Nelson & His World

Discussion on the life and times of Admiral Lord Nelson
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 Post subject: 'Warm the saws'
PostPosted: Sun Nov 08, 2009 8:03 am 
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I've read in numerous biographies and articles that Nelson, remembering the cold steel cutting through flesh when his arm was amputated, always thereafter instructed surgeons in his ships to 'warm the saws'.

I don't recollect a source, though. Did he actually give this instruction or is it a legend that has grown up?

Incidentally, if surgical instruments were immersed in boiling water directly from the ship's range, then they would have been sterilised. Only one amputee of eleven in Victory at Trafalgar died after the operation. Was this an above-average survival rate? If so, could the use of sterilised instruments have contributed to this?

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PostPosted: Sun Nov 08, 2009 11:03 am 
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The galley stove would have been cold in action, but I understand they were experimenting with spirits to reduce mortification.

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PostPosted: Sun Nov 08, 2009 11:15 am 
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If they galley stoves were cold, how could they have 'warmed the saws'? A legend after all.....?

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 Post subject: warming saws
PostPosted: Sun Nov 08, 2009 11:21 pm 
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Warming saws would have been quite impractical - and even if some method had been devised to heat them at the beginning of the action they would have cooled down rapidly. In battle, surgeons had huge numbers of wounded men to deal with in a short period of time. At the Battle of the Glorious First of June, for example, Surgeon Forrest of 'Brunswick' had 112 men to deal with; Shepherd of 'Royal George' had 72; Browne of 'Queen' had 69; and Romney of 'Marlborough' had 90. A surgeon would have had no time to warm up his instruments - or indeed do anything but wipe the blood from them - before the next seriously wounded casualty from the stream arriving from the upper decks was put in front of him.
Time was also the key to success in operations. To finish the job before shock set in, speed was of the essence and a good surgeon could cut through flesh, saw the bone, find arteries and tie ligatures in 2 or 3 minutes flat. After that the casualty was whipped away by the assistant surgeons so the surgeon could get on with the next man while they cleansed the wound and applied the dressing.
At the time there was a general ignorance of asepsis - although the virtues of washing wounds ( and the sick bay) with vinegar seemed to have been understood - so the concept behind the need to 'sterilize' instruments was unknowable. The success rate in amputations must therefore have presumably been due to the improvement in surgical skills that occured in the 18th century, the arrival of better educated surgeons like Beatty, Trotter and Gillespie and the development of efficient methods of managing battle casualties.
I have never heard of any experimentation using spirits on wounds and would be interested in learning of any examples. I don't know how medically effective it would have been, but the introduction of spirits into a sick bay full of thirsty sailors would have converted it into a very merry place - what ever the level of their injuries!

Brian


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PostPosted: Mon Nov 09, 2009 9:45 am 
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They certainly were not aware of the causes of mortification, but alcohol is mentioned as being used in wounds on several occasions (first thing on a Monday morning, I cannot find my source, but just came across this from http://www.cindyvallar.com/medicine.html - I'll get back with a better reference later).

To tend a puncture or slash wound, he removed “unnatural things forced into the wound” (a musket ball, pieces of wood or cloth), using a forceps. (Friedenberg, 11) Then he washed the wound with water or alcohol, packed it with lint scraped from linen sheets, and wrapped a bandage around it.

Rum was sometimes administered as a palliative, and would certainly not have done any good in the vast majority of cases!

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PostPosted: Mon Nov 09, 2009 1:48 pm 
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Nelson’s instruction to warm surgical instruments is not a ‘legend’, but it was not a general instruction to surgeons to warm instruments for all amputations, which Brian’s description shows would have been impractical. Instead, it was an instruction to George Magrath, surgeon of the Victory 1803-4, to warm the knife if he should need to operate on Nelson himself. Magrath said that Nelson's instructions were: ‘... whenever there was a prospect of coming to Action, to have a hanging stove kept in the gally, for the purpose of heating water, in which to immerse the knife, in the event of his being the subject of operation, and on which he always calculated.’ The source for this is Nicolas in ‘Letters & Dispatches’ in which he quotes from a letter he received from Sir George Magrath:
Quote:
The following curious facts, respecting the loss of his Arm, have been obligingly communicated by Sir George Magrath, K.H., Medical Inspector of Hospitals and Fleets, who was Lord Nelson's Surgeon in the Victory, in the years 1803 and 1804, and of whose professional abilities, it will be seen by a subsequent Letter, his Lordship had the highest opinion. After stating that in 1804 Lord Nelson was valetudinary, that the capillary system was easily influenced by the weather which produced derangement of the stomach and indigestion, causing nervous irritability in different parts of the body, but which Nelson called rheumatism, Sir George Magrath writes: "I think this neuralgic predisposition, was originally induced by the clumsy application of the ligature (including I presume the seive) to the humeral artery of his arm, when it was amputated ; and from its long and painful retention, producing agonizing spasms of the stump, which seriously affected his general health, through the medium of the nervous system. Yet, of all the sufferings of the operation, and its subsequent facts, so strongly pressed upon his mind, he complained most of ‘the coldness of the knife,' in making the first circular cut through the integuments and muscles. So painfully and deeply was the recollection engrafted on his feelings, that I had general instructions, in consequence, whenever there was a prospect of coming to Action, to have a hanging stove kept in the gally, for the purpose of heating water, in which to immerse the knife, in the event of his being the subject of operation, and on which he always calculated. His Lordship's abhorrence of the cold instrument was practically illustrated off Toulon, when expecting to come into action with Monsieur Latouche Treville. In the hurry of clearing the Ship, the Cockpit had become the recipient of much of the moveable lumber. I applied to the executive Officers to have my Quarters cleared, but, from the bustle on the occasion, ineffectually. In a state of despair, I was compelled to appeal to his Lordship on the Quarter-Deck, who promptly sent for the First Lieutenant (Quillam), to whom he gave peremptory orders instantly to see the Cockpit in a proper state, accompanied with the significant remark, that ' he (Quillam) might be amongst the first to require its accommodation.' When I thanked his Lordship for his interference, and was departing for my Quarters, he called me back, and good-naturedly said ' Doctor, don't forget the warm water? I then intimated to him, that a hanging stove was in readiness in the gaily, when he signified his approbation by a smile, and an approving nod." Sir George Magrath's interesting account of Lord Nelson's health, while under his care, will be given in its proper place.

