Surgeon Amos Walker Barber, Wyoming Territory

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Surgeon Amos Walker Barber, Wyoming Territory

Frontier Medicine

Photograph

By: Anonymous

Date: Circa 1890

Source: Richard Dunlop. Doctors of the American Frontier. Garden City, N.Y.: Doubleday, 1962.

About the Author: Amos Walker Barber was born in Bucks County, Pennsylvania, on April 16, 1861. He studied literature and medicine at the University of Pennsylvania. After graduating from medical school, Dr. Barber worked as a staff physician at the Pennsylvania Hospital from 1883 until 1885. In 1885, he moved to the Wyoming Territory to accept a position as surgeon in charge of the military hospital at Fort Fetterman. Not long after, Barber was promoted to acting surgeon in the U.S. Army, and he accompanied General Crook's expedition to Arizona. Upon his return from that expedition, Barber was assigned to Fort D. A. Russell. After resigning from military service, Amos Walker Barber opened up a private medical practice in Cheyenne, Wyoming. He joined the Republican political party, and was elected Secretary of State in Wyoming in 1890. He served in that position from 1890 until January 1895, at which time he became Acting Governor. He rejoined the U.S. Army during the Spanish American War, and was appointed Assistant Surgeon in 1898. He returned to Cheyenne and resumed his medical practice after the war's end. Amos Walker Barber died on May 19, 1915, and was buried in Cheyenne.

INTRODUCTION

Frontier doctors during the nineteenth century did not have access to many of the scientific techniques and clinical knowledge being developed at medical schools in Europe. In fact, many frontier doctors never attended a formal medical school of any kind. Although there were three forms of medical education prevalent until near the close of the nineteenth century (university schools, proprietary schools, and the apprenticeship method), none of them placed significant emphasis on clinical or laboratory studies. Anatomy was studied via the dissection of cadavers; physiology was largely theoretical due to the lack of laboratory facilities at most schools. Medicine was still fairly primitive in the United States, and students wishing to obtain an education with greater emphasis on medical science, research, or clinical practice, were forced to go to Europe to further their academic studies. The age of rapid scientific and technological breakthroughs had not yet dawned, germ theory was not well understood, sanitary methods were not routinely employed, and effective medications were scarce. All in all, the practice of medicine throughout much of the nineteenth century relied more on pragmatic skills and a compassionate manner than on sound scientific principles. Because there were relatively few physicians for the overall population—and even fewer hospitals, particularly in the southwest and western frontier areas—physicians had to be prepared to handle any sort of emergency alone. They were often called out in the middle of the night or in harsh weather conditions, and they had little emergency training and even less equipment.

There were few effective medications or techniques with which to treat most ailments; strong emetics, purgatives, blistering, and bloodletting were still commonly practiced—none of which were clinically effective. Pain was treated with morphine, opium, and laudanum (a mixture of alcohol and opium). Broken bones were treated by splinting and, if the fracture was severe, by amputation. Surgery was performed in the home, as was the delivery of babies—although that was largely the province of midwives unless the delivery was extremely complicated and required medical intervention. Payment for services rendered rarely involved an actual exchange of money, and was often given in the form of food, clothing, livestock, or personal services, such as yard or farm work. Highly contagious diseases, such as cholera and typhoid, were treated largely by isolating the sick from the well, and cleaning the areas (environments) of outbreak as much as possible.

PRIMARY SOURCE

SURGEON AMOS WALKER BARBER, WYOMING TERRITORY

See primary source image.

SIGNIFICANCE

Frontier medicine, although reliant on minimal instrumentation and equipment, paved the way for many practical advances in medicine, such as the need for sanitation and the development of hospitals and emergency transportation. Frontier doctors also did much to advance and perfect many medical tools and techniques, such as the stethoscope, the thermometer, surgical tools, anesthesia, and the use of antiseptic conditions.

