1632

by Eric Flint

  Henry Moss McDonnell (1925-1636),

  John Thompson Sims (1921-1637), and

  Emery Ellis (1919-Dec 1634)

  come out of retirement to help provide care for the community. There is also Mr. John Daoud, who has some training as a chiropractor. His background in manual therapy will prove particularly helpful to the rehabilitative medicine teams. Dr. Nichols was visiting for the Stearns wedding, so he does not have his personal library along, and no mention is made of him being enough of a technophile to own a PDA, much less have a substantial library hidden on one.

  Dr. Sims’ son is one of the two dentists, with the other being Jaroslav “Jerry” Elias. There are two veterinarians, Les Blocker DVM (1946) and Bentley Alexander DVM (1961), both of whom are in active practice; however, Dr. Alexander’s office is a partnership left in up-time Fairmont.

  Up-time educated nurses include:

  Beulah McDonald, RN, BSN, US Army Nurse Corps veteran (Korea), now teaching midwifery and acting as the Dean of the College of Nursing and Associated Medical Arts— she is effectively in charge of the new medical curriculum. (B: 1930. Probably received her diploma in 1950. She had also started a nurse-midwife program but stopped as she was close to retirement and thought she was too old.

  Garnet Szymanski, RN, BSN, now one of the Nursing Supervisors for Leahy Medical Center, as well as teaching LPN courses at the Vo-Tech. (B: 1947, date of graduation probably 1969)

  Mary Pat Flanagan, RN, BSN, US Army veteran as an enlisted medic (with a tour in the Balkans and a Bronze Star for her actions under fire in Somalia [xvi] ) and up-time trained as an LPN/91 C (advanced military medic). In her final year of a ROTC LPN to BSN bridge program when caught by the RoF, she is teaching the combat medics and acting as assistant to Dean McDonald. (B: 1971, graduated 1631 based on previous work)

  Hendrickje "Henny" Kiers (De Vries), RN, has a substantial background in psychiatric nursing, and is a supervisor/instructor at Leahy Medical Center until her move to Copenhagen in 1635. (B: 1943, graduated in the early 1960s) [xvii]

  Inez Wiley as a “Craft Midwife” and daughter and granddaughter of Craft Midwives. [xviii]

  Darla (Wild) Bowers as an office trained practical nurse, also a Craft Midwife. [xix]

  Kourtney Pence is shown as a Midwife in 1634 [xx]

  Anne Jefferson, RN, MSN, is setting up a de facto medical practice as a NP in Amsterdam. (B: 1972 Listed as having an MSN from Johns Hopkins, as well as course work toward a PA in critical care obstetrics. [xxi] Probable graduation around 1998)

  Mary Pat had a fair part of her library with her, as she was going to do a rotation in Community Health after the wedding.

  As another baseline for comparison, my mother, born 1931, graduated from her diploma nursing school in 1951, and my ex wife, born 1969, graduated from her LPN program in 1988.

  There are a number of others with at least an up-time EMT certificate. Please see the Grid for other names.

  Good Drugs always help!

  Pharmacists and pharmaceutical chemists are also scarce, with just three pharmacies in Grantville.

  Tom Stone is listed as having a Masters in Pharmacy, with work towards his PhD in that same field, as well as much practical experience. Bill Hudson, one of the up-time EMTs, goes to work with Tom Stone when the two of them return to Grantville.

  Tino Nobili (1940) is the owner and pharmacist for Nobili’s Pharmacy.

  Raymond Little (1960), previously a partner in Moss & Little’s Cut-Rate Drug Store, moves to Leahy Medical Center to run that department using equipment from Trelli’s.

  John Moss (1949) continues the Cut-Rate Drug Store, and agrees to take the apprentices from Trelli’s into his teaching.

  Trelli’s Good Care Pharmacy went out of business and was absorbed by the Leahy Medical Center in 1635 when the owner and pharmacist, Lazare Trelli, had a stroke.

  Up-time medications quickly run out. Trelli's pharmacy had equipment for compounding and pill-forming, which can be used to supplement available down-time equipment in providing safe medications.

