What might have Gilbert Blythe done to save a woman's life?
March 22, 2019 5:06 PM   Subscribe

I'm rereading all of LM Mongomery's Anne books, and there's a passage in Anne's House of Dreams that has me curious about what medical procedure Gilbert might have used to save his patient's life.

The passage reads,
"Doctors who have to be up all night waiting on sick folk don't feel very adventurous, I suppose," Anne said indulgently. "If you had had a good sleep last night, Gilbert, you'd be as ready as I am for a flight of imagination."

"I did good work last night, Anne," said Gilbert quietly. "Under God, I saved a life. This is the first time I could ever really claim that. In other cases I may have helped; but, Anne, if I had not stayed at Allonby's last night and fought death hand to hand, that woman would have died before morning. I tried an experiment that was certainly never tried in Four Winds before. I doubt if it was ever tried anywhere before outside of a hospital. It was a new thing in Kingsport hospital last winter. I could never have dared try it here if I had not been absolutely certain that there was no other chance. I risked it—and it succeeded. As a result, a good wife and mother is saved for long years of happiness and usefulness. As I drove home this morning, while the sun was rising over the harbor, I thanked God that I had chosen the profession I did. I had fought a good fight and won—think of it, Anne, WON, against the Great Destroyer. It's what I dreamed of doing long ago when we talked together of what we wanted to do in life. That dream of mine came true this morning."
Given when it was set (~1885 or thereabouts, if you take the dates from this post, what might he have done? There isn't anything else mentioned about the patient's symptoms, so this might be a bit of a stretch.
posted by coppermoss to Writing & Language (16 answers total) 9 users marked this as a favorite
 
Was the patient pregnant? It could be a c-section. Although then I would be expecting that he had saved two lives, not one. (And c-sections weren't new, but they weren't widespread and had a pretty high mortality rate).
posted by nat at 5:18 PM on March 22, 2019 [1 favorite]


I always assumed a C-section, as well.
posted by charmedimsure at 5:20 PM on March 22, 2019


There's a timeline of surgical procedures in the wikipedia History of Surgery page that might be of interest.

Nothing jumps out at me as a medical procedure that would have been new in late 1800s provincial Canada, life-saving, and the sort of thing that would be performed in the middle of the night instead of having the patient travel to a hospital, but what I don't know about medicine could fill a library so take that with a grain of salt. Though a fistula repair surgery was developed earlier in the century.

Per this page on C-Section history the first recorded case of a mother surviving the surgery was in the 1580s.

Until the 1870s, the C-section technique remained relatively crude....

In 1876, Eduardo Porro, Professor of Obstetrics at Pavia advocated removal of the womb itself after C-section as a way of controlling bleeding....

In 1882, however, German obstetricians, Adolf Kehrer and Max Sänger each developed methods for preventing uterine bleeding by using suture to close the wound.

posted by bunderful at 5:43 PM on March 22, 2019 [1 favorite]


Although the passage says "wife and mother," I always took that to be a reflection of LMM's fairly conservative view of a woman's role in society, rather than a direct reference to childbirth. C-sections were definitely not new at the time, although the mortality rate was still pretty high. Agree with nat that he would have said he saved two lives.

Thinking about other things that could have killed the patient without rapid intervention... post-exposure rabies vaccine was developed in 1882, so that's my best guess on the given timeline.

However.

I am not at all sure about the 1885 date, because that was retconned with Rilla of Ingleside being set during WW1. Prior to Rilla, the biggest time period clue, AFAIK, is the dress with puffed sleeves from Anne of Green Gables, which suggests that Anne was about 15 circa 1890 (the leg-o-mutton era) and places House of Dreams about a decade later, in the early 1900s. (If the dates from that post are to be believed, teenage Anne would have wanted a bustle dress instead -- which Marilla probably would also have ridiculed, but that's not what LMM -- or lovely kind Matthew -- gives us/her.)

