Mr. Belchier was well aware that his story might not be believed: Medical tall tales of dubious provenance were often reported without a shred of supporting evidence. So he went to some trouble to ensure that there was no doubt about this one.
As this case is so very singular and so remarkable that no history can furnish us with any instance similar to it, in order to give a particular account of it, besides visiting the man frequently, from his first admittance into the hospital, and getting from him what information he was capable of giving me, I went myself two days ago to the mill where the accident happened, and enquired into every particular circumstance relating to the fact.
But that wasn’t all. With a theatrical flourish, Mr. Belchier revealed to the assembled dignitaries that he had brought a special guest and an unusual prop with him:
And for the further satisfaction of the Society, I have brought the man himself, and likewise the arm, just as ’twas torn from his body, which has been kept in spirits ever since the accident happened.
Talk about a showstopper! In the later editions of his Anatomy of the Human Body, the eighteenth-century surgeon William Cheselden included a handsome engraving of Samuel Wood, the miller gazing wistfully toward a bucolic landscape in which a windmill can be glimpsed just above the tree line. It’s a romantic vision, if one ignores the object dominating the foreground: his severed arm, its nerves and tendons laid bare by the brutal accident that he was so lucky to survive.
IN ONE SIDE AND OUT THE OTHER
When Dr. Henry Yates Carter submitted three articles to the Medical Facts and Observations in 1795, he described himself as a “surgeon at Kettley, near Wellington, in Shropshire.” This makes him sound like a humble country doctor, but it would be more accurate to describe him as a globe-trotting adventurer. Born in London, he crossed the Atlantic after the death of his parents to take up an apprenticeship with an uncle in Philadelphia. He served as a battlefield surgeon during the War of Independence, then joined the Royal Navy and saw action on both sides of the Atlantic. In 1782, he was the ship’s surgeon of HMS Formidable, Admiral Rodney’s flagship, at the Battle of the Saintes—a famous engagement during which the British beat off a planned invasion of the Caribbean by French and Spanish forces. He retired to practice medicine in England for a few years, finally emigrating to Pennsylvania, where he died in 1849, a few months short of his hundredth birthday.
The cases he sent to the London journal were an unusual mixture of the rustic and the revolutionary. One involved an accident with a waterwheel, another a man whose foot had been run over by a horse and cart. But perhaps the pick of the bunch is this story from his days on the battlefields of America, almost twenty years earlier:
A Hessian grenadier, aged between thirty and forty years, being one of a detachment sent to reduce a fort on the banks of the Delaware, in the act of levelling his piece,* received a ball (grape shot) on that part of the os frontis* which forms the external canthus* of the eye. The ball making its passage through the head, came out under and rather behind the opposite ear, as in the annexed plate.
Hessians were German soldiers who were engaged to fight for the British in the War of Independence, to the fury of many American patriots. Dr. Yates’s mention of the Delaware gives good grounds for thinking that this soldier was injured in December 1776 at the Battle of Trenton, in which the Hessians played a major role. The path taken by the shot (from “a” to “b”) is quite clear in the accompanying illustration:
What were the immediate effects upon the receipt of the injury I am not able to say, not being immediately upon the spot; but he appeared, when brought to the regimental hospital, to have a perfect recollection of every circumstance that had occurred to him, except only for a short time after he fell. He complained of little pain, and did not appear to have lost so much blood as might have been expected. The ball being a spent one, had much splintered the cranium, both at its entrance and exit; and was found in the folds of his coat collar.
Much better to find it there than know it is still inside your brain, I suppose.
The wounds being cleansed, and the splinters of bone removed as far as was practicable from about the external parts, suitable dressings were applied; and his pulse being full, he was let blood; after which he took twenty-five drops of tincture of opium. The next day he had a sense of heaviness over his eyes, and observed that objects did not appear to him so brilliant as usual; towards the evening he complained of nausea and thirst.
Given what had just happened to him, observing that objects “do not appear so brilliant as usual” seems a mild symptom to have to put up with. Over the next few days, the treatment prescribed for the patient—bizarrely, you might think, but quite routinely for the time—concentrated on his bowels: He was given regular clysters, or enemas.
On the third day he complained of pain of his head, accompanied with drowsiness; and, at intervals, of a weakness of his extremities. As the clysters had failed to procure a sufficient discharge of faeces, he was directed to take three grains of calomel and fifteen grains of powder of jalap, which operated well, and procured an alleviation of the symptoms just now mentioned. His eyes were but slightly inflamed, and he complained of but little pain in that on the affected side.
On the sixth day, there was “a pretty good discharge of matter from the wound”—and no doubt from his bowels as well—and his condition began to improve.
Splinters of bone that had been driven in at the superior wound by the ball came away from the dependent orifice at almost every dressing (which was twice a day) for several days.
These bone fragments were pieces of his forehead and eye socket, but they were emerging from a wound behind his ear! Curiouser and curiouser.
The nausea, headache, weakness of his limbs, thirst, and every symptom of fever, gradually vanished; the superior orifice filled up with new granulations, and cicatrized firmly; and in about ten weeks there remained nothing more necessary than a superficial dressing to the inferior opening near the ear.
