Some Period Surgical Procedures

[Misson]

While I haven't actually started writing my own book on barber-surgery yet (I have a month and change), I have lately come across a fascinating book at the recommendation of someone on another forum. It's called The Age of Agony by Guy Williams, originally published in Great Britain in 1975 and then republished in the US in 1986. The man has a way with words and I thought I would share this description with all those curious about medicine during the age of no anesthesia. If it takes your fancy, I will publish some other ones I have found in this and other books of various procedures. (We need a little devil emoticon.)

“Lithotomy –the operation by which an offending stone is removed from a bladder- was, as the eighteenth century dawned, an exceptionally severe one, and most sufferers from the stone would only agree to be ‘cut’ if the pain that was tormenting them was making life practically unbearable. Their reluctance to submit, in all-too-painful consciousness, to the knife is easily understood since the stone-removing operation that was usually performed lasted, under normal circumstances, for nearly an hour and, if the surgeon concerned did not happen to be a virtuoso, could drag on considerably longer.

In this ghastly operation, a huge incision would be made in or near the patient’s groin. Using this raw and bleeding aperture as a means of access to the patient’s interior mechanisms, the surgeon would proceed to dilate, with specially contrived instruments, the neck of the patient’s bladder. Then he, the surgeon, would take a pair of forceps, and with this dangerous implement he would attempt to find, in the somber recesses of the agonized patient, the offending stone or stones. If he, the surgeon, were exceptionally skilful, or exceptionally lucky and if his gropings went unusually well, the unwanted lumps of calcium carbonate would be detected, and would be withdrawn as quickly as possible from their all-too-sensitive resting places – if necessary, by force. The whole process, in the absence of anesthetics, must have been an excruciating experience for the surgeon and his assistants, if they had any human feeling at all: it must have been painful beyond belief for the patient.” (Williams, p. 147)

[Captain Jim]

You, my friend, are going to be such a barrel of laughs at PiP next year. Tons of fun for everyone.

By the way, excellent research. Keep up the good work. You're making us proud.

[Capt. Sterling]

The Age of Agony... love the title.

Hey Mission, have you ever come across any evidence whether or not folks pass out from intense pain, as like in the movies or stay conscious? I was watching an interesting documentary on POWs and one man said the human body does not normally pass out because of extreme pain. If it does, which he claimed was rare and brief, causing more pain will only revive it... He brought this up to show what horrors our POWs suffered when tortured.

So, if the guy is right, and the hollywood idea of relief by pain rendering oneself unconscious is not true...puts a whole other twist on surgery demos...instead of the unconscious patient laying there quietly while being cut and prodded.

[Captain Jim]

There's losing conciousness and then there's shock. The body does have a remarkable ability to shut down the sensation of pain in extreme conditions. For instance I have first-hand experience in having a fibia and tibia compoundly fractured with dislocation of both knees, right ankle and two broken bones in the right foot. Stayed concious and rational and felt no pain whatever. The brain just shut it down. I had to direct my own emergency response as those looking on panicked. Another example is that shooting victims often don't know that they have been shot. So perhaps there was a suspension of pain as we know it as shock set in. Of course you can die of shock if it is not handled correctly, but that is something else again.

Splinters and paper cuts, now those really hurt.

[Dutchman]

dear god mission!!! i've been a street medic for 17 years and that made my knees buckle!!

as captain jim pointed out, most people pass out from shock because of the injury and the pain associated with it. then there are those who are trained or conditioned to fight through it (such as S.F. folks) or so juiced on the adrenalin of the moment- they don't realize it.

a comparison- i once picked up a middle aged male, grew up with lets say an easy life, who thought he was going to die from constipation. He percieved it as pain so therefor it was. now i was not him so i can't grade his pain, but it was real for him. then i had a young male with most of the back of his leg blown off by a shotgun at close range. (he had been shot twice already and done jail time- no idea where his family was) no tears, little blood, lots of missing meat. he refused to ride in the ambulance and his girlfriend drove him to the hospital because he did not want a bill. (yes we bandaged him on scene and did a lot of begging and pleading with him, but he wanted no part of us)

[Capt. Sterling]

Rather like those tales of mountain men giving themselves amputations...snigger

[Misson]

