Dr. Mortimer Brown gives no details of the events leading up to this crisis, but the phrase “a strong and angry man” hints at fierce passions and operatic drama. To “make a section” is a surgical term meaning to cut or divide: The enraged axman had lopped off a sizable chunk at the top and back of the victim’s skull, which remained attached only by the soft tissues. The part of the brain affected was probably the posterior parietal cortex, which deals primarily with movement and spatial awareness.
The man was able, after the injury, to walk some rods with assistance, and talked in a rational manner by the way. Securing the occipital artery,* which had been divided, removing some small fragments of bone, shaving around and thoroughly cleansing the wound, I restored the flap of integuments, with the portion of skull and brain, to its proper position, and secured them by stitches, adhesive plaster, and a roller.
It doesn’t sound like much, but it was probably the best that could have been done for the patient at this date. There was a grave danger of infection, given the nature of the wound.
The head was kept elevated and cool, a light diet enjoined, and a solution of sulphate of magnesia, and tartrate of antimony and potassa, given to move the bowels, reduce the circulation, and restrain the appetite.
A mid-nineteenth-century doctor rarely lost an opportunity to get his laxatives out—whether or not the malady had anything to do with the bowels. But maybe they weren’t such a bad idea, given the man’s subsequent rapid recovery.
The mental faculties remained unimpaired, except for a short time on the second day; the wound healed rapidly, being entirely closed in a week, no unpleasant symptoms afterwards occurred, and on a subsequent examination the severed portion appeared to be firmly united to the cranium, no motion being perceptible on firm pressure, and no inconvenience being felt when galloping on horseback.
I love that last observation: Apparently, the patient was worried that he’d be able to hear bits of his brain rattling around inside his skull during vigorous activity.
There was no evidence in the dressings of the discharge of any portion of the brain, and, in all probability, the severed portions reunited without loss of substance. The case was watched with some interest to mark the development of any peculiar mental phenomena, but nothing occurred worthy of note.
But was brain matter really severed, replaced and reunited, as the author claims? Unlikely. While the body does an extraordinary job of repairing wounds to the skin, muscle and even bone, it cannot regenerate brain tissue damaged or lost by injury—at least, not in any great quantity. It’s far more probable that the affected tissue simply died and was reabsorbed. The fact that this took place without the patient suffering any appreciable neurological impairment is pretty unusual—even if the brain didn’t glue itself back together, it’s still an impressive recovery from an ax to the skull. But I still wish I knew what had aroused the ire of the “strong and angry man” who was wielding it.
GIVE THAT MAN A MEDAL
In 1862, a French army deserter named Jacques Roellinger emigrated (or rather fled) to the United States, where he promptly volunteered to fight in the Civil War. He joined a New York regiment on the Union side, an irregular outfit known as the Enfants Perdus (“Lost Children”) consisting largely of French soldiers, with a sprinkling of Italians, Spaniards and Portuguese. This motley gathering of nationalities proved so unruly that its commanding officer once threatened to place the entire regiment under arrest for insubordination. The ill-disciplined Enfants Perdus were treated with scorn by most of their American comrades, but they played a full part in the war. In the case of Jacques Roellinger, a very full part indeed, as an article published in the Medical Record in 1875 makes abundantly clear:
On June 29, 1865, Roellinger asked to be released from military service. When he appeared before an army board to make his case for a pension, he told the officers that shortly after joining up, he had been present at the evacuation of Yorktown. His platoon had been ambushed and he had been injured. At the medical officer’s request, he showed the panel his scars. The doctor noted that he had been disfigured
(1) by a sabre cut, leaving a long scar, which crossed the quadriceps extensor of the left thigh in its middle third. It appeared to have divided the tendinous and a portion of the muscular structures.
(2) by a sabre thrust, which passed between the bones in the middle third of the right forearm.
Roellinger explained that these wounds had healed fairly quickly, and he was able to resume active service at Williamsburg a few months later. Luck was not with him, however, because he was then
(3) shot in the right thigh, the ball passing through the middle third, just external to the femur.
(4) At the assault on Port Wagner, in Charleston Harbor, July 10th, 1863, he received a sword cut across the spinal muscles covering the lower dorsal vertebrae.
While convalescing from this unfortunate turn of events, he traveled to visit his brother in southwestern Missouri. This “holiday” did not go well: He was captured by guerrillas and tortured “in Indian fashion.” Injuries inflicted on him included
(5) Two broad and contracted cicatrices* he declared were the marks left by burning splinters of wood, which were held upon the surface of the right anterior portion of the thorax.
Undaunted, he managed to escape from his captors, and—clearly a glutton for punishment—was reunited with his comrades-in-arms. On February 20, 1864, he was present at the Battle of Olustee in Florida. His luck had not improved:
(6) a fragment of an exploding shell passed from without inward beneath the hamstrings of the right thigh, and remained embedded in the ligamentous tissues about the internal condyle* of the femur.
