In a chapter devoted to chest injuries, Chelius gives one particularly unusual case history, which had been sent to him by a friend in London, a Fellow of the Royal College of Surgeons called John Goldwyer Andrews:*
J.T., aged nineteen years, a Prussian sailor, whilst engaged in lowering the trysail-mast, the rope supporting it gave way, and he was transfixed by its bolt to the deck.
On nineteenth-century ships, the trysail was a small sail that was hoisted on a boom attached to the base of the mainmast. In a footnote, Chelius explains that this “trysail-mast” was thirty-five feet long and two feet in circumference, with a five-inch metal bolt at one end.
At the time of the accident the mast had been lowered to within about six feet of the deck; the man raised his arms to lay hold of and guide the bolt into its proper place, when at the moment the suspending rope slipped or broke, and the mast dropping perpendicularly, fell on his chest.
A thirty-five-foot mast of oak or pine would have been a fearsomely heavy object. Oh, and did I mention that it had a five-inch metal spike at the end?
It knocked him down on his back, and the bolt passing through his chest, pinned him to the deck, which it penetrated to the depth of an inch, so that his chest must have been compressed, from before backwards, to a space not exceeding four inches.
Four inches is about ten centimeters. Try to visualize that: The sailor’s chest and its contents were crushed to a fraction of their usual depth.
Some time elapsed before the bolt could be drawn out, and he was then carried to the hospital.
There is no mention of how the bolt was removed—but it was preserved as a curiosity and later put on display in the Hunterian Museum, the anatomical collections of the Royal College of Surgeons.
Feb. 25, 1831: On his admission, 10 am, the countenance was livid, the breathing excessively distressed; small quantities of frothy blood were occasionally spat up, the pulse intermitting; and for some time after his admission, these symptoms increased, threatening almost immediate suffocation.
The “frothy blood” was an indication of bleeding within the lung, which had evidently been punctured by the iron bolt. It goes without saying that this was a life-threatening injury.
The bolt had entered the chest, between the fourth and fifth ribs of the left side, about an inch and a half from the middle of the breast-bone, passed obliquely downwards and outwards, and came out between the eleventh and twelfth ribs, four inches from the left side of the spine.
The chest was, the surgeon noted, “flattened” on one side, and damage to the rib cage had left the heart dangerously vulnerable. But this was not all:
In addition to this hurt, the scalp on the right side was considerably lacerated, extending from the frontal to the lower part of the occipital bone, and exposing a great part of the temporal muscle. The lower jaw was also badly fractured.
The head wound, which was significant but not life-threatening, could be cleaned and bandaged, but in the 1830s, there was virtually nothing a surgeon could do for such a serious chest injury, except wait and hope that it was survivable.
A pledget* of lint was applied over the wound, and fastened with adhesive straps, but nothing more was done, and two hours after his admission the more urgent symptoms of suffocation had subsided, and he rallied a little.
The sailor passed a restless night, but to his doctors’ relief, he was still alive the next morning. The therapeutic regime they adopted was orthodox for the time: It involved frequent applications of leeches, laxatives to purge the bowels and a bland diet of milk, arrowroot and powdered biscuits. Opium was frequently administered to ease his pain. His recovery was slow, but a month after the accident, he was reported to be doing well and living on blancmange and coffee. By the end of April, he was also “allowed table-beer and half a chicken daily,” which sounds rather more appetizing. On May 25—some three months after the accident—he was finally convalescent, and well enough to leave the hospital.
This case also appears in a book by George Guthrie, a British surgeon who was one of Europe’s leading experts on chest injuries. In his monograph On Wounds and Injuries of the Chest (1848), Guthrie records his amazement that the patient’s symptoms had been so mild:
The quantity of blood spat up did not exceed that commonly coughed up in broken ribs. The discharge of pus from the wounds, till they had healed, was very trifling. The pulsation of the heart was very violent, distinctly raising the bedclothes. He lost about eighty ounces of blood from the arm, and had three hundred leeches applied at different times.
The amount of blood (slightly more than four pints) taken directly from his veins is nothing too dramatic over the course of three months, but three hundred leeches must have added considerably to this total. The loss of so much of the red stuff cannot have done much for his complexion.
Ten years after the accident, Mr. Guthrie was invited to examine the patient for himself.
He was in good health; the breathing of the side injured good; the action of the heart violent, but not irregular. The depression made by the bolt and its cicatrix* was so directly over the great vessels, that it must have passed between them, pushing them aside, constituting altogether one of the most remarkable cases on record.
Now, that really is extraordinary. The great vessels are the aorta and pulmonary artery, which are so closely entwined just above the heart that it’s barely possible to get a cigarette paper between them, let alone a metal bolt.
It was owing perhaps to the end of the bolt being blunt, and the great force, from the weight of the yard with which it was driven through, that the lung was but little injured.
Guthrie’s suggestion seems quite sensible. His point is that when the human body is impaled, a blunt object sometimes does less damage than a sharp one, because rather than pierce the internal organs, it simply pushes them aside. Guthrie was speaking from experience—and he had made a careful study of similar injuries that seemed to bear out this theory.
