Firearm fires forearm

Case from St George's Hospital

Today’s medical dispatch comes from St George’s Hospital in London, and was reported to The Lancet in 1850:

A wound of a very unusual description was lately inflicted on a young man of twenty-three, who was admitted under the care of Mr. Tatum. From the patient’s statement it would appear, that on the 25th he was out shooting blackbirds. Whilst reloading his gun, the ramrod remained fixed in the wadding. He requested a boy who accompanied him to take hold of the butt end of the gun, while on his side, he seized the ramrod with his left hand, making efforts to extricate it.

A small boy holding the butt of a loaded rifle, while somebody else tries to dislodge a blockage from the other end? What could possibly go wrong?

By some unfortunate circumstance the gun went off, and the ramrod entered the palm of the hand, passed under the annular ligament, along the muscles of the arm, through the interosseous ligament, and came out a little below the external condyle.

A condyle is the knob at the end of a bone. Really remarkable bad luck. The ramrod had passed right through the forearm, emerging just below the elbow.

A very curious circumstance is, that the patient was not aware of being hurt, and looked round to find out whence the report had come. He, however, soon perceived the smoke issuing from his own barrel, and was surprised and frightened at seeing the rod lodged in his arm.

As you probably would be.

The patient endeavoured to pull it from its situation, but his efforts were in vain—it was so tightly fixed that he could not move it. This effort was more than he could bear, and he was on the point of swooning, when he called some men to his assistance, who assisted him home, in a very feeble state. When attempts were made by a surgeon to extricate the foreign body, he failed, until he placed his foot against the bed and pulled with all his might, whilst a second person fixed the patient’s trunk.

Not a terribly sophisticated way of removing the foreign body, but an effective one.

At last the ramrod yielded; very little blood escaped, and no pain was felt for the next two hours, but after this period it became very acute through the whole course the projectile had taken — viz., from the wrist to the elbow. Compresses, with Goulard’s lotion, were applied, and calomel and Dover’s powder administered.

Goulard’s lotion was a solution of lead salts, an astringent preparation often used to treat bleeding and inflammation. Its use was abandoned when it became clear that lead poisoning was a major risk. Dover’s powder, primarily used against colds, contained opium. Calomel, a purgative, was used to clear the bowels.

The patient had several fainting fits during the day, but passed a tolerable night. The next day he was admitted under the care of Mr. Tatum. The arm was red and swollen; the openings at the wrist and elbow were somewhat ecchymosed [bruised], but of a small size, and Mr. Tatum judged that the rod had taken the course described above, from finding the tenderness, on pressure, suddenly stop half-way up the anterior aspect of the forearm, and continue upwards from a point exactly posterior to that region. The treatment now adopted was vigorously antiphlogistic.

Aimed at reducing inflammation, in other words. A sensible course of action, though the chosen measures probably had little effect.

Mr. Tatum ordered leeches to be applied to the wrist and elbow, and this measure was repeated six times between the 26th of January and the 7th of February. During the first week the patient complained of much pain along the wrist and forearm, but this gradually diminished. The discharge was of a healthy nature, though at first mixed with gunpowder; and the only uneasiness now complained of (a fortnight after the accident) is numbness in the wrist, and occasional spasmodic twitches from the ring-finger to the elbow.

Happily, the case terminated with a complete cure:

The patient left the hospital, and has now returned to his avocations, those of assistant in a surgery, and makes a free use of his hands. From the slight amount of haemorrhage and of nervous lesion which accompanied this wound, we are driven to suppose that, the extremity of the ramrod being blunt, the vessels and nerves were pressed aside by it as it passed through the forearm, the rod gliding between the bones and along the posterior surface of the radius.

Probably true. There are many nerves and blood vessels in the forearm which might easily have been severed – if a single one had been injured there would have been obvious symptoms. Somehow he got away with it.

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