Emergency medicine in 1920

September 7, 2009 6:34 PM

I am a 40 year old man that died of a skull fracture in August, 1920.

I was brought to the city hospital of our large metropolitan area by my brother. I died later that night. Cause of my skull trauma is unknown. What was my medical treatment like? What was the education and medical training of my doctors? How sterile was the hospital? What drugs would I have been treated with? What happened to my body and family when I died?

Asking because a former resident of the house I now own many years later died this way.

posted by asockpuppet to health & fitness (9 comments total)

I think an important starting point for anyone capable of answering (not me!) would be "which large metropolitan area?" New York 1920 would be quite different from Berlin 1920 would be quite different from Tokyo 1920, and there are areas that are large metropolitan areas now that weren't much to speak of back then (Denver).
posted by barnacles at 6:49 PM on September 7 [1 favorite has favorites]

City Hospital, St. Louis MO. Sat vacant for years now rehabbed into condos.
posted by asockpuppet at 6:56 PM on September 7

It's my understanding that medical practices were still relatively archaic in this period and any surgery or treatment would have been largely exploratory or experimental.

That being said, a skull fracture followed by death some hours later is relatively ambiguous--presumably there was some kind of trauma, but we have no way of knowing whether there was any expectation he could have survived. Was it a small fracture accompanied by a blood clot in the brain that killed him--in which case doctors might not have had reason to suspect his life was in danger? Or was the damage severe enough to leave the man comatose and fading fast, clearly out of the reach of even modern medicine? Lots of different breeds of head injury can lead to lots of different treatments.

I'm sure those more knowledgeable than myself will have better answers for the rest of your question, but I suspect these details as stated earlier will stand in the way unless you can find out more about the nature of the injury itself.
posted by Phyltre at 6:59 PM on September 7

I'm sure those more knowledgeable than myself will have better answers for the rest of your question, but I suspect these details as stated earlier will stand in the way unless you can find out more about the nature of the injury itself.

Oh I'm trying, but the death certificate says cause and manner unknown on his injury. Record keeping seems to have been lax, as his address is partially incorrect also.
posted by asockpuppet at 7:08 PM on September 7

While I don't have any Emergency Medicine books from that period at my disposal at the moment, I do happen to have Ochsner's General Surgery, 1920 edition. That exact volume is not on Google Books, but another one of Ochsner's from the same period is:
Skull Fractures, pg 293. Scroll to page 303, bottom, for treatment options.

My volume does mention these:
Examination:
included - pulse (low with 'other clinical signs' indicated high intracranial pressure, which would have to be relieved), spinal tap, blood pressure, and eye exam 'by someone skilled'. Cleaning the wound: irrigated (less likely) or maybe covered with saline gauze as first-aid triage. Disinfecting agent of choice seems to be iodine.
Recovery: '1/3 fatal' - seems to indicate long hospital stays for survivors (median: 2 years) versus the 1-6 month recovery mentioned in this linked article.

My volume does make a ton of references to 'things we learned during the war,' and I expect that many doctors practising at 1920 would be veterans.

Sterility means the nurses boiled the linens and the sutures and the repurposed inner tubes used as tourniquets. But let's be honest: "All surgeons have doubtless experienced the inconvenience of having buttons drop off operating suits at inopportune moments." (Ochsner, 1920, pgs 35-7.)

Sterility was a nurse's job to maintain, as far as I can tell. Unfortunately, the nursing books I have here are both from 1935. They indicate bedrest, with head elevated, an ice-bag on the head, and sedation as necessary for complete rest. Those books mention to watch for seizures; Ochsner's book mentions a lack of observed seizures within a particular population; I think seizures were expected for brain injuries although surgeons may have known they weren't necessarily going to happen. There's also a difference within treatments depending where on the head the injury was; base of the skull versus front, top of head, for example.

With 1920, many of the recent texts used by surgeons or in first-aid have passed out of copyright; you may want to browse some of the related books as linked in the bottom left of the frame of the link above.
posted by cobaltnine at 7:33 PM on September 7 [7 favorites has favorites]

In his book The Youngest Science: Notes of a Medicine-Watcher Lewis Thomas describes both 1911 medicine and 1933 medicine from a sort of historical look-back perspective of being a medical doctor who was also the son of a medical doctor. He describes medical science in the 1920s as making "littl eor no difference" as far as extending the lives of patients and describes the role of a doctor as diagnosing the few things that could be addressed and treated and otherwise preparing the patient for whatever their dignosis was, a diagnosis the doctor was usually unable to change much. In the 1920s we didn't yet have insulin or much in the way of antibiotics (more medical milestones frm that decade). This Wikipedia page has a timeline for what was gong on at Bellevue Hospital through the years from 1799-1996. A few more data points

- here is a photo of a woman in a city hospital in the 1920's or 1930s
- here is a photo of an army medical center around 1926
- this is what medicine lables looked like around then
- this book talks a little bit about the state of health care in the 1920s, still a lot of racial disparity, and costs were escalating due to new insurance regulations.

I know this doesn't speak much to your direct question, but I hope it can sort of set the stage for what you're looking for.
posted by jessamyn at 7:43 PM on September 7 [4 favorites has favorites]

The patient is the doctor's son; the doctor is a woman. Amirite?

But seriously, a head injury would have had some treatment options. X-rays had been used medically since 1908, and it was around 1920 that they got cheaper as they moved away from handmade tubes. So they'd have imaging.

As for the sterility of the hospital, it probably would have been a sight better than when this guy was born (Lister developed the principles of antiseptic surgery back in the1860s) but I bet the doctors didn't wear masks. This last guess is based on the eminently respectable resource known as M*A*S*H.
posted by Hardcore Poser at 8:14 PM on September 7

Was the individual black or white? I. e., would he have gone to City Hospital № 1 or City Hospital № 2? It looks like № 2, the one for blacks, was established in 1919 and became "Homer G. Phillips Hospital", so in 1920 he might have gone to either one.

Both of them were public charity hospitals serving the poor, as opposed to the sort of private hospital a wealthy person might go to.

Here is a description of City Hospital № 2 in 1921 by social worker Ida B. Myers in a compilation "Hospital Social Service" by the Hospital Social Service Association of New York City.

In 1909 there was a Homeopathic Department at the City Hospital of Kansas City so if we can assume the same might have been true in St. Louis in 1920 the patient might have received homeopathic treatments.
posted by XMLicious at 9:38 PM on September 7 [1 favorite has favorites]

Arrgh, that should have been "became 'Homer G. Phillips Hospital' in 1939."
posted by XMLicious at 9:39 PM on September 7