Frontier Medicine

The following is a list of possible medical RP scenarios which are by no means limited to those listed. As is the nature of RP situations are often open to poetic license. It is important that the RP comes first in all scenarios and that it is a collaborative effort between the players involved.

It is also important to remember the time period Red Dead Redemption 2 is set in and that it is in the ‘Wild West’ where access to some progressive remedies and medical items available in other countries or places in the USA, may not have been available in this.

Websites which may be of interest are also contained in this document; it is not necessary to thoroughly read the information but it is supplied to you as a handy reference guide.

Some of the medical scenarios may include (but are not limited to) the following:

Gunshot Wounds

Snake bite 

Penetrating wounds

Burns

Animal bites

Head injury and brain trauma

Sprains and breaks

Dentistry

Tuberculosis

Parasites

Rashes and itches

Alcohol and other Drugs

Pox 

Vaccines

Black Lung

Prosthetics

Native American remedies 

Common ailments

Drowning

Injuries from crushing

Pain Medication

Inside the Story of America’s 19th-Century Opiate Addiction | History | Smithsonian Magazine

Morphine was first extracted from opium in a pure form in the early nineteenth century. It was used widely as a painkiller during the American Civil War, and many soldiers became addicted.

Opium

Opium Throughout History | The Opium Kings | FRONTLINE | PBS

Codeine, a less powerful drug that is found in opium but can be synthesized (man-made), was first isolated in 1830 in France by Jean-Pierre Robiquet, to replace raw opium for medical purposes. It was used mainly as a cough remedy.

Laudanum – an overview | ScienceDirect Topics

Laudanum is a tincture of opium containing approximately 10% powdered opium by weight (the equivalent of 1% morphine).

The discovery and development of antiinflammatory drugs – Brune – 2004 – Arthritis & Rheumatism – Wiley Online Library

Pain relief through the ages: what are they and did they work? – BBC Science Focus Magazine

Anti-inflammatory agents included:

Willow bark which was chewed to fight fever and inflammation.

Tumeric administered in many ways: it could be drunk as a tea, juice, or tincture, taken as a powder, or applied as a cream or ointment.

Treating gunshot wounds (GSW)

Patient arrives with multiple GSWs to the arms and torso.

Boiling water

Bandages

Pain relief

Sewing kit

Tweezers

Iodine

Grain alcohol

Person giving medical treatment should RP washing their hands. As this is a collaborative effort the use of /me is important i.e. /me check pulse and the pulse is? – should be met by a response from the injured player /me pulse is rapid, slow etc. 

1. Check their vitals – conscious? breathing, pulse, body temp (touch), skin color (Is the patient pale, blue, grey?)

2. Apply pressure to the bleeding

3. Check for exit wounds

4. Check for bullet – Is it still inside? Is it intact or is it fragmented?

5. If possible, retrieve bullet/fragments from wound

6. Did the bullet hit any organs, bones, or arteries?

7. Address internal issues caused by bullet – is there an exit wound?

8. Clean the wound – Iodine 

9. Stitch up and bandage the area

10. Let the patient know to check the wound for bleeding or pus and to come back and see you if there is any sign of infection. Do not get the bandages wet.

Snakebite

Hissstory: how the science of snake bite treatments has changed (theconversation.com)

Western Fictioneers: SNAKEBITES IN THE OLD WEST

Ammonia was a common remedy through the 1700s and 1800s. 

Many people took to carrying a small bottle of ammonia when they ventured into ‘rattlesnake country’, which they could apply to the bite. Have the patient lay down 

A very painful but common remedy was to get a sterilised knife and cut out as much of the wound and (hopefully) the poison as possible, inject ammonia and clean and bandage the wound, then give the patient six ounces (175mL) of brandy to stimulate his/her circulation.

Alternatively, get out a knife, cut a cross over the bite, then suck out the poison and spit it away. The knife blade would then be heated to red heat and used to cauterize the wound.

In the Old West branding irons, cigars or even gunpowder would be applied to the wound to cauterize it. Some doctors advised cutting the wound out entirely. This was because the hemotoxic can cause extensive necrosis or death of the local tissues.

Penetrating Wounds

History of Wound Care: The Wound Care Nurse’s Journey Part 1: The Civil War | Today’s Wound Clinic

Penetrating wounds are caused by objects that penetrate the body, that is, they pierce the skin and lacerate, disrupt, destroy, or contuse adjacent tissue, thus creating an open wound.

The area of wound and severity of the injury is an important aspect to consider as well as what was used to penetrate the area of the body (arrow, sword, knife). There is no one size fits all approach. During the Civil War treatment agents included honey, chloroform or ether, ointments or grease, morphine powder, different suture materials, and the hypodermic needle.