So thinking about late 1890s/early 1900s medical procedures... appendicitis wasn't recognized/treated until McBurney's work in about 1890 in NYC; I could see how it could take several more years before that teaching filtered down to a country doctor in rural Canada. This article from 1908 talks about the accurate diagnosis of appendicitis -- now a routine first-year med student test question -- as a fairly new and complex thing for practicing physicians, so Gilbert's struggle and gratitude make sense in context. Appendectomy is definitely the sort of thing that would be unlikely but theoretically possible outside a hospital setting. (Though maybe not in the patient's home, which is what the passage sounds like?)
posted by basalganglia at 5:51 PM on March 22, 2019 [19 favorites]


I have not read the book, but the Wikipedia page suggests there is an event near the end triggered by the Canadian Federal Election of 1896. An emergency appendectomy would seem to be a good possibility with this timeline.
posted by Short End Of A Wishbone at 7:02 PM on March 22, 2019


The timeline does seem right for an appendectomy, and I can imagine it not being feasible to put someone with an about-to-burst appendix into a horse-drawn vehicle to to transport them elsewhere for surgery. Not to mention people often considered hospitals to be somewhat dangerous places where you could pick up contagious illnesses. At-home surgeries were definitely a thing - my father grew up in a town outside Toronto (which has since been swallowed by Toronto) and as a child in the 1940s had his tonsils removed on the kitchen table because the doctor thought it safer than going to hospital.
posted by Secret Sparrow at 8:20 PM on March 22, 2019


I think if it were a C section, he would have said he saved two lives, not one. No mention of saving or losing a baby makes that seem unlikely to me.
posted by FencingGal at 6:16 AM on March 23, 2019 [2 favorites]


The reference to the patient being a 'wife and mother' suggests that this is a surgical procedure for women in mid-life -- but perhaps a surgical procedure of a rather gruesome kind that Gilbert doesn't feel he can describe to Anne, or that Montgomery doesn't feel she can describe to her readers.

The likelihood, I think, is that this is a reference to radical mastectomy for breast cancer. This was pioneered by William Stewart Halsted at Johns Hopkins in the 1880s and 1890s, and described by him in a 'landmark paper' of 1894. So assuming the novel is set in the 1890s, it's quite likely that the procedure would have been coming into hospitals at around this time.

Montgomery would have been only too well aware of treatments for breast cancer, as she herself had a breast cancer scare in 1910, which she describes in harrowing detail in a journal entry in 1918:
I got up in the cold and hunted out all the “doctor’s books” in the house and read what they had to say on the subject. I found nothing to encourage me .. I thought I would go mad with fear and dread. I could say no word to anyone – there was no one I could say anything to. Sleepless night succeeded sleepless night – agonized day followed agonized day. I could not work – it was impossible to concentrate on anything.
Happily, it was a false alarm -- but 'the agony had been so awful', she writes, 'that for years I could not bear even to think of it'. Judging from the journal entry, it looks as though she was starting to revisit the experience around the time that Anne's House of Dreams was published in 1917.
posted by verstegan at 9:42 AM on March 23, 2019 [2 favorites]


Tracheotomy, perhaps for Diptheria, would be another possibility, although its a 'new' procedure, it was considered state of the art at that time. Laryngeal intubation was apparently developed just around that time as well, and diptheria anti toxin was not widely available until into the 1900's.
posted by Northbysomewhatcrazy at 12:04 PM on March 23, 2019 [3 favorites]


I always assumed it was some sort of tracheotomy. The text is fairly clear that whatever he did, it was (1) an emergency procedure (2) at the patient's house. I don't think a mastectomy would have been unscheduled or done at home. [ETA: a later book talks about a diphtheria emergency pertaining to a different character.]
posted by fingersandtoes at 2:17 PM on March 23, 2019 [1 favorite]


I think the appendectomy folks might have it. I remembered that there was talk of appendicitis later in the book, and a quick search on Project Gutenberg yielded this later exchange I'd forgotten about:
"I think not—though it may sound conceited and presumptuous to say it. And you know as well as I that he is rather prejudiced against what he calls 'these new-fangled notions of cutting and carving.' He's even opposed to operating for appendicitis."

