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. Grantville Gazette Volume 4 "Heavy Metal Music" March 1633.
Influences
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.)