I have come across nothing about people passing out from pain. Almost every book that mentions such talks about concern for the pain the patient might be experiencing. On that note, here is another fine quote (the quote within the quote is from a surgeon in the Napoleonic War):

“Of the few accounts of the surgeon’s cockpit during battle, that of Robert Young, surgeon of the HMS Ardent, is probably the most graphic and illustrative…

• ‘Ninety wounded were brought down during the action, the whole cockpit cabin, wing berths, and part of the cable tier together with my platform and my preparations for dressing were covered with them so that for a time they were laid on each other at the foot of the ladder where they were brought down, and I was obliged to go on deck to the Commanding Officer to state the situation and apply for men to go down the main hatchway and move the foremost of the wounded further forward into the tiers and wings, and thus make room in the Cockpit…
  Melancholy cries for assistance were addressed to me from every side by wounded and dying and piteous groans and bewailings from pain and despair. In the midst of these agonizing scenes I was enabled to preserve myself firm and collected, and embracing in my mind the whole situation to direct my attentions where the greatest and most essential services could be performed. Some with wounds bad indeed and painful but slight in comparison with the dreadful condition of other were most vociferous for my assistance, these I was obliged to reprimand with severity as their noise disturbed the last moments of the dying. I cheered and commended the patient fortitude of others and sometimes exhorted a smile of satisfaction from the mangled sufferers and succeeded to thrown momentary gleams of cheerfulness amidst so many horrors…’
  After the action ceased fifteen or sixteen dead bodies were removed before it was possible to get a platform cleared and come at the materials for operating and dressing, those I had prepared being covered over with blood and the store room door blocked up.”
  

(Goddard, Jonathan Charles, “An insight into the life of Royal Naval surgeons during the Napoleonic War, Part I,” Journal of the Royal Naval Medical Service, Winter 1991, p. 211-2)

[Dutchman]

mission, any idea how much space were looking at by the description?

i was fortunate enough to be an extra on the john adams set the day an on board surgery scene was done durring battle. the set was a storage container built on hydraulic lifts. the inside of the container was the ships hold- pretty neat actually, but anyhow- from our view on the monitors the three or four that were in there were on top of themselves to start, then the "ship" started rocking. then three of us came down the hatch to add to the mess. (i have not seen the series yet, but if that scene did not end up on the editors floor, i'm the one being dragged down backwards with the striped socks) whats interesting was watching the supposedly secured props become projectiles and the cast trying to get them back in place. just gives you an idea of the space constrains involved.

[Sjöröveren]

I have The Age of Agony and its 19th Century counterpart The Age of Miracles laying around somewhere. Now I'm going to have to dig them up and read them again. I think I got mine from Jas Townsend about 15 years ago. It looks like Amazon has quite a few used copies available for really cheap.

[Capt. Sterling]

(i have not seen the series yet, but if that scene did not end up on the editors floor, i'm the one being dragged down backwards with the striped socks) whats interesting was watching the supposedly secured props become projectiles and the cast trying to get them back in place. just gives you an idea of the space constrains involved.

**running to see the striped socks**

Oh that is the BEST scene out of the first three episodes! The guy bleeds out during the amputation... you cannot see it, but you can hear it pouring on the deck... it really makes the hairs on the back of yer neck stand up...

[Misson]

There are lots of different accounts of where and how big the surgery was. Most of them are from naval accounts and say it was on the orlop deck.

Here's one description of the surgeon's mate's quarters:

"The surgeon’s mate dwelled within the bowels of the ship, in a six-foot-square canvas enclosure in the cockpit on the orlop deck, directly above the hold in the front of the vessel, where the rocking was greatest, the air foulest, and the natural light faintest. It was barely large enough to contain a sea chest, and a medical chest and the canvas walls pinned to the overhead beams provided scant privacy from the general crew. The surgeon’s mate had no uniform and though he was listed on the ship’s roster alongside warrant officers such as the gunner or the carpenter, he received less pay. Neither surgeons nor surgeon’s mates were highly regarded in the naval hierarchy, since the health of the crews was of little consideration and the benefits not entirely understood or appreciated.” (Bown, Stephen R., Scurvy: How a Surgeon, a Mariner, and a Gentleman Solved the Greatest Medieval Mystery of the Age of Sail, Thomas Dunne Books, New York, 2003, p. 88)