But what of this patient’s later career? After being pinned to the deck of a ship, you’d think he might have tried something less dangerous. But not a bit of it.
He recovered his health perfectly; first went into service as a footman, but returned to the sea, and was twice shipwrecked, and saved his life by swimming a considerable distance. In 1841 he was well, and went on a voyage to the West Indies.
At least nobody could accuse him of being risk-averse.
A CASE FOR DR. COFFIN
In 1837, a teenager from Gaspé in eastern Canada tripped in his parents’ lawn and fell on a tool he was carrying. There was no great drama: The wound didn’t bleed much, and after some basic first aid administered by his brother, he was able to walk back home for dinner.
It doesn’t sound like much of a story—except that the tool was a scythe, and it went in one side of the boy’s chest and out the other. It caused a great sensation on both sides of the Atlantic when the details were first published some twelve years later, in a short-lived Canadian periodical, The British American Journal of Medical and Physical Science.* The tale sounded so fantastic that the editor agreed to print it only after receiving evidence from three reliable witnesses, two of them doctors.
The first on the scene, however, was not a medical man but a local justice of the peace, J. D. McConnell:
In the year 1837 Master James Boyle, a youth of about 18 years of age, had been mowing the lawn in the vicinity of his father’s house, in company with his younger brother, and as is the custom, before going to dinner, he had taken the scythe off the snaith or handle, for the purpose of carrying it, in order to have it sharpened. As he walked homewards, a distance of about a few hundred yards, he happened to step on a log of wood, when his foot slipped and he fell upon the scythe blade, which entered his chest under the right armpit and the point appeared under the left. The hapless youth lay still with the deadly instrument in his breast until his br
other, who displayed inimitable presence of mind, drew it slowly out, observing with much caution, as he did so, the curvature of the blade. The effusion of blood which followed was not so great as might have been expected, and with his brother’s aid he walked home.
The family would have preferred to summon a doctor, but in Gaspé, a tiny and remote coastal community at the easternmost tip of Quebec, that was not an option. A footnote explains:
There was no medical man resident in that vicinity when this occurrence took place. Frederick Coffin, a whaler, commonly called “Dr. Coffin” . . .
A name that cannot have filled his patients with confidence.
. . . who generally lends a hand at bleeding, drawing teeth, and other similar services, has been very successful in his attempts at relieving the distressed. Under his care, the youth continued slowly to improve.
A couple of days after the accident, a Royal Navy ship, HMS Sappho, happened to drop anchor in Gaspé Bay. A stroke of luck, for on board were no fewer than three medics.
I lost no time in making the case known to the surgeon of the ship, Mr. Thomson, who directed assistant surgeon Sproule to examine the patient, and to render any assistance that might be practicable, which that gentleman immediately did. I remember his remarking that the absence of bloody expectoration was a favourable symptom.
Coughing up blood would have suggested an injury to the lung, an eventuality the boy seems to have escaped.
As the accident and its unexpected results appeared to me an inscrutable act of Providence, I deemed it desirable that Dr. Sproule should communicate to me by letter his opinion of the case.
The naval surgeon found that the point of the scythe had entered the boy’s armpit, making a wound about 3 inches (7.5 cm) long between the third and fourth ribs on his right side. It had then passed horizontally through the chest before emerging at the same point on his left side. Dr. Sproule was mightily impressed:
Considering the situation of the wound, and the instrument by which it was made, I consider it a most miraculous escape, which I can only account for by saying that the back of the blade was directed towards the large blood vessels, and thereby protected them. Had the edge been otherwise directed, I have no doubt but that the consequences would have been immediately fatal.
Miraculous is not too strong a word. The symptoms were so mild that the scythe must somehow have avoided the major organs. Even so, it seems unlikely that a blade taking that course through the chest could have missed the pleura, the sac around the lungs. The author of the report, Dr. Sewell, suggests that the boy suffered a collapsed lung as air rushed into the thorax through the wound—but the puncture was so small that when the blade was removed, it sealed spontaneously, allowing the lung to reinflate. Whether or not this was precisely what happened, there’s no doubt that he was very lucky.
It only remains to add, that Master James Boyle is, at present, a robust and vigorous man, and without any local complaint. His pursuit is chiefly that of his father, a whaler, and his domicile is up the south-west branch of Gaspé Bay, in the district of Gaspé, Lower Canada.
A rare example of a Coffin saving a patient from an early grave.
THE HEALING POWER OF NATURE
At the annual meeting of the Provincial Medical and Surgical Association in August 1844, a doctor from Newport Pagnell in Buckinghamshire, Edward Daniell, presented this unusual case. He prefaced his account with the observation that it would “perhaps be interesting more from its novelty than for its value in a surgical point of view.” He wasn’t just being modest: As it turns out, his involvement in the proceedings was virtually nil.
