In the annals of early surgery, there is virtually nothing to match this operation for complexity and sheer jeopardy. In an age before X-rays, finding a small foreign body that might be virtually anywhere in the chest cavity, without killing the patient, was a truly herculean task.
No one can have any just conception of the degree of patience required to do what was done, save the one who did it. This is not spoken boastingly, but it is simply the truth. It is sufficient to say that a general exploration of that side of the chest was made, and then it was taken by sections, occasionally passing through holes in the pleura, which latter appeared to have scarcely no normal relations to the surrounding structures, touching by lines the entire surface of the parts, and at last the sound appeared to encounter something of a metallic nature beneath the heart, but the pulsations of that organ were so strong against the instrument as to render it difficult to settle the matter definitely.
This is phenomenal stuff. Dr. Cooper was performing delicate manipulations, around a beating heart, that would not become a normal part of surgical practice for many decades.
At last, however, it became evident that the location of the iron was found, and I endeavored to move it out of its position with the point of the sound, in order to get it into a place more eligible for extraction by the forceps. I failed in this, and in manoeuvring the instrument finally lost the track by which the sound had first passed back of the heart to the metal, and it was during my efforts to recover this, and which was accomplished with the more difficulty owing to some membranes falling in the way, that I discovered the sound had in the first instance reached the metal by passing between the descending aorta and the apex of the heart.
Terrifying! Unknown to the surgeon, he had stuck his probe through the minute aperture between the largest blood vessel in the body and the heart itself. One slip and it was curtains for the patient. Dr. Cooper now tried to extract the metal object, but repeatedly failed to grab hold of it. Every instrument his assistant handed him was as ineffective as the last, until with a flash of inspiration he remembered the forceps in his pocket. They were precisely what he needed.
The metal being again found, the sound was steadily and strongly held in contact with it until a pair of long lithotomy forceps was thereby conducted to the spot and the breech-pin seized and extracted, which, however, was the work of several minutes, owing to the great difficulty in grasping it even after the forceps was made to touch it.
At last! It’s exhausting just reading this; imagine how the patient felt. His protracted ordeal at an end, the wound was now dressed and he was taken back to a ward to rest. His recovery was long and arduous, but in early August, his condition was reported as follows:
The external wound has entirely cicatrized.* No cough nor pain in the left side—good appetite and all the functions of the system well performed. The left breast is somewhat sunken, but the upper lobe of that lung has recovered in a great degree its former action.
The left lung was almost destroyed by the injury and subsequent infection, so this represents an impressive recovery. Dr. Cooper ends his report with an endorsement of the California lifestyle so enthusiastic that the San Francisco tourist board might have used it on their advertisements:
His subsequent astonishing recovery is attributed to his great cheerfulness, good constitution, and to the effects of our unparalleled climate, in which it appears nearly impossible for a patient to die with almost any ordinary degree of injury, provided a reasonable share of attention is afterwards given him.
His recovery was indeed nothing short of astounding. Five years later it was reported that
He has since walked across the plains with a drove of cattle;—got married, and has a family.
Somehow, I doubt he dared hope for such a thing as he lay there awake on the operating table, with a surgeon holding his beating heart.
5
REMARKABLE RECOVERIES
THE HUNTERIAN MUSEUM of the Royal College of Surgeons in London is one of the world’s great medical collections, a cathedral of glass jars containing organs and exotic species preserved in formaldehyde. It was founded in 1799 when the British government bought more than fifteen thousand anatomical specimens amassed by the celebrated surgeon John Hunter, who had died six years earlier, and has since been augmented by numerous curiosities, paintings and surgical instruments. In May 1941, a German incendiary bomb fell on the building, destroying the bulk of Hunter’s original collection and some of the museum’s most prized specimens. One of the artifacts lost forever that night was a partial human skeleton that in the nineteenth century had shared a pedestal with an ex-elephant. The bones were those of the late Thomas Tipple, who in his day had been something of a medical celebrity.
On the evening of June 13, 1812, Tipple went to see a friend in Stratford, a short distance east of London. He traveled in a gig, a light two-wheeled carriage pulled by a single horse. When he arrived, no groom was available to help him, so Tipple decided to unharness the animal himself. He had got no further than taking off the bridle before the horse started forward unexpectedly, driving one of the shafts of the vehicle straight through the left side of Tipple’s chest. Such was the force involved that it emerged underneath his right armpit, pinning the unfortunate Tipple to the stable wall like an insect in a Victorian entomologist’s collection. The first people on the scene found him still conscious, and he was able to help them remove the large wooden shaft that had completely impaled him.
To general amazement, Tipple walked up two flights of stairs unaided, and took off his own vest before going to bed. He survived for another eleven years, despite receiving the minimum of medical attention, which consisted mainly of having three pints of blood evacuated from an arm.* When he died in 1823, a postmortem established that the iron-tipped shaft had broken several of his ribs, almost certainly puncturing a lung in the process.
