On November 9th 1869 a private from the 5th Royal Irish Lancers, ‘Richard F.’, arrived at the Royal Victoria Hospital in Netley, a large military hospital on the south coast of England. He had been evacuated from Lucknow in Uttar Pradesh, where he had been serving with the British forces before being invalided out of the service with an aortic aneurysm. This condition was fairly common at the time; what made his case unusually interesting was his previous medical history. His doctors thought it worth writing a report which was subsequently published in The Lancet:
Private F was about to start on a message from the orderly room of the 5th Lancers, on the morning of April 1st, 1869, when his horse reared as he was in the act of mounting him. He was lifting his lance across the horse’s neck to lower it into the bucket when this occurred, and, being himself thrown forward on his seat, the butt of the lance was also projected in front and touched the ground. No sooner had the horse come down than he again reared; and, in the confusion of the moment, the point of the lance was now brought opposite to the lower part of the right side of the trooper’s chest. The horse came down again on his fore feet while the lance was in that position, with its butt end firmly fixed against the ground, and, as the horse descended, the lance was thrust forcibly into the man’s chest and the point of it out through his blade-bone.
Potentially a catastrophic injury. It might easily have pierced one or both lungs, or even his heart. It is likely that any one of these would have killed him; luckily, however, the lance seems to have missed the major organs.
The horse next bolted towards the regimental stables, which were distant about a hundred yards from the orderly room, and ran about eighty yards before he could be pulled up; the trooper all the time grasping the lance with his right hand to take the weight off his chest, and pulling up the horse with his bridle or left hand. He appears to have been under the impression that the lance had only gone through beneath the skin of his side until he succeeded in pulling up the horse, when, turning his head round and seeing the part of the lance protruding beyond his right shoulder, seized with sudden panic, he threw himself off his horse, and fell on his left side.
Sudden panic seems a perfectly reasonable reaction in the circumstances.
The butt of the lance cleared the horse’s neck as the man went over; on the butt coming to the ground, however, which it did with great force, the weight of the trooper’s body acting on the long weapon by which it was transfixed broke the butt and part of the shaft off.
This was, in fact, two injuries: the first impact propelled the lance through his chest, and the second shattered it.
Private F did not lose consciousness. He managed to get partly up on his legs, and, assisted by two syces (native grooms) who ran to him, he tried to get the lance out of his body; but the regimental sergeant-major, coming up, stopped them, and made F lie quiet till assistance from the hospital, about half a mile off, could be obtained.
Well done the regimental sergeant-major. When the body is transfixed by a foreign object like this it can be extremely dangerous to remove it unless you know what you’re doing: there may be punctured blood vessels inside the wound which can bleed aggressively as soon as the weapon is removed. Pulling the lance out without expert help might have resulted in catastrophic haemorrhage and rapid death.
Assistant-Surgeon Dunn, with the apothecary and hospital sergeant, came without delay to the spot where the wounded man was lying. They found him with his coat and shirt taken off, and some horse’s litter placed under him.
Let’s hope the ‘horse’s litter’ was clean.
The spear-end of the lance was sticking out behind the shoulder, and was bent from the straight line. The length of this protruding portion was a little over eight inches. The iron butt together with a piece of the shaft between three and four feet in length was broken completely off and lying on the ground; the portion of the shaft protruding from the lower part of the chest in front was about two feet long, and was splintered. The man was quite conscious, and did not appear to have lost any blood from the wound, owing to both openings being firmly plugged by the lance.
Which is why it would have been a really bad idea to pull it straight out.
Assistant-Surgeon Dunn then assessed the injury and made the sensible decision to saw off the shaft of the lance close to the entry wound – he concluded that it would be easier to extract the weapon through the man’s back rather than pull it back out the way it had come.
Attempts were then made to draw out the spear-end and part below through the opening in the scapula, but without success. This confirmed the belief that the weapon was broken below the portion which was visible. The openings in the soft coverings and in the scapula itself were next enlarged, and, on the end being drawn out a little, the broken part came into view. The iron of the spear-plate on the flag side of the lance was found to be broken across just at the upper opening for the insertion of the flag, nearly one foot from the point, together with the adjoining wood. The iron band opposite to this spot was not broken, but was bent at a considerable angle. They had to wait till a proper saw could be got from the armourer-sergeant for sawing through this iron band; but as soon as this was obtained and the division effected, the bent spear-end was removed.
Part of the lance had now been removed; but a portion still remained inside the chest.
The movements resulting from the efforts to get away the end of the lance, it was found, had caused the sawn end at the front of the chest to pass inwards a short distance; and, in consequence, what remained of the lance in the chest had to be pushed downwards from the scapular wound, until the end again protruded at the wound of entrance. The end was then laid hold of by the fingers, and on being pulled came away without any difficulty. A good deal of blood was lost during these operative proceedings, but scarcely any after they were completed. The large opening in front of the chest was temporarily closed by sutures and a bandage, and the man carried in a dhooley to hospital, where he remained about two months under treatment.
After the man’s repatriation to England several months later he was examined again. Judging by the position of the entry and exit wounds, the doctors concluded that
the lance probably entered the chest between the cartilages of the fifth and sixth ribs, leaning on the conjoined cartilages of the sixth and seventh ribs as it entered; passed obliquely upwards and backwards through the middle lobe of the lung; and, making its way out between the third and fourth ribs behind, issued through the scapula and integuments at the spot already described. Scarcely any traces of the injury to which the right lung had been subjected could be found on stethoscopic examination. There was loss of respiratory murmur over a limited space near the wound of entrance, but nothing abnormal could be detected in other parts of the lung. The general expansion of the right side of the chest on inspiration was equal to that of the left side. Some of the movements of the right shoulder were a little restrained, owing to the adhesions about the scapula, but not to such an extent as would have prevented the man’s fitness for duty as a lancer; the aortic disease and its consequences were the cause of his being discharged from the service.
The attending surgeon concluded that the aortic aneurysm was unrelated to the injury – quite plausible, since at this date syphilis was overwhelmingly the commonest cause of the condition.
Although aware of instances of penetrating lance wounds of the lung with recovery having been recorded, I do not remember to have met with any record of a perforating lance wound of the chest and lung with recovery; and, thinking that the fragments of the lance by which the injury in the present instance was effected might serve as a permanent illustration of the case, I applied for them to be deposited in the Museum of Military Surgery at Netley, and steps have been taken to obtain them for this purpose.
I’d love to know whether this artefact still exists.