John Smith, a fisherman, aged about 25 years, went out on a Sunday morning in the winter of 1837 with two companions. One of these persons possessed a gun, which was so constructed that it could be taken to pieces and stowed in the pocket. I am not prepared to say whether these gentlemen designed a trespass on the game-laws, or whether their predatory excursions had only reference to those minor bipeds, which the legislature have considered too insignificant for their especial protection.
The “minor bipeds” alluded to by Mr. Daniell were any birds not covered by the Game Act of 1831, which made it illegal to shoot grouse, pheasant, partridge or wild chicken without a license. Theoretically, John Smith could have been shooting any other edible species such as pigeon, duck or even rooks quite legitimately—but even then, he would have needed the permission of the landowner.
I opine, however, that any wild animal capable of yielding a Sunday’s dinner would have been in great jeopardy had it been luckless enough to cross their path at that time.
Only professional etiquette prevents Mr. Daniell from calling his patient what he surely was: a poacher.
Certain it is they themselves felt that their pursuit was lawless, for they hastily took their weapon to pieces, on observing the owner of the fields approaching them. In re-adjusting it a second time the stock was not in perfect apposition, and the wiseacre* whose business it was to render the weapon fireworthy, observing this defect, sought to remedy it by striking the butt end sharply upon the ground. The result may be anticipated, for the gun went off, lodging its contents in the body of John Smith, who stood about three yards from its muzzle.
No doubt, many landowners of the time, confronted with a seriously injured poacher, would not have been in any hurry to get them a surgeon; thankfully, this time nobler sentiments prevailed.
I was sent for immediately, and arrived just as the poor fellow was brought home. The contents of the gun had entered about half an inch below the navel, on the right side, and had passed out about two inches above the hip, and three from the vertebral column; the distance from wound to wound was about six inches.
Mr. Daniell was not sure at first whether the shot had passed straight through the body; it was possible, he thought, that it had been deflected by the abdominal muscles and thus avoided the major organs. But on reflection, he ruled out this idea as implausible.
Under the circumstances, I thought it right to give a very unfavourable prognosis, and the family of the poor man were prepared for a fatal issue. The ignited wadding or cartridge passed through the wound unextinguished, and set fire to the shirt, opposite the posterior opening.
Imagine that: He was shot in the stomach, but it was the shirt covering his back that caught fire. The surgeon was not sure what to do but eventually decided that caution was the better part of valor.
There was neither probing nor poking, no endeavours to remove extraneous substances. Nature was left to her own operations, and nature did her business, far better than we, her assistants, could.
Certainly not the way such a wound would be approached today; but in the 1830s, when surgery was basic and infection a constant threat, probably quite sensible.
The wounds progressed properly, portions of garment, and other extraneous matter, passed out at the posterior opening, and about 40 shot passed with them. There still remain under the integuments perhaps 15 or 20 of the shot, but he suffers no inconvenience from them, and is scarcely aware of their existence. The man continues in excellent health.
The surgeon concludes his report with an observation more philosophical than medical.
There is one practical inference which I think may be drawn from this case, and that is, in deep and dangerous injuries, where vital parts may be involved in the mischief, the less we interfere with the processes of nature the better, and I am convinced that much evil is often inflicted by our readiness to anticipate the beautiful workings of the vis medicatrix naturae.
Vis medicatrix naturae is usually translated as “the healing power of nature”—a Latin rendering of a phrase often attributed to Hippocrates, and expressing a sentiment that underlies much of the great Greek physician’s doctrine. The idea that the medic should place their faith in the power of the human body to overcome disease and injury, only intervening when absolutely neces
sary, remained a central tenet of medical thought for centuries. Mr. Daniell clearly thought that some of his colleagues were too ready to perform a heroic operation when watching and waiting was the better option. He may have been right.
SEVERED, REPLACED, REUNITED
Brain injuries were a topic of particular fascination to nineteenth-century medics. In the 1820s, a major debate about the workings of the organ had erupted between two eminent physiologists based in Paris. Franz Joseph Gall believed that functions were highly localized within the brain, so that discrete regions were responsible for sensation, motor functions and even different emotions.* His younger rival Marie-Jean-Pierre Flourens disputed this theory, arguing that his own animal experiments showed that the brain operated as an “indivisible whole.” While such research provided some interesting results, it was often cruel—and of questionable utility since nobody knew whether the results were applicable to humans.
Cases of recovery from major trauma to the brain were therefore of great empirical value, as well as being diverting curiosities. By correlating the location of the injured tissue with any mental or physical impairment observed in the patient, physicians hoped to learn more about the function of the brain. In the summer of 1852, The New Jersey Medical Reporter printed one particularly striking story, described by its author as “a case of recovery after a portion of the brain had been severed from the cerebral mass, replaced, and apparently reunited.”
The wound was made by a sharp axe, which, in the hands of a strong and angry man, was driven with such force as to make a section of the skull, cutting off a portion of the brain which remained in its situation in the severed portion of the skull, hanging down on the shoulder, attached by a strip of integuments to the neck.
The Mystery of the Exploding Teeth and Other Curiosities From the History of Medicine Page 18