Can anyone elaborate on the form of hanging stove that would have been used? My understanding is that hot coals from the galley fire were placed in a compartment of the stove, on which pots and pans could be heated. Ships were often cleared for action many hours before action began. How long might water have been kept warm in this way?

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PostPosted: Tue Nov 10, 2009 5:46 am 
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Many thanks for those informative posts, all.

Here is a link to a website giving information about the use of alcohol as a medical disinfectant in the 18th century and earlier.

http://tinyurl.com/y8m2pl5

I hope the link works. Scroll down to page 14 for the relevant information.

A very early reference to alcohol in the treatment of wounds is to be found, of course, in the parable of the Good Samaritan in the Bible:

'But a certain Samaritan, as he travelled, came where he [the man attacked by robbers] was. When he saw him, he was moved with compassion, came to him, and bound up his wounds, pouring on oil and wine.' St Luke's gospel, chapter 10, v 35. (St Luke was reputedly a physician so perhaps that is why this allusion to first aid appears!)

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 Post subject: alchohol on wounds
PostPosted: Tue Nov 10, 2009 10:31 am 
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Anna!

I think it is a fair assumption that alchohol was used on wounds from earliest times. What I was hoping for were examples of contemporary first hand description and explanations (ie 'I then bathed the wound with wine/grog in order to...' or 'You should then bathe the wound with wine/grog in order to...) rather than what amounts to an assumption by a later medical writer (including St Luke) about what happened.

The surprising thing is that although contemporary medical textbooks that I have seen - notably William Northcote's 1770 'The Marine Practice of Physic and Surgery' - go into tiny detail about executing different operations, dealing with pain, bandaging wounds and post operative care, they say nothing about bathing the wounds with anything.

Nevetheless, Northcote's summary of necessary pre-operation preparations ends as follows

"On one fide of this place let there be fixed a cheft of a proper height (if you have no other convenient seat) to perform your operations upon; and on another just by (or table) lay all your apparatus, such as your capital instruments, needles, ligatures, lint, flour in a bowl, styptic, bandages, splints, compresses; pledgets spread with yellow basilieon, or some other proper digestive; thread, tape, tow, pins, new and old linen cloth, a bucket of water to put your spunges in, another empty to receive the blood in your operations; a dry swab or two to dry the platform when necessary; a water-cask full of water near at hand, with one head knocked, in, in readiness for dipping out occasionally as it may be wanted. You must also have near you your ong basil – e gum. elem - sambucin ; ol. lip. - olivar. c.—terebinth; bals. terebinth; tinct. styp.—-thaebaie; fp. c. c. per se.- vol aromat. - lavend. c; Wine, punch, or grog, and vinegar in plenty. "

It would be nice if some surgeon had told us what he actually used the "Wine, punch, or grog, and vinegar in plenty" for!

Brian


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 Post subject: Re: 'Warm the saws'
PostPosted: Fri Dec 11, 2009 6:42 pm 
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I've just finished reading 'Bad Science' by Ben Goldacre. (He's a young doctor who is the scourge of woolly thinkers, hacks, quacks, new age alternative therapists, and 'stupid humanities graduates' - among whose number - oh, woe! - I fall. But I forgive him.) Well, young Doctor Ben has a chapter on The Placebo Effect. He mentions some 19th & 20th century surgeons who performed amputations, thyroidectomies etc. without anaesthesia and notes that 'surgeons before the invention of anaesthesia often described how some patients could tolerate knife cutting through muscle, and saw cutting through bone, perfectly awake and without even clenching their teeth. You might be tougher than you think.'


Sadly, despite his obsession with evidence, statistics, peer review etc. etc. he quotes no specific references for this assertion. I wonder if any naval surgeons left observations of the 'unclenched teeth' phenomenon during amputations.

Ben Goldacre, 'Bad Science' (pub. Fourth Estate, 2008) £8.99

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