For much of the nineteenth century, the miraculous survival of Thomas Tipple was cited as an example of the astonishing resilience of the human frame. Life may be fragile, but there are plenty of tales from medical history that demonstrate that we can sometimes overcome even the most formidable injury. Many of these recoveries were attributable to the devotion or ingenuity of a conscientious doctor; some patients, however, may have got better despite, rather than thanks to, any treatment they received. Medicine is a field in which it is notoriously difficult to make a meaningful connection between cause and effect—a fact that has emboldened countless charlatans to make outrageous claims about the supposed efficacy of their particular brand of snake oil. One nineteenth-century doctor claimed that his patient’s paralysis had disappeared when the ship he was traveling on was struck by lightning, while another reported that a train crash had cured one passenger of rheumatic fever. While such case reports may not be quite as compelling an advertisement for the wonders of medicine as their authors assumed, they are often a powerful affirmation of the human spirit.
THE WANDERING MUSKET BALL
Robert Fielding, the son of a Gloucestershire clergyman, was twenty-two and had just graduated from Oxford when the English Civil War began in 1642. A passionate Royalist, he joined the king’s army and on September 20, 1643, took part in the First Battle of Newbury, at which Charles was defeated by the Parliamentarians. As well as being on the losing side, Fielding was seriously wounded, and for a time his survival seemed unlikely. Against the odds, he was able to resume his academic career at Oxford, at least until the victorious Roundheads ejected him from his college fellowship three years later. He was, however, readmitted as a student to study medicine, and in middle age became a prominent and much-loved physician in Gloucester, even being elected the city’s mayor in 1670.
That he achieved any of this is pretty impressive, because he did so with a large slug of metal inside his head. In 1708, the Philosophical Transactions printed Dr. Fielding’s own account of the battlefield injury that put it there.
/> At the first Newberry fight, in the time of the late Civil Wars, the doctor was shot by the right eye on the os petrosum* by the orbit of the eye to the skull, which was likewise broke, with great effusion of blood from the wound, mouth and nostrils. The surgeon carefully probing the wound for the discovery of the bullet, but failing of his intention, on the third day after the shot placed him horizontal to the sun; by which means depressing the broken skull with the probe, he could feel the palpitation of the brain, but could not discover the bullet.
It’s no exaggeration to describe this procedure as brain surgery—not much fun under battlefield conditions. For some time afterward, fragments of bone continued to emerge from various orifices, an event always preceded by an odd symptom: His jaw became locked shut.
When the doctor began to grow cold, his mouth closed up, and so continued for the space of half a year till many fractures of bones were come out of the wound, mouth and nostrils.
Bone fragments started to appear with horrific regularity. On the plus side, he now had a startling new party trick:
Afterwards, whensoever a scale of bone was to come out his mouth would close, insomuch that several years afterwards he prognosticated to some friends that a bone was then coming out, which continued so for six or seven weeks, at which time finding an itching in the orifice of the wound, with his finger he felt a bone, upon which he made known to some friends then present, that they should see him open his mouth, and taking out a bone no bigger than a pin’s head, he immediately opened his mouth.
Why was the doctor unable to open his mouth, and why did removing a bone fragment relieve the condition? It seems likely that the wound was near the mandibular nerve, which controls the four muscles responsible for biting and chewing. If a splinter of bone was pressing on this nerve, it could cause temporary paralysis, relieved only once the pressure had been removed. A year after the original injury, the wound finally healed. But there was still no sign of the musket ball—much to Dr. Fielding’s chagrin.
After this, for the space of ten years, or more, a flux of sanious matter issued out of the right nostril, and then ceasing there, it flowed from the left nostril for some years.
Sanious describes a thin watery liquid. This seems likely to have been cerebrospinal fluid (CSF)—the liquid that cushions the brain against injury. CSF leaks are often the consequence of an injury to the dura, the membrane surrounding the brain.
At length, for the space of two years, or thereabouts, upon riding, the doctor would sometimes find a pain on the left side about the almonds of the ear, which he attributed to cold, but more especially after riding in a cold dark night, which occasioned a kind of deafness too.
The “almonds of the ear” are the tonsils—the name by which they were known to non-medics in the seventeenth century.
And having stopped his ear with wool to recover his hearing, one day, either writing or reading, suddenly an huff* came in the ear, which made him start, and in the manner not to be expressed, unless you can imagine a vacuum; this happened about March or April 1670. Upon this all that side of the cheek hung loose as though paralytic, and under the ear might be felt a hard knob.
Though the facial paralysis sounds a bit like a stroke, it was probably something more benign. The compression of another nerve* by a bone fragment (or by the elusive musket ball) would cause similar symptoms.
After this, tumour upon tumour appeared on that side under the jawbone, which occasioned his consulting some physicians, two at one time, one of which suspected the bullet, which, considering the shot, they thought not credible. At length the tumours coming to the throat, if he held up his head a little, it seemed as if one with a hook did pull down the jawbone; and if anything touched the throat, it was as painful as if pricked with a handful of needles; being at last persuaded to make some applications, a small hole appeared, after that another, and a third part near the pomum adami;* by these the bullet was discovered, and cut out in August 1672.