  Senior Chief Hospital Corpsman David Dorrman is assigned as the NCOIC of the hospital at the Naval Yard. [xxii] He’s also the closest thing available to a medical examiner, working with the Provost Marshal’s Office, including NCIS, the Shore Patrol and the Marine MPs in Magdeburg.

  Preventing the loss of the battle.

  Despite the paucity of fully-trained up-time medical personnel at the time of the RoF, there are thousands of down-time medical workers, from classically-trained physicians to herb-wives, many of whom will be interested in learning the up-time methods. In turn, these down-timers will teach up-timers the effective points of down-time medicine.

  Among the down-time physicians and surgeons already canonized are:

  Scultetus—German, known as the surgeon at LMC to have work on you if Dr. Nichols was not available.

  Balthazar Abrabanel—one of the first down-timers to meet the up-time people, and the first down-timer to be saved by up-time methods [xxiii]

  Gerhard Eichhorn—German, a barber surgeon working with Essen Chemical and the Antonites and involved in development of penicillin. [xxiv]

  The Reverend Bartholomew Wesley, MD and his wife, Anna, who is a midwife, move to Amsterdam just ahead of a King’s Warrant, and participate in the defense of that city. [xxv]

  There are some Jena-trained surgeons are in canon as of May 1634 [xxvi] in Torstensson’s army outside of Ahrensbök. These would have to be down-time personnel, either physicians or barber-surgeons, who have been "taught up to speed." In particular, a Dr. Dietrich Weiss is mentioned as having saved Anse Hatfield’s life, along with most of his left hand and arm.

  Additionally, a Dr. Jensen complains that one of the field medics is being called “Doc” by the troops he is working with. While Dr. Jensen has spent six months working at LMC to learn the uptime techniques, [xxvii] he obviously had little experience with the military, and was quickly quashed by the field commander.

  Nicolaes Tulp, a Dutch surgeon and politician, not yet in canon, could be interesting for the author who chooses to use him, as he was one of the Amsterdam city magistrates after 1622, and mayor of that city for four terms, beginning in 1654. In OTL, he was the subject of Rembrandt’s 1632 painting, The Anatomy Lesson of Dr. Nicolaes Tulp, one of the works that was changed by the butterflies, as evidenced by the cover of Grantville Gazette IV.

  Thomas Bartholin, one of several medical scions of the noted Danish surgeon and anatomist Caspar Bartholin, would be entering medical training in OTL in the mid 1630s. That would make him a natural to attend the up-time influenced program at either Jena or Padua. Other Bartholin family members also entered the profession. Other notable down-time physicians available include Peter Spina and his progeny. William Harvey is already in canon. There are many, many others.

  Important predecessor physicians and surgeons to this era would include:

  Caspar Bartholin the Elder, known in OTL both for a duct under the tongue, and a standard anatomy text of the time.

  Abu Ali Sina (980-1037), more commonly known as Avicenna, and for the Canon of Medicine, one of the seminal works of medicine and surgery

  Theophrastus Paracelsus (1493-1541), whose writings started to replace Galen as the ultimate source of medicine. He is the claimed ancestor of Herr Doktor Gribbleflotz.

  Ambroise Paré, 1510-1590, a barber surgeon known for more humane battlefield medicine, ocular and orthopedic prosthesis

  Hieronymus Fabricius (1533-1619), a gifted anatomist who first described the technique of tracheotomy, a life saving operation to open the airway when nothing else will work.

  A Cast of Thousands

  If the up-timers are limited, and the traditional down-time MDs are relatively rare, often hazardous, and almost always expensive, the numbers of midwives, herb wives, barber surgeons, bone-setters and hedge—or horse—doctors were literally legion. We have some in canon already, including the midwife Greta in Magdeburg, who has taken
up-time training, and is proving to be the bane of her less-scrubbed counterparts.

  Herr Dr. Gribbleflotz has had a number of appearances reproducing up-time medical compounds for the benefit of his pocketbook and the community.

  My shared characters in canon include:

  Katharina Schrey is working with the Sanitation Commission as a quarantine house attendant while she is attending the BSN course [xxviii] . She expects to enter the DO program at Jena when she has her BSN.