From the work cited above by J.C. Goddard, a description of where surgery took place:

“…the orlop deck would be the surgeon’s cockpit…

During an engagement the cockpit provided the surgeon with the worst imaginable conditions in which to carry out his work. In an action of any size, the small area invariably became crowded with dead and wounded men. The cramped conditions, poor ventilation and heat of the battle, with the heavy guns of the lower deck thundering above the surgeon’s head, would cause an unbearably high temperature, particularly on more tropical stations, a high noise level, poor visibility and unsteady conditions.” (Goddard, p. 211)

From the same article, a description of the infirmary:

“The ships sick berth was not necessarily in the same place as the cockpit. A space would be assigned for the sick by the captain, and this was frequently either under the forecastle or just been a space between two gun ports. Blane described the sick berth as ‘the interval between two guns, or any space between decks, which is sometimes formed into a sort of apartment by means of a partition made of canvas.’

A badly placed sick berth could be very deleterious to the health of the occupants. Some of the sick might be placed in the ‘fore-part of the hold which was damp, unwholesome and filled with stench from the bilges.’ This would be a particularly noisome place low down in the ship, for the ballast in the very bottom was very foul and unhealthy. Jason Farquar, surgeon of HMS Captain, complained that ‘the sick berth was small and uncomfortable and the ship in general very dirty’, while George McGrath, surgeon of the HMS Russel, reported in his Journal that many of the sick on board had to be sent to the hospital at Plymouth rather than remain in the sick berth, giving as his reason that ‘there was but a very poor accommodation for sick men on board of the Russel, which was both cold, damp, and even sometimes wet as the weather during the time we fitted out there was raining without intermission – this circumstance alone produced a vast number of diseases during our stay there.” (Ibid, p. 212)

And, finally, some info on the surgeon's concern about the infirmary from Goddard's second part of the article on the Napoleonic War:

“Surgeon William Maly of HMS Albion made a note at the end of his Journal as to the ‘Accommodations for the Sick’.

On representing to Captain Ferier the necessity of having a comfortable sick berth he immediately afforded to hang conveniently twenty beds taking in two ports, round house and head door, it was filled up with wooden panels, proper persons were appointed to attend on the sick and to the cleanliness of the sick berth, a set of small cots were allowed me, these were kept in readiness so that as men were taken ill of acute disease, he was washed, clean clothes put on and one of the sick beds were allotted him, his hammock carefully aired and put by.

(Goddard, Jonathan Charles, “An insight into the life of Royal Naval surgeons during the Napoleonic War, Part II,” Journal of the Royal Naval Medical Service, Spring 1992, page 28)

I recently came across a comment that is probably relevant. It basically said that during period there was no "pattern" for ship building. Each ship, even those of the same rates (which, as I understand it, had to do with how many guns a ship carried) was basically hand-built and so no two would have been exactly alike. So I figure this will be part of the reason that the surgery, infirmary and medical quarters were said to be in different places. Another factor would have been that the ship's surgery was usually something of an afterthought and seems to have been provided in part to keep the men from deserting. It wasn't until the late 18th century that members of the Admiralty took any concern about the health of sailors for strategic reasons. Instead, they usually packed the ship with extra men to offset the number they expected to die during a voyage. (Mostly due to illness rather than battle wounds - on long voyages scurvy was particularly worried over which sometimes resulted in three times the men required being packed into a ship. They figured two-thirds would die from dysentery, fevers and particularly scurvy.) This led to overcrowding, which created other health issues.

I should also note that from a discussion that Coastie04 and I were having in Plunder in the thread Draughts of the Brig Ship Mercury, the orlop deck is actually a pretty good place to put the surgery because the battle action would be as minimized as possible and this area of the ship generally has the least amount of movement, especially in the center. The stark truth is that there probably is no good place in battle to be doing surgery - in fact, hospital ships were created during period by the BRN, but they never seemed to work out very well. This was due to many factors, among which were that the decision to have them was slow to be made and thus they were often completed too far behind schedule to be useful and were hard to maintain and keep supplied. These are actually the same sorts of problems always experienced by the military, as you will no doubt recall from the documentary series M*A*S*H.