The medical officer examined the joint and could feel the shrapnel fragment still lodged in the soft tissue. Roellinger explained that he had fallen on the battlefield but was left alone by the enemy. Expecting another assault, he managed to pull himself up into a tree using some trailing vines. A renewed attack duly came; he was spotted and shot.
(7) The ball entered between the sixth and seventh ribs on the left side, just beneath the apex of the heart, and issued on the right side, posteriorly, near the angle of the ninth rib, traversing a portion of both lungs. Profuse hemorrhage from the mouth followed, and from the wound also, and, fearing that he must soon faint and fall, he slid down from his elevated position to the ground beneath.
By happy chance, he explained, he had been a professional acrobat before entering the army, which helped him to do so without (further) injury. Seeing the enemy in retreat, he took a few potshots at them in revenge. This was most unwise, for they ran back and bayoneted him through the body. The weapon
(8) passed through the left lobe of the liver, and lacerated the posterior border of the diaphragm!
Hoping to finish him off, his assailants then shot him again. The pistol ball
(9) entered on the level of the angle of the left lower jaw, through the border of the sterno-cleido-mastoid muscle, and issued at the corresponding point on the other side of the neck. He added that during his convalescence he used to amuse the company by drinking and projecting the fluid in a stream from either side of his neck, by simple muscular effort.
The medical officer remarked in his notes that even after this terrible experience, the soldier lived “most inexcusably,” and
at some time, I cannot say whether before or after, acquired the further following embellishments, viz.:
(10) The scar of a sabre thrust passing between radius and ulna, just below left elbow.
(11) A pistol shot, passing diagonally outward and upward through the pectorales major and deltoid of left side; and
(12) a deep cut dividing the commissure of the left thumb and forefinger down to the carpal bones.
Astonishingly, there were no ill effects from this long list of injuries except a stiff knee. The soldier was granted his request and g
iven an honorable discharge. But what was he intending to do in retirement? Go fishing? Open a bar? Nope:
When the catalogue was ended this surgical museum politely apologized for his haste, saying that he was on his way to the steamer, intending to join Garibaldi’s army, at that time campaigning in the Valtelline.
The brave Roellinger was duly awarded his pension. But there’s one more twist to this extraordinary tale. It may seem odd that a French army deserter would want to fight for Garibaldi in the mountains of northern Italy, and indeed it soon emerged that he wasn’t French, and his name wasn’t Roellinger. On the day that he applied for his pension, the man calling himself Roellinger visited another claim office and filed a second application, this time in the name of Frederick Guscetti. He would have got away with this attempted fraud were it not for a chance encounter between the two agents who had dealt with him. The authorities were notified, and “Guscetti” was arrested and sentenced to seven years in the notorious Sing Sing prison.
Except that his name wasn’t Guscetti either. It was common practice in some Civil War regiments to assume the identity of a dead comrade, in the hope of landing an extra pension. The real Frederick Guscetti had feigned death in a failed attempt to escape a prisoner-of-war camp but was very much alive and working as a civil engineer. The serial imposter was finally unmasked as another Italian, a man called Giusetto, whose greed apparently outweighed his intelligence.
But what of the genuine Jacques Roellinger, the original victim of this elaborate identity theft? He, too, was still alive and now living in Ohio, having deserted his New York regiment after only a few days of service. In fact, the one thing incontestably true about Roellinger/Guscetti/Giusetto’s story was his improbable litany of injuries.
A BIT OF A HEADACHE
One of the things that all first-aiders should know is that blades or other penetrating objects should never be removed from a stab wound. Extraction should be attempted only by medical professionals in appropriate surroundings, since the foreign object may be acting as a barrier to further blood loss, and removing it may provoke a fatal hemorrhage.
Those with a background in emergency medicine would doubtless wince at the treatment given to a patient in France in 1881—which somehow he survived.
On April 8th a man had an argument with his wife on the subject of rent money, which he could not give her. Overwhelmed by her abuse, he wanted to end his life. Taking a small dagger ten centimetres in length, he placed it vertically on the top of his head, and with the help of a hammer drove it up to the hilt.
Not only a strange choice of method but a horribly awkward one to execute.
Having done this he was no better off than before. Not only had it not brought him any money, but it had failed to end his life, and he felt nothing. He still had his intellect, his senses and movement. Deeply embarrassed at having positioned his dagger so badly, he had to call the doctor, who attempted to remove the knife from the skull; but all his efforts were fruitless.
What can have been the feelings of this local practitioner, confronted with a patient who was walking and talking despite ten centimeters of cold steel buried deep in his brain? Sensibly, the local doctor called an eminent hospital physician, Dr. Dubrisay. The two medics together attempted a grotesque tug-of-war, with one of them holding the man’s feet and the other the dagger. Then they tried a different approach by both lifting the dagger by its handle but succeeded only in suspending the patient in midair. At their wits’ end, they took the man—who was still conscious and apparently not in any discomfort—to a workshop that owned a steam engine:
He was placed on the ground, seated and held in place, between two beams, in the middle of which was a strong pair of iron pincers moved by mechanical force. The dagger blade was seized and pulled without any sudden jerks and extracted, raising the patient slightly, who fell back upon the ground. He immediately got up and walked, accompanied M. Dubrisay to his carriage and thanked him.
