A forgotten thing

gunshot wound of the brainThis case, published in the Buffalo Medical and Surgical Journal in 1865, is one that makes you marvel at the resilience of the human body. The author, John C. Hutchison, was barely nineteen – young to be writing articles for medical journals – and working at the Marshall Infirmary in the city of Troy, New York:

Lydia Lista, a little girl aged seven years, walked to my office July 4, 1864, with her mother, who stated that her daughter had been injured by a buck-shot fired from a toy cannon by her brother while at play. She fell to the ground immediately on receipt of the injury, and vomited soon afterwards.

The doctor saw little to be worried about: the girl was on her feet, walking and talking and apparently well. But he was in for a surprise.

I introduced a probe into the external wound, which was situated on a level with the top of the right ear and half an inch posterior to it, expecting from the appearance of the child that the shot had not punctured the skull. The probe, however, entered the brain substance and passed in about four inches.

In the days before X-rays, doctors were obsessed with probing wounds to see how deep they were – one can understand why, but it often did more harm than good. This one was very deep indeed.

There was no opening on the opposite side of the skull. I expressed an unfavorable prognosis, and sent the patient home, requesting the mother to call her family physician, Dr. Isaac H. Barber.

A counsel of despair – Dr Hutchison had little hope of the girl’s recovery.

I did not see the child again, but Dr. B. has informed me that there were no symptoms of any description indicating injury of the brain except some slight vomiting, which continued for two or three days. No treatment was deemed necessary except rest, and she soon appeared as well as ever.

Sadly this is not shaping up for the happy ending most readers are now hoping for.

She remained in good health, going to school and playing as other children until January, 1865, when she was attacked with scarlet fever and died of that disease on the 17th of that month. She had no symptoms indicative of disease of the brain during her last sickness.

A four-inch gunshot wound of the brain sounds a pretty extraordinary thing to recover from; but it soon transpired that the case was even more remarkable than first suspected.

On the day after her death a post mortem examination was made by my pupils, J. C. Goodridge, Jr., and J. H. L. Elmendorf. Hearing of the death but a short time before the funeral, and the family positively refusing an examination, being in an adjoining room, made it necessary to conduct it with the utmost secrecy and as expeditiously as possible.

Performing a post mortem in secret and against the explicit wishes of the family, particularly on a child, is of course profoundly unethical. Nineteenth-century case reports often note that an autopsy was not carried out because permission was not granted. Hutchison’s conduct in this case was certainly not unique, but I’m sure plenty of his colleagues would have disapproved.

The brain being removed was brought to my office for examination. The specimen slows by four slightly depressed cicatrices [scars] that the ball entered the posterior lobe of the right hemisphere, near its juncture with the middle lobe, and emerging from this it crossed the longitudinal fissure, entered the left posterior lobe and made its exit from the brain upon the opposite side; then traversing the cerebrum from right to left in a direction backward and upward. The condition of the brain at the points of entrance and exit of the ball were normal. The membranes were healthy. Finding the ball had passed entirely through, the brain substance had not fallen back into the original track, and could not be found by such incisions as would not injure the specimen, we assumed that it was imbedded in the skull near its point of exit from the brain, and that in the necessary haste of the examination it had been overlooked.

This is pretty astonishing: the piece of buckshot had passed right through the brain, bounced off the inside of the skull and taken a different path back through the brain matter. It was as if the girl had been shot through the brain twice, without any untoward effect.

On examining the brain to-day, December 27, 1865, Mr. Goodridge detecting a point of unusual hardness and a corroded substance, found the ball imbedded in the substance of the brain near the surface an inch and a half in front and half an inch below its point of exit from the left hemisphere. I suppose that after traversing the cerebrum the ball struck the skull of the opposite side and rebounding lodged in the brain at or near where it was at last discovered.

Hutchison concludes with a brief recapitulation of the case, noting that the girl had made an

entire recovery, the child going to school and playing as other children. Subsequent death from another cause and a post-mortem examination revealing that there had been no disease of the brain; that the ball had traversed the posterior lobes of both hemispheres of the cerebrum, and rebounding had lodged in the brain substance, where it had remained with impunity, causing no inconvenience, and had become almost “a forgotten thing.”

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