An unwanted buzz cut

An extraordinary recoveryIn 1869 The Boston Medical and Surgical Journal reported the following unusual case which had taken place a few years earlier in California:

On our recent tour through Mendocino county, we made the acquaintance of B. F. Chase, a foreman in the Caspar mill, who received a wound in July, 1864, the nature of which, and his complete recovery, furnishes one of the most remarkable cases of the kind to be found on record. He was doing some work under a picket saw, which, when in motion, runs at a tremendous speed.

A fast rotary saw. I can only find one other example of the phrase ‘picket saw’, but I assume it was used to cut pickets (wooden stakes, like those used in a picket fence).

Inadvertently raising his head against the saw, he instantaneously received a cut beginning at the frontal bone, one-half inch above the nose, and running back to the occipital bone, making an incision nine inches in length (taking in the convexity of the skull).

An astonishing injury, particularly when you read what the doctor had to say about it.

Dr. A. G. Folsom was sent for and arrived in half an hour. He very naturally supposed the wound was a fatal one, and at first thought that it would be useless to dress it, believing the man would die within a few minutes. But Mr. Chase being perfectly conscious and suffering no pain whatever, the doctor finally concluded to attempt a careful dressing, even if the patient should die under the operation— encouraged somewhat, he says, by remembering the case of the man in Vermont who had a tamping iron blown through his head and recovered therefrom.

The ‘man in Vermont’ was Phineas Gage, a railway worker who survived an explosion which drove a large iron bar through the head. The fact that the human brain could survive such massive injury without serious impairment was a revelation; and today this remains one of the most famous cases in American medical history.

The cut in Mr. Chase’s-head gaped open so that the skull bones were a full inch apart. The doctor made no attempt to probe the depth, but did insert a pocket rule 1½ inches into the brain (besides the thickness of the skullbone), which was as far as it would go without touching the walls of the cut.

The doctor was a braver man than me. Sticking a ruler inside a patient’s head sounds risky, if not foolhardy, but no doubt he knew what he was doing.

On account of its circular shape the saw must have penetrated the brain much deeper than a point on a straight line from one extremity of the wound to the other. Dr. Folsom estimated that the brain was cut nearly to its base, or fully three inches deep.

This is a very deep cut indeed.

He carefully removed all fragments of the skull—taking out over 30 pieces—and washed out the sawdust that had got into the opening, using warm water to promote haemorrhage, which was slight for such an extensive wound. He also washed out more than a table-spoonful of brain.

Just pause to savour that last sentence for a moment.

How much more the saw carried away we can only conjecture. The doctor then shaved the scalp, applied a tourniquet to bring the bones together, and closed the aperture with six stitches, finishing with adhesive plaster, and leaving three openings, one at each end and one in the centre. The only dressing ever used was cold water.

This seems good basic medicine to me. A strip of skull had been lost to the saw, but the use of the tourniquet was one way to reduce the resulting scar – and ensure that the brain retained a protective covering of skull. The openings were a sensible precaution against swelling: if the wound had been hermitically sealed to the outside world there would have been no way for excess pressure to be released, with brain injury a serious risk.

The patient was in possession of all his faculties during the whole time, and said he experienced no pain, then nor afterwards, until he was entirely recovered. He visited the mill in about four weeks after the accident, and soon after resumed his duties as filer and foreman, which position he still holds. He says he never lost sleep or appetite, or experienced any physical or mental pain or weakness from his wound. The doctor’s theory for this wonderful case is that the wound was a clean, smooth cut, unaccompanied by concussion, and that it is usually the concussion and not the incision of the brain that causes death.

A questionable thesis; it depends very much which part of the brain has been injured. It sounds as if the saw ran in a straight line right down the middle of the skull, in which case it may have cut along the longitudinal fissure, a natural cleft between the two hemispheres of the brain. There is less brain matter here to damage, so although it took some tissue away from the frontal and parietal lobes, somehow the patient escaped serious impairment. Either way, to have escaped a wound of that nature with his life, let alone his faculties, was an amazing stroke of luck.

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