Why Anna and Sophie have chapped hands

In the 19th century the most important advance in medical science was called (at the time) Listerism.  Simply put, Joseph Lister, working with  Louis Pasteur’s advances in microbiology and the discovery that bacteria cause putrefaction and infection, came to a conclusion:  In a medical setting the first line of defense is to keep the patient isolated from all such bacterial agents. There were two ways to achieve this: Antisepsis (using chemicals, usually carbolic) or asepsis (using heat) to sterilize.  In 1881 John Tyndall wrote

Living germs  … are the causes of putrefaction. Lister extended the generalization of Schwann from dead matter to living matter, and by this apparently simple step revolutionized the art of surgery. He changed it, in fact, from an art into a science.

In 1876 Lister came to the U.S. to lecture about his findings.

In 1878 Dr. Lewis Stimson performed the first demonstration of an antiseptic surgery in the United States, using  Lister’s antiseptic technique while amputating a leg.

In 1881 President Garfield died not from the bullet fired by an assassin  but because the physicians treating him rejected Listerism and caused massive, systemic infection by probing his wounds with unsterilized instruments and dirty hands.

As the summer waned, Garfield was suffering from a scorching fever, relentless chills, and increasing confusion. The doctors tortured the president with more digital probing and many surgical attempts to widen the three-inch deep wound into a 20-inch-long incision, beginning at his ribs and extending to his groin. It soon became a super-infected, pus-ridden, gash of human flesh.

This assault and its aftercare probably led to an overwhelming infection known as sepsis, from the Greek verb, “to rot.” It is a total body inflammatory response to an overwhelming infection that almost always ends badly — the organs of the body simply quit working. The doctors’ dirty hands and fingers are often blamed as the vehicle that imported the infection into the body. But given that Garfield was a surgical and gunshot-wound patient in the germ-ridden, dirty Gilded Age, a period when many doctors still laughed at germ theory, there might have been many other sources of infection as well (Markel).

At least some people were paying attention, because in 1883 Dr. Stimson was asked to operate on former President Grant’s leg.

This photo was taken in the surgical amphitheater  at Bellevue in the early 1880s.  By modern standards it’s shocking (note especially the bloody floor), but it should have also been shocking to physicians in 1880.  I’m sure medical historians have written about the factors that led American physicians to reject the findings of Pasteur and Lister, but my guess is that it was simple hubris.

Because there were physicians and surgeons who accepted scientific findings and practiced antisepsis and asepsis, I felt justified in having Anna and Sophie act like sensible human beings and wash their hands. And instruments. And everything else. In carbolic.


Cheyne, W. W.  Antiseptic surgery: its principles, practice, history and results, London 1882.

Kessin, Richard H.  and Kenneth A. Forde. “How Antiseptic Surgery Arrived in America.” P&S 2007.  link.

Markel, Howard. The dirty, painful death of President James A. Garfield. PBS,  September 16, 2016. link 

Pennington, T. H. “Listerism, its Decline and its Persistence: The introduction of aseptic surgical techniques in three British teaching hospitals, 1890–99.” Medical history 39.01 (1995): 35-60.

Tyndall, J. Essays on the floating-matter of the  air. London, 1881.

 

What ails you?

I had an email from Cristy:

Hello,
I am most of the way through The Gilded Hour and loving it! Yet I am torturing myself trying to figure out what “common ailment” the slack faced young girl from chapter 43 suffers from?! Please enlighten me!

It’s a very short passage Cristy is asking about. Anna and Elise are discussing a patient who is very young and whey-faced, or pale. She is pale because she’s lost a lot of blood, which follows from abortion. A woman who takes too much of certain herbal combinations that stimulate menstruation can end up hemorrhaging.

If there is no infection present and the abortion wasn’t incomplete, there is a good chance the young woman can be saved. 

Cristy, thanks for taking the time to write and ask about what interests you.

The historical novelist’s nightmare

If you’ve followed my ramblings at all you’re aware that I take research really seriously. Most historical novelists have this quirk, in my experience. Most of us have at least a dollop of ocd, would be my guess.

When I’m working out themes or major plot lines I am especially careful with my background research. So for example, I read widely about the development of sterile techniques in medicine after Lister’s work began to be accepted. Something that really jumped out at me early in my research was the fact that until late in the 1800s doctors and nurses operated with bare hands. There were no rubber gloves, and so they had to dig right in, bare handed. The idea makes me a little woozy, to be truthful. I can watch any kind of surgery without a problem, but I can’t quite cope with the idea of a bare hand digging into an abdomen to locate a tumor. 

