The bone-setters will probably also know that the joint above and below the fracture needs to be immobilized by the splint. Similarly, in cases of joint injury, the bone above and below the joint needs to be immobilized for treatment. Most fractures can be handled by these methods, although more complex fractures will take much longer to heal. Femoral neck ("hip") fractures and some femoral shaft fractures will not respond quickly to this level of treatment, and will be a major source of post trauma mortality for a long time after the RoF.
The next step in the management of more complex fractures will have to wait until stainless steel pins and rods are reintroduced. Known as skeletal traction, these pins act to transfer the force needed to maintain alignment directly to the bones. The pins are inserted through the skin to pierce the bone and come out the other side of the limb. Once inserted, traction is used to align all of the bone fragments into some close approximation of the natural bone. The pins are already in canon as of May 1634[xxxi], with the repair of a young boy's hand after he caught his fingers in a moving belt. I do not know if the pin used was from "old new stock" (left over from before the RoF), new stock (doubtful, as this is very early for even the smallest amounts of chromite to be returned to Grantville and appropriately refined to add to a batch of stainless steel) or a pin that was removed from another patient, cleaned and resterilized for reuse. This also argues that plain film radiographs are available at this point, as I doubt that Dr. Nichols would allow the use of this technique in a child this young without them[xxxii].
The traction will initially be provided by the hands of the surgeon's assistant and later continued by a system of pulleys, cords and weights, easily reproduced in the NTL, until the plaster hardens. Hip and femoral fractures will respond to this treatment, but may require three or more months in bed while the traction keeps things in line. "Spica" type casts, where not only one limb, but the pelvic or shoulder girdle is involved, with a strut passed between the limb cast and the body cast, can also be used for some hip and femoral fractures, but has the trade-off of weight versus freedom from traction. The pins can stabilize multiple bone fragments while the plaster cast holds the pins and the whole limb immobilized as the fracture heals. A somewhat more advanced system would use metal (even brass) rings and rods to form a system to provide the support needed to keep the pins in position, but this system will work best when the skin is left intact except for where the pins enter. Balancing the advantages and disadvantages of the systems is something that will have to be learned as the techniques develop.
To deal with fractures that are too complex or angulated to be reduced by traditional closed methods, or fractures that are already open due to wounds or the penetration of the sharp edge of bone through muscle, fat and skin, aseptic techniques allow the surgeon to clean and debride the tissues and to bring the bones back into alignment. Pins and traction are used to align the bones, the wounds are partially closed, and a plaster cast is again used to maintain the alignment of the pins (and therefore the bones) and immobilize the limb.
A surgeon experienced in this technique, with a good anesthetist and a good surgical team would be able to save the life and perhaps even the leg of someone as badly injured as King Charles I of England after his accident on icy roads.
One of the few situations where an open reduction will be needed for an otherwise closed injury will involve a fracture/dislocation of the elbow. Simple closed reduction of this injury often results in entrapment or damage of the ulnar nerve in a high percentage of the cases, while doing the open procedure, followed by pinning and casting, yields good results in the vast majority of the cases. These techniques will improve the lives of folks who suffer fractures, and markedly reduce both the number of amputations and the number of people who die from amputations.
More advanced orthopedic techniques are known to the up-time physicians and recorded in many books and periodicals in Grantville. These techniques, such as several types of open reduction and internal fixation (ORIF) and prosthetic joints, will be redeveloped as materials science produces the exotic alloys combining the needed strength with corrosion resistance and low weight. I would expect this to happen while Dr. Nichols is still around to provide guidance to the development teams.
The spread of the up-time techniques of amputation will only be limited by the spread of the controlled anesthetic and aseptic surgery techniques needed to support them. While few surgeons down time were experienced in abdominal or chest surgery, most of them were quite good at leg and arm amputations already, and many of them are well-practiced anatomists. With the development of appropriate tourniquets, the use of tourniquets to reduce blood loss will spread. Taken together, these techniques allow for meticulous stump preparation. Other up-time ideas that will be quickly adopted include the use of rasps and rongeurs to shape and smooth bone ends, sterile bone wax to plug the marrow cavity of the long bones, and the development of muscle and skin flaps that allow simpler healing and earlier use of prosthetics.