I have much more, but I'll save it for my book.

[Misson]

Oh, ah. I just typed in another bit from Williams on patients and pain:

“In the period with which we are dealing, patients taken into the ante-chamber had no…happy relief. They would be given gin, or rum, or some soporific drug, to make their ordeal just a little less harrowing. Then, they would be exhorted to be brave, to be determined and upright, and to clench their hands, while unspeakable things were done to them.” (Williams, p. 111)

[Dutchman]

its amazing how many ships- right up to current deadrises on the chesapeake bay are built by eye. i've seen many a workboat where one side is just as fair as the other with no plans. of course i've seen just as many that were off as well. watching those old timers with an adze and broad axe is amazing. i can make them work- but its not pretty. those guys are true artists!

ok for those who have seen the john adams flick- did the scene of sewing the dead sailors into the hammocks make it- same episode.If so, i'm second from the left. I died four times in that movie- it was great!

to keep on track with missions works, other than mercury, has anyone ever seen a list of the contents of black beards charleston box? It was valued at 400 pounds i think.

[BriarRose Kildare]

okay, i must say WOW! Your accounts that you have written Mission are greatly appreciated. I now have a much clearer understanding on the dilemmas of surgery and medicine at sea. I am now more than ever looking forward to your book that you are writing. You have truly captured my interest.

Have you found an estimation on how often those who went through such horrific surgeries actually survived? Just wondering.

[Misson]

Somewhere I recall reading that only about 1/3 of the patients survived amputations due mainly to infection. But don't quote that as I don't recall where I read it and I'm not certain whether it applied only to sea surgeons or included land surgeons as well.

They didn't really start keeping statistics on such things until the mid/late 18th century and many of those records came primarily from hospitals. Surgeon's journals usually recorded deaths, but they weren't really an enforced record until 1703. On top of this, many of the journals were not preserved. I believe this requirement was only for naval surgeons, so it is not reflective of the whole. (In other words, there are no reliably comprehensive records. Means 'no.')

[Calico Jack]

Naval records from the 18th century suggest a better than 50% survival rate for amputations, which is the more remarkable when you learn about the role and importance of "laudable pus."

[Misson]

I have read that it was estimated to be lower than that in the late 17th/early 18th, although as I mentioned there weren't really consistent records (journals) until 1703 and those that survive are sort of vague from what few I've seen copies of. Although they were pretty good about noting deaths. (It seems to me I read that a lot of the journals from the early/mid 18th were not kept or were lost...)

There was also a decided dislike on the part of many surgeons for tying ligatures (silk ties) to close severed arteries and the lack of interest in the "flap method" of leaving an extra flap of skin so it could be sewn over the stump. Both had been discovered by the 17th century (the flap method is from the 16th), but neither was widely used during GAoP according to Keevil.

[Raphael Misson]

I found this interesting - primarily because of the problem with guns. It's from the English translation of The Apologie and Treaties of Ambroise Paré (originally published in French around 1585):

"A Waterman at the Port of Nesle, dwelling neare Monsieru de Mas, Postmaster, named John Boussereau, in whose hand a Musket brake asunder, which broke the bones of his hand, and rent and tore the other parts in such sort that it was needfull and necessary to make amputation of the hand two fingers above the wrist: which was done by James Guillemeau [This has been anglicized by the English translator in the 17th century. Jacques Guillemeau was a favorite student of Paré's - and his son-in-law] then Chirurgion in ordinary to the king, who dwelt at that time with me. The operation likewise being redily done, and the blood stancht by the Ligature of the vessells without burning irons: hee is at this present living."

(This whole thing was put together by Paré to refute another surgeon's contention that cautery was necessary for amputations.)