Because physicians and nurses understood about contagion and the importance of sterile technique, they went to extremes in washing their hands. They used a combination of antibacterial solutions, many of which were highly abrasive and corrosive, which played havoc with skin and nails and caused all kinds of problems. This is actually a famous paragraph in the history of medical science, written by William Halsted (full citation to be found here).

In the winter of 1889 and 1890—I cannot recall the month—the nurse in charge of my operating-room complained that the solutions of mercuric chloride produced a dermatitis of her arms and hands. As she was an unusually efficient woman, I gave the matter my consideration and one day in New York requested the Goodyear Rubber Company to make as an experiment two pair of thin rubber gloves with gauntlets. On trial these proved to be so satisfactory that additional gloves were ordered. In the autumn, on my return to town, an assistant who passed the instruments and threaded the needles was also provided with rubber gloves to wear at the operations. At first the operator wore them only when exploratory incisions into joints were made. After a time the assistants became so accustomed to working in gloves that they also wore them as operators and would remark that they seemed to be less expert with the bare hands than with the gloved hands.

an original surgical rubber glove
an original surgical rubber glove

It wasn’t until 1892 this venture started by Halsted came to pass and the first rubber gloves were used in surgery — by the nurse Halsted mentions in the excerpt above, the woman we went on to marry in a twist worthy of any romance novel. Dermatitis My Love.  You can read the whole story of how he circumvented this problem in an article called Venus & Aesculapius: The Gloves of Love at Discovery Magazine.  

it wasn’t until the end of the century that sterile gloves were widely used by surgeons as well as nurses. 

If you have read The Gilded Hour you will remember that both Anna and Sophie deal with this issue, which will evolve into a bigger plot point in Where the Light Enters.  

Now, with all that in mind, consider this excerpt I came across today:

chronology-gloves

My blood pressure must have jumped twenty points when I read that. Now, I knew this had to be a mistake — which it is — but it certainly got my attention because if it were true and rubber gloves had been in use in operating rooms by 1882, I’d have some finagling to do. 

Consider this a tempest in a teapot, if you like. I think of it as a reminder (to myself) that my ocd actually serves a good purpose. 

Frustration, Dissected

I have been pretty fortunate in my career as a novelist. Ten novels in, working on the eleventh, I have a lot of loyal and supportive readers. Not everybody loves every book, but it would be silly to expect that; there is no novel out there, no matter how beloved generally, that doesn’t have its detractors. People who find it boring, or activity dislike it for whatever reason.

Women's Medical School, Philadelphia. 1900. Dissection.
Women’s Medical School, Philadelphia. 1900. Dissection: Getting to the heart of the problem.

When you’ve been writing novels for enough time, you know even before one hits the shelves which aspects might not go over well.  If you are writing a series with many dedicated followers and you kill off a major character, you must brace yourself for unhappy feedback from readers. Of course there are a lot of reasons to let a character go; it might have been exactly the right thing to do given the long-term plan for the series, but some readers will not forgive you. They will walk away. Nothing you can do about it. 

When I got past the 250,000 word mark on The Gilded Hour and was wrapping up, I knew that readers would be unhappy about the big cliffhanger. Unless I had the time (and the publisher was willing) for me to hang on another 100,000 words, the cliffhanger was unavoidable and, I hoped, evocative in a good way. 

The one thing I really wanted to do was to have a “first in a new series” label placed in a prominent spot on the cover. I thought this would help cushion the cliffhanger shock. It’s a point I argued  with my editor until I was hoarse, but the editorial higher ups said absolutely not. They were afraid that if it said “first in a new series” people would not buy it for that reason.  

As it turns out, my instincts were right. If it had been clear from the start that the novel was the first in a series, some people might not have bought it, but I think there would be less unhappiness out there than there is. Today I glanced at the Amazon reviews and the first five or so — the most recent — are pretty brutal. People absolutely disgusted with me because they have to wait to find out who did it.  People who loved the Wilderness novels, but find this newest book to be awful.

I’m not frustrated so much with the readers as I am with the publisher. Publishers truly think they have a better sense of what readers like and dislike, but any novelist who interacts with readers simply does know better. I’ve got close to twenty years worth of mail from readers — I would say less than three percent of it strongly negative — to draw on. For example:  The woman who read Dawn on a Distant Shore and then wrote to say that she had heard that most people only had one novel in them, and it seemed I was an example of that. She suggested I go back to my day job. Her tone was utterly polite and concerned, and I didn’t know whether or laugh or just give up. 

There are also a lot of really positive and encouraging reviews, which is what I need to concentrate on. And now I’ll go back to work and try to do just that.