Two spoonsful of brain on the pillow

Here’s a story so replete with ghastly details that if it happened today it would immediately be featured in a TV reality documentary about emergency medicine, complete with dramatic reconstructions and lavish amounts of tomato ketchup. This was reported to the San Francisco Medical Press in 1860 by a Dr Peter Campbell from Sonoma in northern California:

In 1850, a boy about ten years of age was riding a horse engaged in plowing; the animal took fright and ran off, the boy fell backwards, and the plow-iron entered his head a little above the eyebrow, tearing out a furrow across the temporal bone, and part of the parietal, fully half an inch in diameter and six inches in length.

A catastrophic injury. The plough dragged a large hole from the eyebrow, backwards across the temple and finishing somewhere to the rear of the skull. See diagram to the right.

I found him comatose, with about two spoonsfull of brain on the pillow, and more protruding; I cut off the protruding substance, and removed some spiculae of bone which penetrated inwards.

Not a sight one wants to see, whether as physician, parent or friend.

I drew the divided edges of the scalp together with sutures, so as to cover as nearly as possible the wound, and dressed it with adhesive plaster. The next day I found a large fungus protruding from the brain, an inch in height, and occupying the entire length of the orifice, having forced off the plaster; it resembled the raw substance of a lobster’s claw.

An unexpected and horrifyingly vivid comparison. ‘Fungus’ is merely descriptive of the extruded brain matter; the poor boy didn’t suddenly have mushrooms sprouting from his cranium.

This I clipped off close to the brain, and then applied caustic. This operation I had to perform three successive mornings, after which the wound began to heal. I had recourse to venesection and saline cathartics on alternate days, and applied a lotion of vinegar and water. The boy was still unable to speak, and on the twelfth day became insensible.

With a six-inch rupture of his skull, extensive swelling and loss of brain matter – not to mention the likelihood of infection – it is fair to say that the prognosis was poor. His family would not have been wrong to fear the worst at this point.

I found a long depression of the frontal bone, and a part of the parietal bone, above the old wound, covered with a tumor…

Not a tumour in the modern sense, but a swelling caused by infection.

…this I laid open, upon which it discharged about six ounces of pus; I washed it with port wine, and applied the usual dressings, and the boy recovered in about five weeks.

Port wine no longer represents the gold standard in antiseptics, I’m glad to say.

He has since grown to be a youth of six feet in height, learned fast at school, and become an intelligent young man. I advised him to guard against the use of spirituous liquors, passions, or mental anxiety. He has enjoyed good health until lately, when he unguardedly drank two or three glasses of brandy, and on his way home fell in an apoplectic fit, and lay in the field a considerable time.

He has, by assiduous care, slowly recovered. I would like to know if the parenchyma of the brain was reproduced, or if reproduced, what was the cause of the apoplexy on drinking spirituous liquors now, after the expiration of nearly ten years.

‘parenchyma’ = the functional (as opposed to structural) parts of an organ. Dr Campbell is wondering whether the brain matter lost as a result of the accident was regenerated during the boy’s recovery. As for the cause of the ‘apoplexy’, it may have been an epileptic seizure, a common sequel to brain injury.  The other possibility, of course, is that he drank considerably more brandy than the ‘two or three glasses’ claimed.