[Mission]

This one's for those of you out there with an attention span longer than a half-dozen typical internet users put together, but I thought it was a nice, detailed account of a skull fracture case from Richard Wiseman's Of Wounds, of Gun-Shot Wounds, of Fractures and Luxations. It is actually one long freaking paragraph, so in deference to the reader, I am artificially inserting some breaks to make it slightly more readable:

"A young Fellow, a Mason by Trade, being at work with others making a Stack of Chimneys three Stories high, the Foundation of the house sunk under him. He was taken up speechless; but being presently let blood by a Noble Lady's advice, he recovered his Senses, and was removed to his Lodging. The Part contused and swelled as was the right Temporal Muscle, and that side of his Head. He vomited often, and shrewd [showed] Symptoms of a Fracture. I caused the Hair to be shaved off, and made an Incision in the upper part of the Tumour, from his Ear forward, above two inches in length, passing as near the Temporal Muscle as I durst; and having at the same time divided the Pericranium [the dense fibrous membrane covering the surface of the skull], I thrust it off from the Bone; then with a Sponge prest out of Red wine wiped away the blood, and saw a Fissure running the whole length of the Wound. I also espied another Fissure stretching from this downwards towards the external Canthus of the Eye [the place where the upper and lower eyelids meet - in this case at the outside corner of the eye]; and the lower I pressed with my Finger; the more rough the Bone felt. I was unwilling to cut the Temporal Muscle; but there seeming to me a necessity of it, I drew my Knife downward, and laid open the Wound in the forum of a Roman T. but the lower Lips [of the wound], being musculous, wound not so turn back to bare the fractured Bone as I designed; therefore I contented my self with what I had done, and filled up the Wound with Dossils [plugs] of Lint, embrocating [moistening] the Parts about with ol. ros. cum album, ovi. [oil of roses with egg white], and applying empl[aster] é Boli [a sort of bandage with oil, litharge [lead-oxide] and bole, or argillaceous [clay-containing] earth] over it, with Compress and Bandage, then laid him to rest with an Anodyne draught [pain alleviating drink].

The next morning I found the Patient in a Fever. He had rested ill, and had vomited often, and complained of much pain in that lower Jaw. I took off the Bandage and Emplaster, and drest the Lips of the Wound with a Digestive ex terebinth, &c [turpentine - used as an antiseptic and to create the formation of pus in wounds] upon Pledgits [compresses of lint] dipt in ol. hyperici [st. John's wort] hot, embrocating the Parts about with ol. cham. & ros. [oil of roses and probably chamomile] and applied a Cataplasm ex far. hord. flor. ros. rub. balaust. &c. [Geez... this is a plaster containing a bunch of stuff - including extracts from roses, flower of the pomegranate, barley and I don't know what else] as you may find it described in the method of Cure. Then we let him blood in that Jugular, and advised a Clyster [For fun, look that one up on your own]: a Ptisan [nourishing decoction, originally Barley Water] and contemporary Juleps [a sweet drink - a spoonful of sugar and all that] were also made him. Having afterwards considered of the necessity of making more way to the depressed Bone, and the danger which might happen by cutting off more of this Muscle, I resolved to consult Doctour Walter Needham [physician and anatomist - physicians were theorists and gave direction to surgeons]; to which purpose I sent to him, and he accordingly met me the next day.

We found the Patient restless, and accompanied with an increase of all the forementioned ill Symptoms. We took off Dressings, and discerned the upper Lips of the wound digested [inclined to the release pus], but the lower more dry and swelled, especially upon the lower part of the Temporal Muscle, upon the pressure wereof a white Matter discharged from within, between the Cranium and musculous Flesh, where we judged the Depression of the Bone to be. there was a necessity of cutting off part of the Temporal Muscle, and that in the form of a Semicircle: wherefore we marked it with Ink from the upper part, so passing within an inch or more of the external Canthus of the Eye, and carrying it toward the Ear, to take off that Lip which was lying over the Depressure. This being so marked, we cut it off. There was an effusion of blood out of both ends of the Arteries: but having Dossils [plugs of lint, remember?] ready dipt in the Royal Stiptick [French medicine, used to stop bleeding], we applied them; and having filled up the bared Cranium with our Dressings, we bound up the Wound. From this time his Jaw was so weak, that we were forced to muffle it up with Chin-cloaths." (Wiseman, p. 398-9)

I'm going to interject something here that I learned from reading Wiseman, which I find really interesting. During this time, there were two sorts of devices in use for making holes in the skull. One is the trepan (or brace trepan) and the other is the trephine (or hand trepan). See the pic below for a comparison:

Before reading this book, I had thought that the trephine was a different spelling of trepan. One thing you learn when reading period books is that the spelling of a word sometimes seems almost random. After going through several books written by surgeons, however, I have found that their spelling is much better than most period books and it often quite consistent. So I should have suspected something was up. The above photo is from the copy of the Wiseman book which I am reading -although neither picture is from Wiseman's original book; they are both from Woodall's book The Surgeon's Mate. In the Wiseman book I own, they are in the introduction written by the excellent modern naval surgeon John Kirkup. Kirkup also wrote a book on the history of surgical instruments called The Evolution of Surgical Instruments; An Illustrated History from Ancient Time to the Twentieth Century which was published in 2006. I very highly recommend it if the topic interests you. Anyhow, Kirkup notes the difference between the trepan (which Wiseman seems to prefer) and the trephine or hand trepan. In fact, there is a point in the book where Wiseman describes himself showing both instruments to the friends and family of a patient and asking them which instrument they think would be better for the operation. They choose the trepan. And that is that - end of digression. Onto the trepanning.

"At our next dressing we set on a Trepan: after which with a Levator we raised up the depressed Bone, and dropt into that Wound a Solution of resina en mel. ros. [resin of honey and roses]. We then drest the trepann'd hole with ol. ros. [rose oil] upon a soft Dossil; applied Digestives [probably turpentine, used to cause wound supperation - pus to form] over the Lips of the Wound. At the second Dressing Doctour Walt. Needham was present, and saw the Dura mater [the tough and inflexible outermost of the three layers of the membranes enveloping the nervous system] under the trepann'd Bone incarned [covered with granulation tissue, which happens before scar tissue forms] so well, that from that time we only applied a little round Dossil to keep the Flesh from thrusting out of it.

But from the Fracture below much purulent [pus-containing] Matter came away daily: we supposed it was the more increased, by reason of the hollowness which it had made between the Muscles and fractured Bone, which being depending, did yet retain its Cavity, notwithstanding our endeavours by Compress and Bandage. Therefore to prevent the enlarging of that Cavity, we applied a Caustick on the outside, and the next day divided it; from which time the Matter discharged it self that way, and thereby the internal Cavity was disposed to cure. The Fissure that stretched it self from his Ear towards his Brow did lie so undiscovered, that we neither saw beginning nor ending of it; nor did we care: that part of it which we saw served to discharge the Serum sufficiently. I rasped the Cranium and covered it with Dossils dipt in spir. vini. [rectified spirit distilled from wine] &c. keeping them close to the Lips of the Wound; and by timely rubbing the aforesaid Lips and every Superexcrescense with the Vitriol-stone [a hard, crystalline mixture of ferric sulfate and aluminum sulfate], I kept the Cranium dry, and disposed it to exfoliate [cast off dead flesh or bone].

After the discharge of Matter ceased from within the Cranium, I left the Exfoliation and Incarning of it to my Servants, visiting the Patient but seldome my self. His Wound was cicatrized [covered with scar tissue] in less than two months" as indeed they all usually are, if they be treated as they ought. But if they fall into such ignorant and obstinate hands, who suffer the Cranium to be overgrown with loose Flesh, a great discharge of Matter will follow, and the Cranium must of necessity corrupt, and consequently the Cure must be prolonged." (Wiseman, p. 399)

Post script: Thank God I stumbled across this book on Google Books about 2/3 of the way through typing this. It was very helpful in trying to discern the abbreviated Latin medicines.

[Mission]

Here's a nice gruesome Halloween-ey one from Wiseman. Wade into this one only if you're strong of stomach and/or lacking in imagination:

"At the Siege of Taunton [1645] one of Colonel John Arundell's men, in storming the Works, was shot in the Face by Case-shot. He fell down, and in the Retreat was carried off among the dead, and laid into an empty house by the way until the next day: when in the morning early, the Colonel marching by that house heard a knocking within against the Door. Some of the Officers desiring to know what it was, lookt in, and saw this man standing by the Door without Eye, Face, Nose, or Mouth. The Col. sent to me (my Quarters being nearest) to dress the man. I went, but was somewhat troubled where to begin. The Door consisted of two Hatches; the uppermost was open, and the man stood leaning upon the other part of the Door which was shut. His Face, with his Eyes, Nose, Mouth, and forepart of the Jaws, with the Chin, was hung down by his throat, and the other part pasnt [? passed?] into it. I saw the Brain working [coming] out underneath the lacerated Scalp on both sides between his Ears and Brows. I could not see any advantage he could have by my Dressing. To have cut away the lacerated Parts here had been to expose the Brain to Air. [Note: Wiseman believed exposing the brain to air caused putrefaction of it which he felt eventually lead to death.] But I helpt him to clear his Throat, where was remaining the Root of his Tongue. He seemed to approve of my Endeavours, and implored my help by the Signs he made with his Hands. I askt him if he would drink, making a sign by the holding up a Finger. He presently did the like, and immediately after held up both his Hands, expressing his Thirst. A souldier, fetcht some Milk, and brought a little wooden Dish to pour some of it down his Throat: but part of it running on both sides, he reacht out his Hands to take the Dish. They gave it him full of Milk. He held the Root of his Tongue down with the one Hand, and with the other poured it down his Throat, (carrying his Head backward,) and so got down more than a quart. After that I bound his Wounds up. The dead were removed from thence [the house - which was full of bodies] to their Graves, and fresh Straw was fetcht for him to lie upon, with an old Blanket to cover him. It was in the Summer. There we left that deplorable creature to lodge, and while we continued there, which was about 6 or 7 days, he was drest by some of the Chirurgeons with a Fomentation made of Vulnerary [Wound healing] Plants, with a little Brandy-wine in it, and with Stupes of Tow [hot, wet hemp, flax or jute] dipt in our common Digestive [something promoting the formation of pus in wounds - often turpentine]. So we bound him up." (Wiseman, p. 402-3)

[Mission]

Wiseman is just full of interesting examples. Remember that there was no anesthesia at this time.

"One was shot in the Face betwixt the Nose and Eye on the right side into the Ethmoïdes [a small bone that forms part of the eye socket and the nasal cavity] by a Pistol-bullet. After he had been cured some years of the external Wound in his Face, he became troubled with a Fretting Ichor [watery, pungent discharge], which discharged by that Nostril; and especially at his first rising in the morning out of bed it would run half a Spoonful of a yellowish colour, which had made a chop or gutter in the lower end of that Nostril by its acrimony. After some years he felt, upon bending his Head backwards or forwards, the Bullet to rowl to and fro over the Roof of his mouth. He complained to me of his Grievance at the Hague in Holland... I offered to his consideration the casting in Injections, or passing a Probe into that Nostril downwards, to try if either way it might be washt or thrust downwards into the gullet, or be excreted into his Mouth. But these ways had heretofore proved ineffectual. We therefore resolved upon the cutting through the Palat-bone. To which purpose I placed him in a clear light, one holding his head steady, while I cut into the Bone, that it would not yeild to my Spatula as expected: wherefore I applied a bit of Caustick Stone [made of a chemical which caused burning and destruction of tissue, applied here to remove the skin], and held it to the place with a Pledgit [compress] of Lint a few minuits; by which I consumed the soft fleshy part over the Bone, and afterwards cut into the Bone such a hole, that in the moving of his Head I could see the Bullet loged in the Hole: which encouraging us to proceed in our work, the Bullet was afterwards taken out, and he eased of that discharge of Matter which threatened a filthy carious Ulcer... since seen him at Court. But the Ulcer did not close up with a Callus; however the place is supplied by a small Plate without offence." (Wiseman, p. 417-8)

I wonder what the small plate was made of? Here's another interesting one:

"In another that had his Leg shot off, in the place of Amputation below the Knee, some two months after, when I wondred the Bone did not exfoliate [naturally cast off dead flesh], I put in my Forceps to try whether any part of the Bone was loose: and finding it very loose, I took hold of it gently, and feeling it willing to come away, I pulled it out. It was the Apophysis or head of the Os tibia, which makes the Knee. I was surprized at it; but considering what was loose must [be taken] away, I pulled it out, to the amazement of the lookers on. This was relaxt from its Ligaments by the force of the [original] blow." (Wiseman, p. 421)

I'm guessing he removed the skin from the knee down after this?