The southwestern and western frontier areas were affected severely by contagious diseases, since these areas tended to have small, rather dense population centers separated by large unpopulated regions. As a result, diseases spread rapidly from one household to another. The living conditions were often harsh, the sanitary facilities were minimal, and the ability to contain epidemics nonexistent. Among the more virulent of the contagious diseases affecting the frontier were tuberculosis, smallpox, measles, pneumonia, diptheria, dysentery, septicemia, cholera, and typhoid. Port areas also experienced outbreaks of pneumonic and bubonic plague, carried by flea-infested rats leaving ships (trading, military, and other maritime vessels). The rodents carried the bacteria-infested fleas to livestock and domestic animals. The livestock were slaughtered and used for food, under unsanitary conditions, thus transmitting the disease to humans. At that point, it could be further spread by direct human-to-human contact. The diseases prevalent among the frontier settlers were even more lethal to the Native American population, because the Native Americans had no immunity to the diseases. Measles, smallpox, and tuberculosis were especially devastating to the Native Americans that came into contact with the frontier settlers.

In general, epidemics and outbreaks of highly contagious diseases had a high fatality rate, particularly among babies and young children. The hardships of life on the frontier, coupled with the lack of "modern" medical care, reduced the life span of many settlers. At the end of the nineteenth century, the average life span for a Caucasian male was only forty-seven years. Life spans did not lengthen appreciably until the advent of vaccines and antibiotics, technical advances in wound care, surgery, and emergency medicine, and publicly mandated use of sanitation in homes and business establishments.

In more remote frontier areas, settlements were so isolated that epidemics were less frequent, but more likely to be lethal. Cholera was the chief source of contagion. Medical care was less readily available, since the local doctor might have to travel great distances between populated areas. Whisky was the commonly used anesthetic, sanitary conditions were minimal, and vermin—particularly lice—were rampant. Settlers sometimes fought with Native Americans. When a settler was struck with an arrow, a frontier doctor typically removed the projectile by cutting off the arrowhead and pulling the shaft back out through the body. Infections were common. Pain was often treated by a topical application of opium powder or morphine directly on the wound. Severely mutilated limbs were amputated, and doctors worked to hone their skills so that they could complete an amputation within two to three minutes.

Wagon trains seldom included doctors. Most often, the wagon master carried a kit of basic first aid supplies and patent medicines. Anyone who became sick on the trail was laid inside a wagon, usually on top of supplies that became contaminated by the patient. The combined effects of exposure to the elements and jerky wagon movements frequently killed individuals who fell sick during the journey. Cholera was the most common contagious disease on the trail, and it was typically both acquired and transmitted through the drinking of stagnant or contaminated water along the route.

Mining camps, common in the southwest and western territories, were often violent places. Doctors spent much of their time removing bullets, repairing lacerations, and splinting or amputating broken limbs. Many traumas were sustained within the mines as well—typically crush injuries, blast burns, and fractures from falls down shafts. In mining towns, alcohol-related injuries were common and sexually transmitted diseases (STDs)—particularly syphilis—were rampant. Influenza and upper respiratory infections were quite common in mining towns, since the men spent their days exposed to cold water and their nights consuming alcohol in very crowded saloons. Snake bite, another hazard of frontier living, was treated by washing the site and packing it with potassium permanganate.

On ranches, doctors frequently treated cowboys who had sustained horse-related injuries. Broken legs, concussions, and dislocated shoulders were common. Complicated fractures often necessitated amputation of the limb. Chloroform was the usual anesthetic. Since surgical instruments were in short supply, any sharp saw or knife that was readily available and appropriately sized became the surgical instrument.

With the coming of the railroads near the end of the nineteenth century, doctors treated many burns and scalds. They amputated arms, hands, and fingers crushed in couplers. However, on a more positive note, doctors also made good use of the available steam and plentiful hot water to improve sanitary conditions and prevent wound infections.

Medical care was better for those in military service than for virtually anyone else living on the frontier, because military surgeons were among the most highly trained in the country. Military doctors were required to have graduated from an "accredited" medical school. In addition, they had to pass an examination testing not only their medical knowledge, but also their understanding of geography, history, languages, literature, and other general information in order to receive a commission. Physicians accompanied every military expedition outside of the western and southwestern forts and encampments. Battlefield injuries and traumas were relatively few, but many soldiers were infected with contagious diseases. Fevers, dysentery, rheumatism, and upper respiratory tract infections were the most prevalent illnesses. Smallpox was largely prevented by inoculation of all soldiers with cowpox; tuberculosis was rare, because anyone with tuberculosis symptoms was prevented from enlisting. Sexually transmitted diseases were rare at isolated forts, although not uncommon at forts near densely populated towns. Pneumonia, accidental gunshot wounds, and homicide were the most common causes of death among the soldiers. The larger forts had infirmaries and hospitals that provided the most advanced medical care available at the time.