Additional improvements in physical therapy, orthotics, and rehabilitation will improve the number of amputation patients who return to an active lifestyle. These and other topics will be covered in Part 3.
****
[i]http://en.wikipedia.org/wiki/Surgical_suture
[ii] http://en.wikipedia.org/wiki/Polyglycolic_acid
[iii]Meade, Jackson, Ochsner. The Relative Value of Catgut, Silk, Linen, and
Cotton as Suture Materials. Surgery, 7(4), 485-514, 1940
[iv] Personal communication with Stanchem, 20101210
[v] Attributed to Ziva David "Why would you look for needles in a haystack?"
[vi] A bowel resection is the operation where a portion of the bowel is removed and the remaining ends are sewn back together.
[vii]1632
[viii]Grantville Gazette Volume 15: "Dog Days" insulin in quantity production by 1634
[ix]Grantville Gazette Volume 10: "Little Angel"January 1634
[x]Grantville Gazette Volume 5: "Ounces of Prevention"
[xi]Grantville Gazette Volume 10: "The Prepared Mind" April 1634
[xii]http://en.wikipedia.org/wiki/Louis_De_Geer_%281587-1652%29
[xiii]Grantville Gazette Volume 19: "First Impressions" Schwabach as "The 'chief seat of needle manufacture in Bavaria.'"
[xiv] Dressings are at least clean, and preferably sterile, and go against the wound. Bandages are clean but not necessarily sterile, and bind the dressings to the body.
[xv] Pictures of these items are included in the material to be posted at the 1632.org site
[xvi]http://en.wikipedia.org/wiki/Glutaraldehyde
[xvii][xvii]https://www.sciencelab.com/page/S/PVAR/10414/SLG1573
[xviii]"Ounce of Prevention" ibid: Lindane (gamma hexane hexachloride) is being produced by Essen Chemical by the summer of 1632
[xix]http://en.wikipedia.org/wiki/Hexachlorophene
[xx] Literally "Iodine carrying" compounds- organic molecules that allow iodine to remain in a watery solution
[xxi]http://en.wikipedia.org/wiki/Povidone
[xxii]http://en.wikipedia.org/wiki/Chlorhexidine
[xxiii]1634:The Galileo Affair
[xxiv] http://www.amazon.com/M-S-H-Cassell-Military-Paperbacks/dp/0304366617/ref=sr_1_9?s=books amp;ie=UTF8 amp;qid=1297729088 amp;sr=1-9
[xxv] Hemo (blood) stasis (stoppage)- the act of controlling bleeding.
[xxvi]Knife Man
[xxvii]http://en.wikipedia.org/wiki/Henry_Drysdale_Dakin
[xxviii]http://www.physorg.com/news171523022.html
[xxix] Personal communication with Christos Gianou, MD, former Chief Surgeon of the ICRC, and editor of the 2009 ICRC textbook on War Surgery (link to the textbook: http://www.icrc.org/Web/Eng/siteeng0.nsf/html/p0516)
[xxx]http://en.wikipedia.org/wiki/Orthopedic_cast
[xxxi]Grantville Gazette, Volume 15: "Breakthroughs"
[xxxii] Especially since it is noted that Dr. Nichols has limited experience in small bone orthopedics. Grantvil
le Gazette Volume 4 "Heavy Metal Music" March 1633.
Influences
Kristine Kathryn Rusch
At the start of every year, I buy six calendars. I use them for various purposes, mostly to keep track of my reading or my exercise or my writing. I use the calendars on my phone, which I synch with my computer, to keep track of my appointments and deadlines.
