For those who don’t know, I’m a nurse turned author.)

From pre-historic times to today, herbal remedies have been used to treat human ills. Often they were the only treatments available. Our existence is testament to their effectiveness. Scoffed at by medical men (yes, they were all men), herbalists and their close cousins, homeopaths, nevertheless persisted. What was known as mainstream medicine at that time, however, would be unrecognizable by today’s practitioners. Purging, puking, and bleeding as well as dosing with heavy metals, such as mercury, harmed more often than cured, their unwary patients. (See Medical Care in the 19th Century-Part One and Part Two for more on this era’s archaic practices.)

 

medicine-box[1]

 

Herbal Remedies

Herbs can be collected in the wild or cultivated in gardens. Most remedies are derived from the leaves that are harvested at the peak of their effectiveness, but sometimes the stems, roots, or early shoots prove more useful. Leaves may be dried and used in teas or combined with starch or lard for poultices. Plant parts may be soaked in water or oil, and the solutions used in tinctures, decoctions, essential oils, salves, or ointments. I watched Lise melt beeswax and combine it with St. John’s wort solution that she poured into metal cups, left to solidify and use as an ointment to treat burns, sores, and cracked lips.

In the 19th century women, often midwives, treated ill family members and neighbors with herbs, a practice passed down through generations. Realism meets fiction as Adelaide, the protagonist in my Singular Village Mystery series, works as both a midwife and herbalist in 1830s Zoar, Ohio.

Doctrine of Signatures

After famously burning classic medical texts, 16th century German physician Paracelsus declared that plants resembling human body parts could cure ails in that organ, a concept that became known as the doctrine of signatures. Thus, “like treats like.” For example, St. John’s wort doelike shape renders it perfect for treating skin wounds.

Homeopathy

Similarly, Samuel Hahneman, a 19th century German physician, agreed that like treated like but took treatments one step further, diluting substances over and over until it appeared that nothing of the original substance remained. These dilute substances, however, proved remarkably effective. The practice became known as homeopathy.

In fact, homeopathy was practiced in 19th century Zoar. Here’s a photo of a medicine box of homeopathic remedies found in Zoar’s historic artifacts.

The medical community today would argue that neither herbal remedies nor homeopathy are scientifically proven to be effective. Regardless, patients dissatisfied with mainstream medicine, often turn to alternative practitioners, such as herbalists. Medical practice is continually evolving as new remedies and treatments emerge and others decline. Might chemotherapy be deemed archaic 200 years from now?

Eleanor Sullivan: http://www.eleanorsullivan.com

Watch as Adelaide confronts problem illnesses and birthings (along with solving a murder!) in the next Singular Village Mystery: Graven Images, due September 1st!

 

Graven Images cover.indd

 

Q and A: What Potentially Fatal Disease Could My Young Female Character Suffer From in 1955?

Q: I have been browsing through FORENSICS AND FICTION but do not see the perfect solution for my story. In my WIP, set in 1955 St. Louis, a 10 year old girl has a medical problem which is difficult to diagnose. She has been living on the streets but is rescued by an older woman who takes her for medical help. Once the doctor determines the problem, he recommends treatment. Trouble is, the only place for treatment is California, so they must take a road trip. (I want it to be CA because I want them to travel on Route 66)

At first, I considered exposure to sewer gas as a good diagnosis. But once she got out of the sewers she would get well. That won’t do. I’m thinking it must be an autoimmune disease or a parasitic or unusual infectious disease. Can you think of a fatal disease in those categories which would have had cutting edge treatment being done experimentally in CA in the 50s?

Catherine Leggitt, Author, Inspirational Speaker

www.catherineleggitt.com

A: As you pointed out, sewer gas wouldn’t work since once your young lady was free of the environment its effects quickly reverse. I would suggest leukemia. In 1955, acute leukemia in a child that age was common, there was no treatment, and most sufferers died. The mortality remained around 90% for many types of leukemia until well into the 1970s. It could be months or many years between first becoming ill and dying, but death was almost inevitable in 1950s. The timeline would depend on how aggressive the particular leukemia was and how well your child handled it. But medicine could do very little.

In leukemia, white blood cells (WBCs) are overproduced by the bone marrow. These cells are abnormal in that they don’t fight diseases as do normal WBCs. This would leave the child susceptible to infections such as pneumonia, urinary tract infections, even the flu. Each bout of any of these could be weathered with antibiotics—penicillin and sulfa drugs were around in 1955—or she could die from any of these diseases.

Leukemia Cells are seen here as large and purple; the smaller pale red ones are RBCs

Leukemia Cells are seen here as large and purple; the smaller pale red ones are RBCs

As the WBCs increase in the bone marrow they literally “squeeze out” the marrow cells that make red blood cells (RBCs) and platelets. Low RBCs we call anemia and here she would be fatigued, short of breath with activity, and her physical abilities would be limited by these factors. She might appear pale and take on the look of someone who is chronically fatigued, which she would be. Platelets are involved in blood clotting so with low platelets she would bleed easily, with even the most minor trauma. She could easily have episodic nose bleeds and would bruise very easily.

Most leukemia victims suffered all three of these derangements–high but abnormal WBCs, low RBCs, and low platelets–so your girl could have any of the above symptoms, in any combination, and in any degree of severity.

Since there were no effective treatments in 1955, patients and parents sought all kinds of treatments. Herbs, electrical current, tonics of all types (most of which were alcohol based), faith healers, and almost anything you can think of. Your young girl could easily be referred to someone “out in California” by her local St. Louis doctor.

This should give you a lot to work with for your story.

Google Leukemia and you will find many sources but remember that things are much different now than in 1955. Here are a couple of links to get started:

http://serc.carleton.edu/woburn/overarching/leuk_treatment.html 

http://www.nature.com/leu/journal/v15/n4/full/2402065a.html

 
7 Comments

Posted by on February 20, 2013 in Medical History, Medical Issues

 
 
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