[Graydog]

Here's a nice gruesome Halloween-ey one from Wiseman. Wade into this one only if you're strong of stomach and/or lacking in imagination:

"At the Siege of Taunton [1645] one of Colonel John Arundell's men, in storming the Works, was shot in the Face by Case-shot.... His Face, with his Eyes, Nose, Mouth, and forepart of the Jaws, with the Chin, was hung down by his throat, and the other part pasnt [? passed?] into it. I saw the Brain working [coming] out underneath the lacerated Scalp... So we bound him up." (Wiseman, p. 402-3)

Did it go on to say how long it took him to die? This begs me to ask the question, does the book talk about mercy killings?

Thanks!

-Greydog

[Mission]

Did it go on to say how long it took him to die? This begs me to ask the question, does the book talk about mercy killings?

-Greydog

You have read everything I have read about the guy. He was alive after six or seven days, which is quite a long time from the sound of his injury. My supposition is that he probably lived in that abandoned house and scared little children into starting foolish legends about the ghost of the abandoned death house.

This book has said nothing about mercy killing. In fact, none of the surgical books I've read from period that I've read so far have said anything about that. They did what they could for the patients, usually explaining how to cause them the least amount of pain possible, given the conditions. Some surgeons note that there wasn't anything they could do or that people died because they couldn't get to them in time, but nothing about intentionally taking life.

Remember that people had to put up with a lot more hardships during this time and my guess is that they would probably be more used to pain and would not be interested in being put out of their misery. I would also suggest that people who had problems that would cause severe chronic pain probably died of whatever was causing the pain sooner than we do today. The average life expectancy was lower (due to many factors - including diet, environment, health care available and whatnot) and the threshhold for inconveniences was probably higher. These are just suppositions on my part, however.

[Graydog]

Thank you so much for the fast and detailed response!

I'd agree with your conjecture as well. It rather does fly in the face of treatment to kill them instead. I should have been more precise in my question. I was referring to battlefield mercy killings, which by their very nature I can see them being unadressed or a very limited discussion in the book as the act of others.

It was just that the fellow in question made me wonder why they didn’t just shoot him instead of treat him. Based on the description and the conditions of the period makes it appear his long term survival would be nil.

Thanks again!

-Greydog

Edited October 30, 2008 by Graydog

[Mission]

Well, let's look at what Wiseman does say.

"...I could not see any advantage he could have by my Dressing. To have cut away the lacerated Parts here had been to expose the Brain to Air. [Note: Wiseman believed exposing the brain to air caused putrefaction of it which he felt eventually lead to death.] But I helpt him to clear his Throat, where was remaining the Root of his Tongue. He seemed to approve of my Endeavours, and implored my help by the Signs he made with his Hands. I askt him if he would drink, making a sign by the holding up a Finger. He presently did the like, and immediately after held up both his Hands, expressing his Thirst..."

So, on the one hand, he didn't see any point in dressing his catastrophic wounds. But on the other, he goes to great lengths to help make the man more comfortable and doesn't appear to even consider ending his life. Later on, he notes that "...we left that deplorable creature to lodge [in the now empty house], and while we continued there, which was about 6 or 7 days, he was drest by some of the Chirurgeons with a Fomentation..." So we can say that his fellow surgeons were compassionate as well as they bothered to dress the man. Now his fellow soldiers may have done away with him had they known he was alive - and I have seen references to this happening somewhere or another but I don't recall where exactly - but they already thought the man was dead. That's why they stuck him in the house with the rest of the bodies.)

The comfort of the patient is actually a common theme in the books I've read. Ambroise Paré (The Apologie and Treatise of Ambroise Paré) talks about it; in fact, he goes on for pages about why his field experience suggests that ligating (tying off) arteries is preferable to cauterization (basically burning them closed), if only for the patient's own comfort and future healing. Woodall (The Surgeon's Mate) agrees with Paré on this point and talks a great deal about the patient's comfort in other instances. And you've seen where Wiseman stands. However, this may be because of the books I am being guided towards. Still, each of these books went through multiple printings, in the case of Paré and Woodall, their books continued to be printed after their death. So they must have had some influence on their profession. Note that Paré and Wisemen were surgeons to various Kings, an honorary recognition of their skill by the monarchies (Woodall may have been as well, but I don't have that in my notes yet). Still, their compassion may be because they were some of the leading surgical lights in the field at the time.