  George Lenkert, her husband, also works with the Sanitation Commission, and has completed EMT training.

  Caspar Weybrecht has also completed EMT training, and will be starting in the Jena BSN/DO program in 1636.

  Anna Krause is a couple of years behind him in school, but she is already in canon as the first geographic epidemiologist. She is also planning to attend the program at Jena.

  Kerryn Offord and Danita Ewing were both kind enough to send me copies of information posted much earlier on the Bar from H.W. “Butch” Clor and Danita, laying out the expected progress of medical training down-time. Updating this material will become part 4 of this series.

  Success has many fathers and mothers.

  Medicine had many significant influences between 1632 and 2000, including many physicians, nurses, and educators, with various therapists and paramedical personnel coming in after 1970. Anatomists and surgeons in particular made major advances that paved the way for modern surgeons, starting with an increase in teaching human anatomy by direct dissection. There were two major problems with this: first, the lack of proper preservation of said bodies, which meant that there was only a short time each body could be used and second, the relative lack of usable bodies, since the only ones available were supposed to be those of executed felons. The change from execution to transportation as a sentence for many crimes lead to a marked decrease in the supply of bodies. This occurred even as the demand for fresh bodies went up. The increase in demand lead to the Burke and Hare murders [xxix] (to supply Dr. John Knox) and the only somewhat less unsavory activities of Dr. John Hunter in London as he "acquired" the bodies needed to support the anatomy classes he was teaching with his brother, Dr. William Hunter [xxx] . The outrage over the murders and body snatching lead to the Anatomy Act of 1832, which allowed the use of donated bodies in the teaching of medical anatomy. [xxxi]

  An incomplete list of others would include Florence Nightingale, Baron Lister, and the aseptic surgeons Drs. Kocher, Crile, Halsted, Oschner, and the Mayo Brothers. Abraham Flexner, an educator and the physicians John Shaw Billings, William Osler, and William H. Welch systematized and revolutionized medical and surgical education in the OTL in many different ways, based on the program at Johns Hopkins University.

  Nurses McDonald and Flanagan, and physicians Abrabanel, Nichols, Shipley and Adams will do much the same in the NTL.

  Dr. Hugh Owen Thomas of Great Britain developed the first traction splints, along with many other orthopedic devices. He is considered the father of modern trauma orthopedics. His career was influenced by the problems that his father, Evan Thomas, had as a non-physician bone-setter in the early 1800s.

  William T. G. Morton, a dentist, demonstrated the use of ether as a general anesthetic in 1846. Others, too numerous to list, will become more important as materials technologies develop to allow more advanced surgeries. Additionally, the use of assorted skeletal traction techniques is old and will make a comeback since it will be some time before the materials and techniques that allow up-time orthopedists to bypass the prolonged bed-rest needed by external traction.

  I’ll examine the problems of medical training in more depth in parts two and four of this series

  If it’s not written down, it wasn’t done.

  Most of the journals that I subscribed to and at least thumbed through every month were associated with various professional organizations. These included:

  The American Family Physician (also available on CD ROM covering years 1990-1995, continuing medical education (CME) was a major feature of this magazine

  The Journal of the American Medical Association JAMA

  The Journal of the American Osteopathic Association JAOA

  The Journal of the American Board of Family Practice JABFP

  Family Practice Physician

  The Southern Medical Journal.

  Scientific American Medicine, considered one of the better textbooks of medicine and surgery, was in two large, loose-leaf binders, and updated monthly. A choice of hard copy or DOS (later ISO CD ROM) based CME programs was also included.

  Family Practice Management was dedicated to helping physicians manage their office, and offers more CME.

  The Clinics of North America series were slim hardbound volumes, issued quarterly, covering many different subjects. I personally subscribed to the Primary Care series, but also had access to the Surgical and Emergency Medicine series. Both Large Animal and Small Animal Veterinarian Clinics series were also available, and would probably be in the vet’s office libraries.