Amazing. Dr. Fielding had been shot almost thirty years earlier, and it took all this time for the musket ball to migrate—somehow—from the upper part of his skull to his throat, where it was finally extracted. Miraculously, he seems not to have been even slightly impaired by the presence of this piece of lead in his skull, and was still well enough to write about it more than six decades after the original injury.
THE MILLER’S TALE
The Isle of Dogs, a large peninsula on the north bank of the Thames, is an area of London not generally known for its bucolic charm. The skyscrapers of Canary Wharf house one of Europe’s largest financial centers, while remnants of the heavy industry that once supported the local economy still peek out from between expensive apartment blocks. But until the late eighteenth century, the area was sparsely populated farmland, the only significant buildings a line of windmills built on the western flood defenses* to take advantage of the stiff breezes coming off the river.
In 1737, a worker at one of these mills had an accident so astounding that he became a local celebrity. Prints of Samuel Wood’s likeness were sold in taverns and bookshops, and his case was still being quoted in scientific journals well over a century later. The surgeon who treated him, John Belchier, described what had happened to his famous patient at a meeting of the Royal Society a few months later:
Samuel Wood, about 26 years of age, being at work in one of the mills near the Isle of Dogs, over-against* Deptford, and going to fetch a sack of corn from the farther part of the mill in order to convey it up into the hopper, carelessly took with him a rope, at the end of which was a slipknot which he had put round his wrist; and passing by one of the large wheels, the cogs of it caught hold of the rope, and he not being able to disengage his hand instantly, was drawn towards the wheel and raised off the ground, till his body being checked by the beam which supports the axis of the wheel, his arm with the shoulder-blade was separated from it.
Sounds excruciating. At least, that’s what you’d think.
At the time the accident happened, he says he was not sensible of any pain, but only felt a tingling about the wound, and being a good deal surprised, did not know that his arm was torn off till he saw it in the wheel.
Put yourself in Samuel Wood’s shoes for a minute: Imagine spying an arm stuck in a piece of machinery and only then realizing that it is yours.
When he was a little recovered, he came down a narrow ladder to the first floor of the mill, where his brother was, who seeing his condition, ran downstairs immediately out of the mill to a house adjacent to the next mill, which is about a hundred yards distant from the place where the accident happened, and alarmed the inhabitants with what had happened to his brother; but before they could get out of the house to his assistance, the poor man had walked by himself to within about ten yards of the house, where, being quite spent by the great effusion of blood, he fainted away and lay on the ground; they immediately took him up, and carried him into the house, and strewed a large quantity of loaf-sugar powdered into the wound in order to stop the blood till they could have the assistance of a surgeon, whom they sent instantly for to Limehouse.
Sugar was generally sold in conical loaves in the eighteenth century and would have to be broken down and powdered by hand before use. It may seem strange to put it on a wound, but it was often used in such scenarios, and is still a common remedy in many developing countries. There has even been some recent interest in the use of sugar as a possible antimicrobial agent in the management of wounds.
But the messenger being very much frighted, could not give the surgeon a clear idea of the accident, so that when he came to see the condition the man was in, he had no dressings with him for an accident of that kind; but had brought with him an apparatus for a broken arm, which he understood by what he could learn from the messenger to be the case.
Equipment that was certainly inadequate for the task in hand.
However, he sent home for proper dressings, a
nd when he came to examine particularly into the wound, in order to secure the large blood vessels, there was not the least appearance of any, nor any effusion of blood; so having first brought the fleshy parts of the wound as near together as he could by means of a needle and ligature, he dressed him up with a warm digestive,* and applied a proper bandage.
The next morning, the surgeon checked the wound for bleeding, and was surprised to find none. After changing the dressing, he sent Samuel Wood to St. Thomas’s Hospital so that he could be kept under close observation, in the care of a surgeon called James Ferne.
He was constantly attended, in expectation of a haemorrhage of blood from the subclavian artery; but there being no appearance of fresh bleeding, it was not thought proper to remove the dressings during the space of four days, when Mr Ferne opened the wound, at which time likewise there was not the least appearance of any blood vessels; so he dressed him up again, and in about two months’ time the cure was entirely completed.
The accidental amputation was evidently a neat job, leaving plenty of skin and muscle to heal over the wound. When they examined the severed limb, the doctors found the shoulder blade and both bones of the forearm had been broken . . .
. . . but whether these bones were fractured before the arm was torn off, the man cannot possibly judge.
The poor man had had his arm and shoulder blade ripped off by industrial machinery. It seems fairly safe to assume that the triple fracture in that arm was caused by the accident rather than being a freak coincidence.
But why hadn’t he bled to death? A major blood vessel, the subclavian artery, had been severed as a result of the injury. In normal circumstances, this would have produced copious bleeding, perhaps enough to kill him in under an hour. But somehow this had not happened. The surgeon concluded that the tissues around the artery had compressed it, acting as a tourniquet and preventing any loss of blood.
The Mystery of the Exploding Teeth and Other Curiosities From the History of Medicine Page 16