But I still buy a wall calendar because I can’t imagine my kitchen without one. This year’s, Asgard Press’s Vintage Sci Fi 2011 Calendar, is turning into one of my favorites. It presents the covers of old sf magazines in their entirety, reproducing the art in bold vivid colors. I just turned to the month of April and found the cover of Thrilling Wonder Stories from October, 1946.
As usual, the cover presents a scantily clad woman (1946-style) in some kind of peril. Pretty as she is, she didn’t catch my eye (although her pointy bra-shirt-thing did strike me as painful). What caught my eye was the name of the cover story, “Pocket Universes,” by Murray Leinster.
I recently read my first Murray Leinster story last summer, as I prepared to write an article on alternate history for a British textbook. I decided I had better read the classics of that subgenre which I had missed. Leinster’s story, “Sidewise in Time,” appeared in a 1934 issue of Astounding, and had a huge impact on the budding sf field.
My reading experience was fascinating. The story was dated-the characters flat, the style dry and didactic-but it had power. I still remember it months later (which is rare, considering how much I read), and the concepts in it seem fresh, even now.
I haven’t read “Pocket Universes.” I didn’t even know it existed until I turned the page on my calendar, but I’m intrigued. I said to my husband, “How many subgenres did Leinster start?”
My husband, the writer Dean Wesley Smith, knows more about sf history than almost anyone I know. He had no idea how many subgenres Leinster started, but Dean did surprise me with another comment. He walked to the calendar, touched the surface, and said, “Wow. Keith Hammond and John Russell Fearn.”
Those two men were also named on the cover, so I could guess that they were both science fiction writers. But I was astounded that Dean knew who they were. I asked him about it.
He said, “They were major names in their day.”
Major names that I, someone who dabbles in sf history, hadn’t heard of. (Later, Dean told me that Hammond was one of the many pen names for Henry Kuttner, whom I had heard of.)
I’m not surprised by the fact that I haven’t heard of some of sf’s early major names. I started reading sf seriously in the 1970s. My family actively loathed the sf genre, so in our book-filled household, the only sf novels were mine. (Conversely, I have read at least one book from every major bestseller in all the other genres from about 1900 forward, just because those books were lying around the house.) The librarians pointed me to Asimov, one of my favorite lit teachers pointed me to Clarke, and I discovered Andre Norton on my own. But the older names mostly missed me, primarily because the libraries didn’t stock the pulps or sf collections, and I wasn’t allowed into used bookstores (they were filthy, according to my mother, the neat freak).
Still, after forty years of reading the genre and thirty years of working within it, you’d think I would have heard of all of the big names of various times. After all, sf is a young genre. When I came into it, it was still possible to read every sf book published in a given year and still have time to read widely in other genres.
Yet I know that, if I ask my friends who’ve been active in sf longer than I have, they have probably heard of Keith Hammond or John Russell Fearn. These friends might even have read the Murray Leinster “Pocket Universes” story, and could quite probably tell me if it was one of his important, genre-shifting tales.
Even with the deluge of material published in the pulps every single month, sf readers could read everything. Because sf readers formed groups and shared their collections, newcomers to the genre could find classics or important works, even if those works hadn’t been reprinted somewhere else (not that there were a lot of reprint venues back then. Publishing was very different). The small size of the community was both protective and informative.
It actually got smaller by the time I started reading. There were only a handful of magazines and some very important anthologies. The novels were scarce as well. When sf people got together, they could argue about the important works of the year, and be confident that most fans had read (or tried to read) them.
When I quit editing The Magazine of Fantasy amp; Science Fiction in 1997, I had burned out on reading sf short fiction. I continued to read Gardner Dozois’s best of the year volumes to keep my hand in, but I didn’t really try to keep up. After the burnout faded, I came back and was able to keep up relatively well until about six years ago.
Online magazine started and, startlingly, best-of volumes became a cottage industry. One year, I believe there were as many as five in sf alone (and I also read fantasy, mystery and mainstream best-ofs. Romance, my other favorite genre, doesn’t have enough short stories to sustain a best-of volume). I started to get overwhelmed.