  Various other slick and pulp periodicals were also available, many of them in the category of "free to physicians." The better ones I subscribed to included:

  Emergency Medicine

  Hospital Practice Physician

  The Cortlandt Forum

  Medical Economics (which had a fair number of articles that would be useful down-time on how to run a practice or hospital)

  Emergency Medicine News

  Nursing journals would include The American Journal of Nursing, Nursing (insert year here—my mother kept a subscription from at least 1970 to 1990), and professional journals for midwives and nurse practitioners. There was also a version of Clinics of North America, dating from at least 1995, directed towards the NPs

  Most of these should be found when the libraries are consolidated, with enough overlap to cover the period 1950-1999 almost completely. Other articles would have been available with access to the National Library of Medicine through several different sources, most commonly, the local hospital. On-line searches (MEDLine/MEDLars) were available by 1994, and were even easy to use by 1998, replacing the hard copy Index Medicus for most purposes. Some of these articles were already available online, and my collection of hard and electronic copies easily numbered a thousand or more articles on various, and often odd, subjects by early 2000. In checking my personal library, and sorting out items that I acquired before January 2000, I have found a number of titles that would have been common enough that at least one of the five local doctors would have had a copy. I need to do an inventory and will post it as an addendum at 1632.org.

  While I had a "typical small town/rural primary care practice" for the time, I will admit that I had a selection of medical books that were probably a bit wider than most physicians my age. This was due to my work in the US Army Medical Corps at various levels, as well as my interest in the fields of sports, emergency and field medicine. Additionally, I subscribed to the Classics of MedicineLibrary, a division of Gryphon Editions. Gryphon specializes in publishing high quality editions of classic literature, using leather covers, archival quality acid free paper, and fully sewn bindings—the kind of books that look good in a professional library, something that will attract most physicians at some stage of their career.

  Stanchem reminded me that up until the late 1990s, it was common for drug companies to give assorted textbooks and other "giveaway goodies" to physicians. These would include everything from small monographs from Upjohn and Bacto covering office laboratory subjects, to more general textbooks in many specialties—I have a nice copy of Principles of Ambulatory Medicine that I received this way. It is hard to tell what Shipley and Adams might have received in this manner, much less the older physicians. While not directly related to trauma, these books would have been an important core for the medical library. Inexpensive but usable stethoscopes, assorted scissors and other medical equipment should be found amongst the detritus of the older offices.

  Relevant surgical a
nd medical textbooks from the period 1983-1999 include:

  Various anatomy books

  Grey’s is still the classic, and widely available in the 1990s.

  Grant’s was commonly used in medical and nursing schools

  The Ciba-Geigy Anatomy series, illustrated by the late, great Frank Netter, MD was one of the most colorful available.

  The Color Atlas of Human Anatomy featured detailed photographs instead of drawings, and was popular with medical and nursing students.

  Principles of Surgery (4thedition, Schwartz, 1984)

  Advanced Trauma Life Support, 6th Edition

  Modern Manual Therapy of the Vertebral Column (Greive, 1986)

  Management of Wilderness and Environmental Emergencies (2ndedition, Auerbach & Geehr, 1989)

  Sports Injury: Assessment and Rehabilitation (Reid, 1992).

  Tintinalli’s Emergency Medicine, 5thedition, was available in early 2000, but I’m not sure it would have been available by the time of the RoF. I would expect at least one copy of the earlier 4thedition to be available at the RoF.

  I also had a selection of spiral bound "pocket textbooks" covering different subjects, mostly purchased as aide memoire items for student and resident rotations. Drs. Adams and Shipley will have done the same, as did virtually all medical students, interns and residents at the time. Many of these titles came out in formats compatible with PDAs, but that didn’t really start until 1999, so the selection would have been limited, even if the doctors were technophiles.

  I lost the copy of the DePuy instrument catalog that I acquired in or about 1995, when I was helping select new instruments for the local ED, but it had good drawings and photographs of many of the instruments. I’ve included a link to a similar on line catalog as a simple reference to the instruments [xxxii]

  Among the Classics of Medicine Library editions that would have been available in 1999 would be:

  The Expert Midwife (Rueff, 1637, 1997),