The amputee obstacle course

shoulder amputationIt’s May 1852, and Dr Sandborn from Lowell in Massachusetts has had a very interesting morning:

The patient, Mr. Wm. Mason, 18 years of age, had been for a short time employed in the Tremont Cotton Mills, of this city, as a tender of a machine called the “picker.” On the morning of the 6th of May last, while in the act of slipping a belt on to a pulley, the sleeve of his frock (probably) was caught by an iron shaft revolving with great rapidity, drawing him over it, and finally tearing the left arm completely off just below the shoulder. The point at which the humerus separated was about six inches below the shoulder-joint. The laceration of the soft parts extended into the axilla, and to a considerable distance over the left pectoral muscle.

To help you picture this frightful injury (assuming you want to): the bone and soft tissues separated in different places. In addition to losing his arm, the boy had much of the muscle and skin torn away from his armpit and the left side of his chests. Meanwhile, six inches of the bone of his upper arm remained in place, denuded of soft tissue.

In addition to the injury to the arm, above described, the skull was laid bare by three distinct wounds four or five inches in length, commencing at the left eyebrow, and extending in a radiating manner over the frontal and temporal region.

His head must have become caught in the mechanism too, removing part of the scalp. 

At the time the accident occurred, the patient was alone in the room,, which is in the 2d story of the building; and his appearance in the room below, in the mutilated condition described, was the first intimation his fellow workmen had of the accident. He described the manner in which the accident occurred, and one of the men went up and found the arm lying on the floor beside the machine and the wall of the room (which is about eighteen inches from the shaft), covered with blood, showing that the man must have accompanied the revolutions of the shaft for a certain length of time before the arm finally separated.

If you’re surprised he was in any state to walk downstairs, you’re not alone. The author returns to this subject at the end of the article.

I saw the patient twenty minutes after the accident. He was then lying on the floor of the basement room of the mill, suffering a good deal of pain, but retaining his strength and faculties to a wonderful degree. There was no haemorrhage of consequence from the stump. Brandy was administered to him pretty freely, and he was immediately removed to the Hospital, where, in the absence of Dr. Kimball, the patient came under my charge. There was no doubt as to the course to be pursued, and accordingly, with as little delay as possible, the patient was brought under the influence of chloric ether, and I proceeded to disarticulate the humerus at the shoulder, assisted by Drs. Green, Davis and Kendrick, of this city.

 Amputation was clearly the only option. Once the remaining portion of bone had been removed at the shoulder, the operation entailed forming a flap of skin to cover the wound. But: 

At this stage of the operation an unexpected difficulty presented itself; and the patient was for a short time in extreme peril. It has been noticed that there was no haemorrhage from the lacerated stump. Neither did any immediately follow the operation; and on searching for the axillary artery, it was found that it had been torn off higher up, and therefore had escaped the knife altogether.

The axillary artery is a large vessel which takes blood to the armpit and upper arm. What seems to have happened here is that it was severed some distance above the main site of the injury, and a clot prevented further haemorrhage. As soon as the surgeons inserted an instrument into the wound, the clot was removed and copious bleeding began, putting the life of the patient in grave danger. 

The thumb and forefinger of the left hand were thrust up the wound in the direction whence the blood proceeded, and the extremities of the vessel caught, at the point where they emerge from between the clavicle and rib. The wound was then enlarged in the direction of the clavicle, a tenaculum thrust through the mass held by the thumb and finger, as high up as possible—and finally a stout ligature applied above, arresting the bleeding entirely. No other vessel required to be ligatured. The patient at this time was looking very badly, and required pretty active measures—with stimulants, frictions, &c, to restore him to any degree of consciousness. He soon began to rally, however, and the edges of the wound were then drawn together by three or four sutures, and a cold water dressing applied.

A crisis efficiently averted: ligating the severed vessel was exactly the right response. The patient was delirious for three or four days, but then made a good recovery. Back to the accident. Were you wondering how the young man made it down a flight of stairs with his arm gone? It was worse than you’re imagining.

The conduct of the young man at the time of the accident was also most remarkable. It was noticed above, that he was at work alone in an upper story of the building. To reach the stair-case—which was at the opposite end of the room—he was obliged to climb over a pile of cotton which surrounded the machine—in all not less than twenty bales —and on reaching the room below, retained his self-possession perfectly, and detailed the circumstances of the accident with remarkable calmness.

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