Sterilise/wash your hands

Are there signs of fever? Are there signs of inflammation?

Use an antiseptic to wash the wound and prevent sepsis.

Use ether as a form of anaesthesia.

To best relieve pain, apply morphine powder directly to the wound.

Suture the wound and apply a clean bandage.

The Treatment of Burns and Scalds

History of burns: The past, present and the future | Burns & Trauma | Full Text (biomedcentral.com)

Use cold water to cool the burn to prevent long term consequences.

Check the patient’s vitals and area of the body affected.

Do not remove clothing as it may be stuck to the flesh.

Apply Aloe Vera plant or ointment topically to the area, and advise the patient to apply the ointment to the area 1 to 3 times daily.

Any blisters that may form must be left intact.

Animal bites

Wash and clean the area with iodine

Apply pressure to the area if bleeding and check for any teeth in the wound

Suture the wound and apply a clean bandage

Give pain medication and alcohol

Concussion (Head injury and brain trauma)

united states – How were concussions treated in late 19th-century America? – History Stack Exchange

If the person has a concussion, when they wake up, they will show many symptoms like dizziness, vomiting, doubled vision, severe confusion, and repeated coming into and out of consciousness.

Have the patient lay down and place a small pillow under her/his head.

Warmth should be applied to the feet and limbs by means of hot blankets.

Strychnine (gr. 1/25th) may be administered subcutaneously and also camphor, and in bad cases it may be advisable to put the patient into a warm bath.

The patient should be placed in a quiet room. While she/he is still unconscious (five grains of calomel (mercury chloride) placed on the back of the tongue or one or two drops of croton oil on sugar).

Sprained Ankle

19th Century Historical Tidbits: Sprained Ankle Part 1

For a sprained ankle, place the end of the bandage upon the instep, then carry it round, and bring it over the same part again, and from there round the foot two or three times, finishing off with a turn or two round the leg above the ankle.

Breaks

Setting of a Broken Bone. (doctortreatments.com)

A broken bone presented a painful procedure in a time before anaesthesia, but simple fractures of the arm were relatively easy to fix, even in the late 18th and early 19th centuries. In reaction to the injury, muscles contract and are stretched before the bone is set. Arm muscles do not offer undue resistance. Thus the bone of a forearm can be set without too much exertion on the part of the surgeon or bone setter. Once set and placed in a sling, the arm bone required time and rest for healing.

Controlling the Pain

Methods of pain control included: using Ether or chloroform, icing the limb, prescribing laudanum, drinking alcohol, and providing nerve compression or hypnosis.

Dentistry

Tooth removal was often done by farriers or the local blacksmith who used string, hot coals, forceps and pliers to remove the tooth.

Extractions were by forceps or commonly keys; rather like a door key…When rotated it gripped the tooth tightly. This extracted the tooth – and usually gum and bone with it…Sometimes the jaws were also broken during an extraction by untrained people.

Tuberculosis (TB) 

During the nineteenth and early twentieth centuries, TB was the leading cause of death in the United States, and one of the most feared diseases in the world. It is highly contagious.

Tuberculosis is characterized externally by fatigue, night sweats, and a general “wasting away” of the victim. Typically but not exclusively a disease of the lungs, TB is also marked by a persistent coughing-up of thick white phlegm, sometimes blood.

There was no reliable treatment for tuberculosis. 

Some physicians prescribed bleedings and purgings, but most often, doctors simply advised their patients to rest, eat well, and exercise outdoors. Very few recovered. Those who survived their first bout with the disease were haunted by severe recurrences that destroyed any hope for an active life.

Parasites

Signs and Symptoms of Human Intestinal Parasites

Loss of appetite

Stomach ache

Nausea

Weakness

Fatigue

Weight loss

Anaemia

Herbal remedies

Cloves

You Will Need

2-3 cloves

1 cup of water

Honey

Method

Add two to three cloves to a cup of water.

Bring it to a boil in a saucepan.

Simmer for 5 minutes and strain.

When the solution cools a little, add some honey to it.

Drink immediately once it is cool enough to drink safely.

Consume this solution 3 to 4 times daily for a week.

Black Lung (Coal workers’ pneumoconiosis (CWP))

There is no cure for CWP.

Symptoms

Coughing and coughing up black mucus.

Very severe shortness of breath.

Heart failure.

Treatment

In 1885, the first ever recorded use of oxygen was documented for a medical purpose. This medical procedure was to treat a patient with pneumonia. This revolutionary treatment was administered and pioneered by Dr. George Holtzapple. Just two years later, a product was invented and sold that stored enough oxygen for intermittent use.

