As we last observed, our young Ranger has been wounded from a French musket ball. His comrades have been able to get to him and pull him from harms way. As darkness falls over the battlefield, the French and their Native Allies fade into the darkening shadows. Now our young warrior will face yet another enemy, 18th Century Medical Care. His fate is still very much in doubt.

During the 18th century, a common theory abounded that the healing process consisted of two stages. The injured individual, in order to survive, must successfully pass through these stages. If the treatment and care was improper, it was thought that death would occur, as often happened.

The first stage, known as the Stage of Inflammation, started immediately after any break in the skin occurred. The normal course of action of this stage became apparent by the third or fourth day post-injury. The outer edges of the wound would become swollen, painful and hot. During this time many believed that if the pain could be lessened, the symptoms of swelling and inflammation would be preventable.

The pain treatment of choice for many was the use of opium. Often, either in conjunction or in lieu of pain control, the site would also be covered with a poultice. This poultice consisted of a mushy mixture of absorbent powders. Along with these treatments, the old stand-by of bleeding the patient would be done as a proper course of treatment.

The long range objective of this type of treatment is to have the injured tissue absorbed by the body or change into pus, which was considered the main component of the second stage of healing. Therefore achieving pus became an important goal to ensure the recovery of the victim.

The Stage of Digestion started when a whitish matter appeared at the injury site. This "laudable pus" (Wilber, p.31) was considered a positive part of the healing process. It meant the wound was finally healing. The 18th century prognosis would now be very positive.

General wound care in the 18th century was dependent on the type and nature of the wound. While rendering care, the 18th century medical practitioner main objective was to protect the area from air and generally let mother nature make the repairs.

Simple lacerations (a torn and ragged wound) received several different types of care. A common one was the use of a sticky plaster and bandage. While this may appear to be primitive by our standards, we use something very similar today, called the "butterfly bandage". The 18th century medic simply applied the sticky plaster to both sides of the wound, and then a strip of cloth, the bandage, to one side and pulled that side towards the other, closing the wound. The tissue would then be allowed to grow back together.

Remarkably during this time period, the understanding and mechanics of suturing or putting a string through the wound walls and tie these together to approximate the skin edges was a common practice. Of course the idea of using sterile needles, thread and proper cleansing of the site was far in the future. Often times the physicians of this time period would dip the tip of the needle in oil, have someone hold the wound together and then using wither a cotton thread or sinew, sew or suture the site together. The suture usually stayed in place for two or three days. One must remember that the needles were used over and over, rarely being washed.

Treatment of puncture wounds caused by bayonets, swords, or knives were usually dependant on whether or not the instrument punctured a body cavity. If there was a penetration into the cavity, the treatment of general wound care would be followed. The opening to the wound would often times be dilated or opened wider with the use of forceps. This was to encourage bleeding from the wound site.

There is some logic to this practice, as a larger opening would also allow for drainage of body fluids and matter. Unfortunately if the wound was in the abdominal region, fecal matter would often contaminate the area. If the wound happens to be in the lungs, a sucking chest wound would often result, seriously threatening the life of the victim. No proper treatment was provided for this type of wound, with death the end result.

Gunshot wounds are often very difficult to treat. As the ball enters the body, it carries with it the dirt of the weapon, clothing of the victim and splinters of bone and other tissue contaminating all that it pass through. All of these items will greatly assists in the process of infection. The ball itself will also destroy blood vessels, many which could not be repaired with the technology of the period. If bone was struck, it would shatter and splinter, with pieces now becoming additional projectiles themselves causing further damage.

If the ball does not go through and through the body or leave the body, it has to be located in an attempt to remove it. To locate the ball the physician would use forceps, usually straight in shape and if he did not have forceps then his finger would serve the same purpose. Actually many physicians felt "the finger is the best the best and surest probe". (Wilber,p.34) If one observes a surgeon today, he/she will probe the site using fingers, but with sterile gloves in use.

If the ball could be felt, there is a good chance it could be removed from the body. But many times the victim would have musketballs remain in their bodies. Sometimes these would work their way towards the outer edge of the skin and then could be cut out. Other times they would remain in place until the time of death.

Sooner or later every military physician would have to perform the task of amputation. Some were very skilled at this procedure, could do it rapidly and the victim could survive. Other times, inexperience would prove fatal as the wound itself. All practitioners would follow standard operating steps when doing amputations.

The victim had to be placed on a flat surface. The procedure was done without anesthesia, therefore proving to be extremely painful to the victim. Strong assistance was needed to hold the victim down. Sometimes musket balls would be placed in the mouth to bite on, or leather bite pieces. Many times alcohol would be given to try to lessen the pain. But if there were large number of casualties, the alcohol would soon run out.

A tourniquet would be applied above the injury site. The skin and tissue would then be cut, hopefully in a quick manner, usually using a curved amputation knife. Sometimes the surgeon would tie off the major arteries to prevent further bleeding and blood loss. Sometimes times the arteries would be cauterized, sealing the artery. The bone would then be the next item to be cut, using a saw of some sort. It was hoped, for the sake of the victim, that this part of the procedure would be done as quickly as possible.

After the limb had been removed, the raw stump needed to be covered with a dressing. Often times flour would be sprinkled on the site, with a covering of lint or tow over the flour, and finally a cloth dressing.

If the victim survived the amputation itself, there would be the possibility of death due to hemorrhagic shock or the loss of blood. Of course infection would also play a very important role in whether the victim would ever reach home. It must be remembered that the surgeons would just wash their hands and equipment in a pan of water and move on to the next patient. Aseptic procedures were in the dim future.

It should be obvious by now that our young Ranger had very poor odds of surviving his wounds with the type of care rendered during the 18th century. More times then not it was divine help that must have played an important part in the road of recovery.

Even if the soldier never received a wound other than a minor one, he faced a even greater threat to his health everyday...disease. Disease killed more soldiers during the 18th century then any enemy musket ball. In the next part of the 18th century Medicine, diseases of the period will be discussed. Until then, keep your head down, your powder dry, and please...find me some more leeches!

Davis, William Lee, MD, 18th Century Medicine, Muzzleloader, May/June, 1994, pp3-36

O’Keefe, Michael; Limmer, Daniel; Grant, Harvey; Murray, Robert; Bergeron, j. David, Emergency Care, 8th Ed. Brady/Prentice Hall, Upper Saddle River, NJ, 1998

Wilber, C. Keith, Revolutionary Medicine 1700 - 1800, The Globe Pequot Press, Old Saybrook, Conn, 1980.

Williams, Guy, The Age of Agony, Academy Chicago Publishers, Chicago, Ill. 1986

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