In little more than two months, the wound had healed. And here’s the amazing thing: The man made a full recovery.
I did not see this man after he had actually left off every application to the affected part; but from the condition of the wound, and the patient’s health and vigour, I have not any room to doubt, that in a few days after I last saw him he was capable of returning to his duty.
When you consider the mess that piece of grapeshot must have made in its progress from one side of his head to the other, it’s a marvel that he made it out of his sickbed, let alone back to the front line.
A BAYONET THROUGH THE HEAD
Not even Alexandre Dumas could have invented a hero as improbably courageous, gallant and talented as Urbain-Jean Fardeau. By turns a teacher, priest, soldier and surgeon, he excelled in every occupation he tried. Combining his medical studies with a swashbuckling career in the French Revolutionary Army, he so distinguished himself with the sword that he was one of the first recipients of the Légion d’honneur in 1802. An hour after it was presented to him by Napoleon Bonaparte in a splendid ceremony near Boulogne, Fardeau dived into a churning sea (pausing only to kiss the insignia freshly pinned on his tunic by the emperor) and swam out to a boat that had got into difficulties, saving more than 150 lives.
During the War of the Fourth Coalition, Fardeau accompanied Napoleon’s armies in their campaign in Eastern Europe, and was present at the Battle of Pułtusk on December 26, 1806, an encounter that took place in the bitter cold of the Polish winter. While there, he witnessed an unusual incident, which he later narrated to a meeting of the Medical Society of Paris:
A soldier named Malva, a voltigeur from my regiment, was wounded in the head by a bayonet which had been unmounted and propelled by a cannonball.
The voltigeurs were specialist light infantry soldiers. Their name means literally “vaulters”: It was originally intended that they should trav
el into battle by leaping onto the rump of a passing cavalry horse, before sliding lightly to the ground to fight on foot.* The soldier named Malva had discovered a notably unlucky way to get injured. It seems that the bayonet, while still mounted to a rifle, had been struck by a cannonball and dislodged, turning it into a lethal missile. Its velocity must have been tremendous, so one would expect it to do a huge amount of damage.
The voltigeur was struck on the right temple, two fingers’ breadth beyond the angle of the orbit and a little above it. The bayonet (which was between 12 and 14 inches long) passed up to the hilt, from the front towards the back, and from above downwards, so as to traverse the maxillary sinus on the opposite side, and projected five inches.
The maxillary sinus is one of the cavities of the skull, beneath the cheekbone. It is also known by the rather more poetic name “antrum of Highmore,” which sounds more like a Scottish aristocrat than an anatomical feature. The bayonet had therefore passed right through the skull, entering the right temple and exiting the left cheek, with no less than five inches of blade visible beyond the exit wound. This situation might be described as less than ideal.
The man was knocked down, but did not lose consciousness. He made several ineffectual efforts to pull the bayonet out, and two comrades, one holding the head, while the other tugged at the weapon, also failed.
After this touching scene, which rather puts me in mind of two hungry birds tugging at the same worm, the soldiers admitted defeat and took their comrade to see the regimental surgeon.
The poor wounded man came to me leaning on the arms of two fellow-soldiers. I endeavoured with the assistance of a soldier to pull out the bayonet, but it seemed to me as if fixed in a wall. The soldier who helped me told the patient to lie down on his side, put his foot on the man’s head, and with both hands heaved out the bayonet; a considerable haemorrhage immediately followed, the blood pouring out violently and abundantly.
A surgical procedure that entails putting your foot on the patient’s head is rarely a subtle one. Nor indeed sensible, in this case: Today a doctor would want to be pretty sure what structures the bayonet had damaged, and where it lay in relation to the blood vessels, before attempting to remove it. But we must make allowances for the exigencies of battlefield medicine.
For the first time Malva felt unwell; I thought he would die, so left him to bandage other casualties. After twenty minutes he revived, saying that he was much better, and I then dressed his wound. We were in the snow, and it was bitterly cold; I wrapped the whole of his head well in charpie and bandages.
Charpie was a material used for surgical dressings, consisting of thin strips of linen unraveled into threads.
He set off for Warsaw with another wounded soldier; he travelled on foot, on horseback, in a cart from barn to barn, and often from wood to wood, and reached Warsaw in six days, having travelled 20 leagues.* I met him again three months later in hospital, perfectly recovered. He had lost his sight on the right side: the eye and lid had retained their form and mobility, but the iris remained much dilated and immovable.
Which is not a bad outcome, if you’ve recently had a bayonet through your head. At this point the soldier Malva drops out of the historical record, although we know plenty more about M. Fardeau. After leaving the army, he returned to his hometown of Saumur and became a celebrated ophthalmic surgeon, tending to the poor and generally living a blameless and philanthropic life. Nobody seems to have had a bad word to say about him; in fact, the only reason Dumas never wrote a book about Urbain-Jean Fardeau may be that he was just too damn nice.
