Pegged out

Cases in practiceIn 1865 a young eye surgeon from Gloucester, Robert Brudenell Carter, sent a series of case reports for publication in The Ophthalmic Review. Carter was an unusually accomplished individual whose achievements went far beyond

surgery. He performed with distinction as an army surgeon in the Crimea, and his dispatches from the conflict were published in The Times.

Robert Brudenell Carter
Robert Brudenell Carter

Carter founded ophthalmic hospitals in Nottingham and Gloucester, but eventually became disillusioned with medical life in the provinces. When he decided to move back to London in 1868 it was the newspapers, rather than hospitals, to which he applied for a job. The Times made him a staff member, as did The Lancet; and the following year Carter resumed his surgical career at the Royal Eye Hospital in Southwark.  For the rest of his life he pursued this unusual double life as an eminent surgeon and a prominent member of Fleet Street.  And here’s a nice piece of trivia: he was the first Times journalist to use a typewriter.

This case report gives some hint of his literary abilities: Foreign body in the orbit

G. W., a hale, vigorous old man, turned 73 years of age, fell down stairs in the dark, being drunk, some time in the last few days of May. He did not lose consciousness from the fall. He injured the nasal side of the right eye, and bled very freely from the wound; but he did not seek medical aid till June 1st, when he went to Mr. Clarke, who found a ragged conjunctival wound and much swelling of the lids, and ordered a simple dressing.

So far, so unremarkable. It seemed that the old man had fallen on a sharp object which had grazed the surface of his right eyeball, and made a small wound between the eye socket and the nose.

The patient presented himself at intervals until the 6th of June, when Mr. Clarke discovered the presence of a foreign body in the wound, but deferred its removal until the following day, when he visited the man at his home. He then felt the extremity of a piece of iron, which he seized with forceps and attempted to withdraw. By using considerable force, and after much time, he removed the entire shaft of a cast-iron hat-peg, measuring three inches and three-tenths in length, and weighing twenty-five scruples.

An amazing item to find completely hidden in an eye wound. A scruple was a unit of weight used by apothecaries and pharmacists, equal to one twenty-fourth of an ounce. This hat peg was a substantial object, more than 8 cm long and weighing 32 g.

On further inquiry, Mr. Clarke found that this hat-peg had been one of a row, screwed to the wall near the bottom of the staircase; so that the man must have fallen upon the end of the peg, and must have broken it by his momentum after it had become completely buried in his orbit.

hat peg
The offending item

I’ll be honest, I winced a little at this point.

The base of the hat-peg was still in its place in the row, and presented a recently fractured surface fitting accurately to that of the portion removed from the patient. The annexed woodcut represents the hat-peg and its base precisely of their natural size. 

Looking remarkably like a modern hat peg, indeed. 

When the question arose with regard to the exact period of impaction, no one could answer it. There were the seven days during which the patient had been under medical observation; but he could not remember on what day of the week he fell down, and could only say that it was four or five days before he went to the doctor. Four or five, with an illiterate old man, means simply x; but it may be presumed that the actual period of impaction was between ten and twenty days. The patient recovered without a single unfavourable symptom.

The lucky man.

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