Rashes

Use tar soap, advise the patient to maintain cleanliness.

Chickenpox

A daily dose of castor oil.

The idea was to purge the body of the infectious disease, but such treatment usually just compounded the misery and forced the patient to stay close to the toilet.

Constipation

The Merck Manual, recommended small amounts of strychnine as a treatment for acute constipation (Strychnine injections were also recommended for both flatulence and ulcers.) Opium and turpentine were also recommended, but patients probably derived more relief from the less dramatic manual-recommended regimens, such as eating apples and figs or drinking coffee.

Hiccups

In 1899, doctors recommend inhaling chloroform. Other hiccup remedies listed in the Merck manual included nitro-glycerine and the slightly less toxic sugar and vinegar.

Asthma

Cannabis indica was used in chronic cases. Inhaling the fumes of tobacco and cannabis, as well as stramonium (a hallucination-inducing nightshade) and lobelia (a flowering plant known for its sedative properties) was also used as treatment.

Nausea

Bloodletting with leaches or cocaine.

Earache

Almond oil applied to the inner ear. Glycerine or leeches behind the ear.

Alcoholism

In the 1880s, Sigmund Freud helped popularize the idea of using cocaine to treat alcoholism, calling it a “magical drug.” In its heyday, cocaine was also promoted as a cure for morphine addiction, depression, anxiety, fatigue, and migraines. It was available over the counter in tonics, powders, wines, and soft drinks. Patients likely felt energized by regular cocaine infusions, but they soon became habituated.

The 1899 manual also offered simpler, less dangerous—but also likely ineffective—ways to battle alcohol cravings, including slowly sucking an orange or drinking water hot (“one pint drunk as hot as possible an hour before meals will remove craving”), or cold in small sips.

Drowning

Saving lives with a puff of smoke? – Science Museum Blog

In the 18th century, resuscitation involves two principles: stimulation and artificial respiration. Amid stimulation, in addition to warmth, the choice treatment was to blow tobacco smoke into the rectum, which was used until the beginning of the 20th century. 

Prosthetics

History of The Prosthetic Leg Through The Ages – Amputee Coalition (amputee-coalition.org)

Syphilis

Mercury ointment or pills.

Wound care

Keep the area clean, use of iodine.

Wash the wound with clean water, boiled first, vinegar (acetic acid), and wine.

Other agents used in the treatment of wounds during the Civil War included honey, chloroform or ether, ointments or grease, morphine powder, different suture materials, and the hypodermic needle. Used for centuries, honey acted as a remarkable resource for healing wounds, so providers would apply it to the wound along with a dressing.

To best relieve pain, physicians and nurses would apply morphine powder directly to the wound.

Lint was used in a compressive dressing; it was folded and pressed into or onto the wound and a bandage was placed over the lint. This method helped control bleeding.

Cholera

Treated with red pepper in whiskey or brandy, or burning barrels of pine tar beneath open windows (though that had no real effect). In 1849 on the Santa Fe Trail, Dr. Burchard gave pills compounded of camphor, cayenne pepper, opium and calomel or rectal injections of a medicine made from sugar of lead, laudanum and gum Arabica.

Cough

Treated with onion syrup or paregoric (a mixture of opium and camphor). To promote expectoration doctors used carbonate of ammonia or muriate. They also used a mixture of equal parts of linseed oil, honey and Jamaica rum.

Fever:

Doctors used coal tar derivatives as sleep producers. People also treated fevers with sassafras tea and used aconite to control them. In 1866 a doctor recommended a liniment mixture of sulphuric ether, aqua ammonia, and muriate of ammonia. “Wet the scalp and all painful parts every 2 or 3 hours, or until the pain abates.”

Scalping:

Often fatal. A four-year-old Nebraska boy had his scalp reattached by a doctor using thirty-five sutures. The doctor then put a wet skullcap on the head which was kept wet with a solution of boric acid. The child recovered.

Yellow Fever:

Characterized by chills, high temperatures, headaches, delirium and swollen joints. Treatment included doses of quinine, sulphate of magnesia and calomel, which were only partially effective and fatal relapses were common.

Vaccines

Timeline | History of Vaccines

Common ailments 

19th Century Remedies from The Home Physician (doctortreatments.com)

Merck’s 1899 Manual, by Merck & Co.—A Project Gutenberg eBook

Every man his own doctor : [Ayers, J. Hamilton] [from old catalog] : Free Download, Borrow, and Streaming : Internet Archive