AN INTERESTING AND REMARKABLE ACCIDENT
This is one of those cases that at first reading seems inherently unlikely—but, bizarre as it sounds, has a perfectly rational medical explanation. It took place in the 1830s but was only reported in any detail three-quarters of a century later. This account was written by Dr. Roswell Park, an American pioneer of neurosurgery who also founded the first institution in the world to be dedicated solely to cancer research.* Dr. Park had stumbled across the story a long time earlier, and was so astonished by what he read that he decided to investigate further.
There came into my possession some twenty years ago, perhaps longer, the subjoined statements regarding the nature of a very unusual accident, with still rarer sequels, which befell Dr. James P. White, one of the founders of the Buffalo General Hospital, during the year 1837.
James Platt White was an influential gynecologist, a founding professor of the University of Buffalo and a prominent member of Buffalo society in the mid-nineteenth century. He was the first American medic to conduct obstetric demonstrations with real patients, allowing his students to listen to the fetal heart and examine the birth canal as labor advanced. This practice was already widespread in Europe, but American students were still expected to learn their midwifery from textbooks and mannequins, and his innovation caused great controversy among those who believed such practices indecent.
In December of that year something happened to the stagecoach in which he was riding, near Batavia, and he was violently thrown, and in such a way as to seriously injure his head and neck. I have not been able to learn any of the details either of the event or of his subsequent symptoms.
All we know thus far is that Dr. White injured his head and neck in a stagecoach accident. So far, so unremarkable; and of the next six weeks of his life nothing is known. But after that, something truly extraordinary happened to him: He coughed up part of his own spine.
Well, it’s better than coughing up somebody else’s.
This surprising occurrence was reported in a short statement that appeared in The Medical News in 1886. It was written by Joseph Pancoast, a leading surgeon of the day and therefore (one would hope) a trustworthy source. Dr. Pancoast was happy to confirm that this unlikely incident had taken place, and had even seen the portion of Dr. White’s spine, which he described as
A front segment of the atlas vertebra, a little more than an inch on the superior margin, a little less below, with the facette which received the odontoid process.
The atlas vertebra, also known as C1, is the topmost bone of the spine. It is named after Atlas, the Titan who in Greek mythology supported the sky on his shoulders. It’s a feature of crucial importance since it protects part of the brainstem, which among other things regulates the heart rate and respiration. The mobility of the C1 vertebra also allows us to turn our heads and nod. The odontoid process or peg is a protuberance from C2, the second vertebra of the neck. The facette (now usually spelled facet) is the joint between the two vertebrae.
This chunk of bone was not the entire vertebra but a large portion of it. It seems that Dr. White had retained just enough of the bone to protect a critical part of his spinal cord from potentially fatal injury.
This bone, in possession of Professor Pattison, I repeatedly saw and carefully examined; he exhibited it to his class, and it was mislaid or lost.
What a shame! It would have been quite an artifact.
The bone was in our possession in 1838-39-40, or thereabouts. I then understood and believed (since confirmed by conversation with Professor White) that it came from his throat, coming out through the mouth as a consequence of ulceration; the result of an accident while riding in a stagecoach on the morning of December 17th, 1837. The bone was discharged at the expiration of forty-five days after receipt of the injury.
If there was ulceration at the back of the throat, it must have hurt like hell. There are very few comparable cases on record, but in all of them, the patient had great difficulty eating or drinking, was in severe pain and confined to bed. But who cares about mere agony? Can you imagine anything worse than suddenly “discharging” a large piece of your spine through your mouth? Writing seventy-five years after the nightmarish event, Roswell Park observes:
Of his condition during the forty-five days previous to the extrusion of the fragment there is no account,
neither is there of the time elapsing before his restoration to his usual activity; but inasmuch as he died in 1881, having passed the subsequent part of his life in a most active professional career, it is legitimate to conclude that he suffered little, if at all, from the consequences of his injury.
He didn’t escape its effects entirely: According to one obituary, the loss of his vertebra left him unable to turn his head.
In 2005, this case prompted an article by an eminent orthopedic surgeon working at White’s old hospital in Buffalo, Eugene Mindell. After considering all the available evidence, Mindell concluded that White had suffered an injury known as a Jefferson fracture,* in which the atlas vertebra is shattered by a sharp impact. A few fragments of bone burst through the wall of the pharynx, causing an open wound that resulted in an infection of the exposed portion of vertebra. Eventually, the infection caused necrosis, when the dead portion of bone (known technically as a sequestrum) had come free and been coughed up (yuck). Finally, scar tissue had formed (or the two adjacent vertebrae C1 and C2 fused together) and the wound healed.
Dr. White was so little affected that he was able to return to work and live a normal life for more than thirty years afterward. In 1886, The Medical News described his injury as “an interesting and remarkable accident,” a description that barely does it justice.
THE LUCKY PRUSSIAN
Maximilian Joseph von Chelius was a prominent nineteenth-century German surgeon who had a significant influence right across Europe. His lectures were frequently quoted in the London and Edinburgh journals, and his textbook Handbuch der Chirurgie, translated into English as A System of Surgery, was widely used.
The Mystery of the Exploding Teeth and Other Curiosities From the History of Medicine Page 17
