Brolly painful

It’s a great headline, but I can’t take any credit for it.

When I was at school one of my contemporaries suffered an unfortunate injury. As he was bending over to pick something up, a friend thought it would be amusing to prod him in the bottom with a golf umbrella. The joker sadly misjudged the degree of force used, causing an injury which necessitated a trip to the school doctor.  The damaged derrière was diagnosed as an anal fissure, a small tear in the muscular wall of the anus: not serious, but it made sitting down painful for a few days. Somehow this piece of school gossip was picked up by the Daily Mirror – presumably tipped off by an entrepreneurial boy who fancied making a few quid – which printed the story under the headline BROLLY PAINFUL.

I was reminded of that trivial incident when I came across this rather more serious case, published in 1873 by the Irish Hospital Gazette. It was reported by a surgeon called H. G. Croley:Case of spinal injury

It appears that a boy, eight years old, was engaged in playing with the steel rib of an umbrella, and that, while holding the rib in his mouth, he fell from a bed to the floor in such a manner as to drive the steel point through the back of the pharynx. The steel was drawn out by the child himself. The immediate results of the injury appear to have been a slight haemorrhage, accompanied by nausea; during the night, the child was delirious, and, upon the next day, he was observed to have double vision.

After three days in which the boy showed no improvement, his parents took him to hospital.

Upon examining the throat, a punctured wound was noticed at the back of the pharynx, on a level with a probe passed back under the velum without raising it. On being put on his legs, the child tottered. He had convergent strabismus…

A squint, in other words; ‘convergent’ meaning that he looked cross-eyed.

…some intolerance of light, and very marked febrile disturbance. It was concluded, from these symptoms, that the rib of the umbrella had penetrated to the spinal cord, between the first and second cervical vertebrae.

The boy was incredibly unlucky: injuries to the first and second vertebrae of the neck (known as C1 and C2) are rare. Still more unusual is for a foreign object to penetrate the space between the two of them. The possible consequences of such an injury are catastrophic, since the bones protect the lower part of the brain stem, which includes structures which regulate basic functions such as breathing and the heart rate. This was a critical emergency, and the therapy offered was woefully inadequate.

The treatment consisted in the application of leeches to each side of the spine, and ice to the shaven head, and the administration of calomel and James’s powders.

Calomel was a purgative; James’s fever powder, introduced in 1746 by the physician Robert James, was a mixture of antimony (highly toxic) and calcium phosphate. Neither is the slightest use against significant neurological trauma.

There was a difficulty in swallowing; the temperature ran up to 102° and 105°; the child whistled, screeched, had the knitted brow, and threw back his head. These symptoms were for a time quite alarming, but the boy made a good recovery.

Surprising – given the site of the injury and the symptoms, the outcome might easily have been paralysis or death. To test the theory that the boy had suffered a spinal injury, one of Mr Croley’s colleagues tried an experiment on a dead body:

Mr. Stokes, tried, in the dissecting room, the effect of passing in a sharp piece of wire at a place in the dead subject corresponding with the wound in the child’s throat, and… found the wire had pierced the spinal cord between the first and second vertebrae.

Lucky boy.

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