The blade of the dagger was found to be slightly bent, suggesting that it had passed right through the brain and come into contact with the inside of the skull on the other side. The doctors were worried that their patient would develop an infection from the effects of this dirty foreign object:
Fearing the appearance of the symptoms of meningitis, the patient was taken to the St Louis Hospital under the care of M. Pean; but he left after eight days, without developing any signs of inflammation or of paralysis.
But, one hopes, having learned a valuable lesson.
6
TALL TALES
WHEN MEDICAL ESSAYS and Observations, the first English-language medical journal, was founded in 1733, its editor Alexander Monro (primus)* remarked that to write properly on such a technical subject, an author needed four essential qualities: sagacity and knowledge (“to guard against errors and mistakes in the names and natures of things”); accuracy (“to omit no essential circumstance”); and candor (“to conceal nothing material”). To ensure that the articles he published were rigorous and correct, they were first sent to an expert for evaluation—they were peer-reviewed, in fact, just as scientific papers are today.
While most editors had noble aspirations to print nothing but the unvarnished truth, their journals sometimes strayed into the realms of fiction. Until the late nineteenth century, they relied heavily on anecdote rather than hard data, and some physicians would accept a patient’s story at face value even if they had not witnessed most of the events at first hand. Unable to distinguish between the impossible and the unlikely, medics sometimes gave both equal weight.
In such circumstances, it is hardly surprising that folk myths and fabrications often made it into print. Take, for example, the story of Mary Riordan, published in a Dublin journal in 1824. Mary was a young woman from rural Ireland who sank into a deep depression after the death of her mother. She began to pay long daily visits to the graveside, and on one occasion was found unconscious after spending a freezing winter night there in the pouring rain. Her health soon began to suffer, and she developed crippling stomach pain that, she claimed, she could relieve only by eating handfuls of chalk. Mary became so ill that on more than one occasion a priest was summoned to give her the last rites. And then, one evening in the spring of 1822, she vomited an object that she described to her doctor, William Pickells, as “a green thing as long and as thick as one of her fingers, which flew. It had wings, a great many feet, and a turned up tail.”
Which ought to be enough to ruin anybody’s day.
Over the months that followed, insects at various stages of their life cycle were discharged from both Mary’s mouth and anus. Dr. Pickells observed:
Of the larvae of the beetle, I am sure I considerably underrate when I say that, independently of above a hundred evacuated per anum, not less than seven hundred have been thrown up from the stomach at different times since the commencement of my attendance.
Mary was suffering from some intractable mental illness, no doubt—possibly Munchausen’s syndrome (also known as factitious disorder), which can cause patients to feign the symptoms of a serious, and often exotic, disease. But Dr. Pickells believed every word of Mary’s story, concluding that the beetles and their larvae had hatched from eggs she had consumed during the night she spent in the graveyard some eight years earlier. He conceded, however, that he had seen only a few of the creatures himself: Most were destroyed by the patient “from an anxiety to avoid publicity,” while others had escaped immediately after being vomited, “running into holes in the floor.”
It’s a story so outlandish that it seems hard to believe that Dr. Pickells gave it any credence. But it was far from the tallest tale told in a nineteenth-century medical journal—other still more ludicrous yarns were spun in the name of science. Some of these unlikely case histories were doubtless repeated in good faith; others were obvious frauds; but the delicious irony is that a precious few of them may actually have been true.
SLEEPING WITH THE FISHES
One of the overwhelming priorities of medicine in the eighteenth century was the improvement of resuscitation methods. Drowning was a major cause of death, and physicians realized they needed better emergency procedures to treat those who had fallen into rivers, canals and lakes. Humane societies were founded in several European countries to investigate possible new techniques, among them the Society for the Recovery of Persons Apparently Drowned, which opened its doors in London in 1774.* Such institutions brought a new rigor to the study of resuscitation, although there was already a considerable literature on the subject. One example is A Physical Dissertation on Drowning, published anonymously in 1746. At the time, it was attributed to an author identified only as “A Physician,” now known to be the London doctor Rowland Jackson.*
Jackson’s aim was to demonstrate that prolonged immersion in water was not necessarily fatal—and that even an apparently lifeless body hauled out of a river might still be resuscitated, given the right emergency care. To prove his point, he scoured the medical literature for examples of people who had recovered after a long time underwater. Though fascinating, to a modern eye they seem somewhat—OK, completely—implausible.
About eighteen years ago, a gardener of Fronningholm, now sixty-five years old, and sufficiently vigorous and robust for a person of that age, made a generous attempt to rescue an unfortunate neighbour who had fallen into the water; but being too foolhardy, he ventured upon the ice, which broke, and let him fall into the river, which at that part was eighteen ells in depth.
An ell was an old unit of length, equal to 45 inches. It was therefore 67½ feet, or slightly more than 20 meters, to the riverbed—a considerable depth.
The Mystery of the Exploding Teeth and Other Curiosities From the History of Medicine Page 19