Now I’m back reading sf short fiction, and I seriously can’t keep up with this month’s material, let alone this year’s. I am several issues behind on Lightspeed, haven’t cracked an Analog for 2011 yet, and have only read two Asimov’s. I am halfway through two of 2011’s “important” anthologies, and haven’t even purchased the other “important” books. I gave up and only ordered one best-of from 2010, because I never read 2009.
And now-now!-friends, former students, and my favorite writers, are starting to put up original stories as stand-alone e-books. I have five Steve Perry stories on my Kindle and had no time to read one. (Steve, known for his novels, is one of my favorite short story writers. I used to beg him for short stories when I edited F amp;SF and Pulphouse: The Hardback Magazine.) Dean’s doing a couple of stories per week, and at least I get to read those because I’m his first reader. Former students, whose work I love, are putting up stories in droves, and I can’t keep track, let alone read them all.
This week, I managed to clear all of my immediate deadlines and realized that I still felt buried. It wasn’t until I picked up my Kindle, saw all the stories I had purchased but not yet read, that I realized why.
That moment-and the appearance of Murray Leinster on my calendar-got me thinking. We have long since passed the days when the die-hard sf fan can read everything. We’re moving into a time when the amount of material-good material-is so overwhelming that we won’t even know it has all been published, let alone whether or not we want to buy it.
I used to flirt with the idea of coming back to editing by doing a best-of collection. Every year, at least one of the major juried awards asks me to sit on the short fiction committee or to give input as to the nominees. I usually decline because I haven’t read everything.
Now I realize that reading everything just in the sf genre is impossible. Best-ofs are no longer the best based on one editor’s opinion, an editor who has taken the time to read (or glance at ) every single short story published in a given year. Now the best-ofs are the best based on one editor’s opinion of the stuff he managed to read in a single year. Locus Magazine, for some strange reason, has stopped reviewing Analog, the oldest sf magazine in the field. Maybe the reviewers at Locus are overwhelmed. Maybe they don’t even try. I have heard from a few of them that AnalogAnalog gets jettisoned from the discussion, not because Analog has ceased to publish good fiction, but because it gets lost in the amount of material published-and reviewers, often the first step toward getting noticed-simply don’t have time to search out the magazine themselves. doesn’t mail review copies. Which means, in this digital oversaturated world,
Reviewers aren’t more important in this world; they’re less important. I’ve actually given up my Locus subscription because the news in it is months old when I get the magazine, the digital subscription price is ridiculous, and the lists of upcoming boo
ks/magazine are easily available elsewhere. I follow dozens of bloggers who do a better job of reviewing (and seeing the field) than all but one or two of Locus’s reviewers.
I’m not picking just on Locus. It’s tough for the nonfiction magazines (the trade magazines) of the publishing fields to stay current. RT Book Reviews struggled with this a few years ago and has become the most relevant print source for all genres, although its website isn’t that great. Mystery Scene gives me bang for the buck because it stopped being a review/announcement magazine (although it still does that) and has some spectacular analysis pieces as well as great columns about the mystery field.
In sf, the most relevant nonfiction publications are now online. From SF Signal to Io9, I find my dose of sf analysis, reviews, thought-provoking articles online daily. I’m someone who prefers to read on a device or on paper, and yet I’m reading those sites all the time because of their fascinating content.
I think it’s impossible now for a story to reach every single sf fan. I think there will still be books or stories that shake the genre, but it will take time for that bit of writing to have its impact. Rather than having a top story every month, sf might have stories that influence slowly. Word of mouth will make pieces much more important, filtering that story through the world of sf over the space of years rather than weeks.
I find it odd that in this quick-paced digital world, the influential stuff will hit us slowly. But I think the one thing this new world gives us is time. We have time to discover the story because it remains available. Digital sites have unlimited storage space, so stories we hear about in 2011 will still be easy to find in 2014. That story might not influence my writing in 2011, but it might when I read that story three years from now.
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