"He's right," exclaimed Anne, with a complete change of front. 'I believe myself that you modern doctors are entirely too fond of making experiments with human flesh and blood."

"Rhoda Allonby would not be a living woman today if I had been afraid of making a certain experiment," argued Gilbert. "I took the risk—and saved her life."

"I'm sick and tired of hearing about Rhoda Allonby," cried Anne—most unjustly, for Gilbert had never mentioned Mrs. Allonby's name since the day he had told Anne of his success in regard to her. And he could not be blamed for other people's discussion of it.
Certainly makes it seem like he did an appendectomy, doesn't it?
posted by coppermoss at 3:07 AM on March 24, 2019 [1 favorite]


That Gilbert specifically references appendicitis in the first quoted paragraph, and then says "a certain experiment" in the 3rd paragraph instead of appendectomy, suggests that the procedure performed was something not to be discussed in polite company (or put into polite books) in that time period. If it was an appendectomy there's no reason he would not have said so; instead he's using euphemistic language. (The language "in a certain condition" was once used to refer to a woman who was pregnant).

But it could also mean that LMM didn't have a specific procedure in mind.
posted by bunderful at 6:49 AM on March 24, 2019


I think the "he's even opposed to operating for appendicitis" means that appendectomies were common enough that to be against them proved that Dr Dave was exceptionally old fashioned. The certain procedure Gilbert did was something very rare and innovative.

I think the reason the author didn't specify what it was was that it she didn't have a specific thing in mind. There's no way it was a c section -- all the references are to saving Mrs Allonby's life, never to a baby.

The rest of that book gets real specific on stuff that she wants to specify. A major plot point hangs on a trepanation operation for brain swelling, after all. She knew how to research what she wanted to research. I think she left it vague because she didn't have a specific thing in mind.
posted by fingersandtoes at 7:36 AM on March 24, 2019 [3 favorites]


What about an ectopic pregnancy? Probably not for polite discussion, especially since you can’t save the fetus; definitely fatal if untreated; and the timeline is right according to this pdf.
posted by nat at 2:01 AM on March 26, 2019 [1 favorite]


Well, first thing: early operations for appendectomy - for that matter, any intestinal surgery - often eventually produced complications caused by scar tissue at the incision narrowing the passageway, which caused a partial obstruction, which led to continuous vomiting and debilitation, which led to another surgical operation, which led to more scar tissue, which led to more vomiting and debilitation and often death.

This was called the vicious circle, referring the circular incision and scarring caused by suturing the two pieces of bowel together. And as a result, surgical treatment of appendicitis was taken as a last resort, until the Murphy button was invented (and eventually, advanced techniques in suturing).

Second, a very common "female complaint" of the pre-surgical era was ovarian cysts which, since there was no effective diagnosis and treatment, usually grew to ginormous dimensions and greatly afflicted the women suffering from them. When they became too debilitated, a doctor might be consulted. If the doctor believed it was a cyst, the common treatment in that era was to make an incision in the abdomen and insert a drainage tube into the cyst to drain it of accumulated fluids and thus provide some temporary relief. Gilbert may have diagnosed a cyst and performed this procedure, which of course a children's author wouldn't explain in any detail. When doctors finally began removing these cysts, they were often so large as to merit reporting in the newspaper.

People interested in the history of medicine would enjoy reading The Doctors Mayo by Helen Clapesattle. It provides a great many fascinating anecdotal accounts of surgical procedures performed by these pioneering doctors, and gives a good perspective on what life was like in the old days before common complaints had no surgical recourse. (Tl;dr: nasty, painful, and short.)
posted by Lunaloon at 9:01 AM on March 26, 2019


Just randomly came across this question and the timeline is totally different but I've been watching "Anne with an E" on Netflix and just watched one where Gilbert turns a breech baby while helping a woman he doesn't know give birth. It's implied that this woman works in a brothel and has no one to help her but he's very kind to her and jumps into action. He also says that his mother died giving birth to him and that he was a breech baby. This all happens when he is of school age and traveling the world on a steamer ship so...?
posted by amanda at 8:49 AM on November 17, 2019


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