In 1873 Thomas Lauder Brunton was asked to give a lecture to the Abernethian Society of St Bartholomew’s Hospital in London. Lauder Brunton would later become famous as the pioneer of amyl nitrite, the first drug shown to be effective in treating angina pain. But in 1873 he was a little-known 29-year-old, only recently appointed to the hospital as casualty physician and Lecturer in Materia Medica (which we would now call pharmacology).
As the subject for his lecture, Lauder Brunton decided to talk about shock and syncope – both terms which now have rather specific meanings in medicine, but he used them to describe the body’s reaction to mental or physical trauma. Sometimes the two can be closely related: physical injury may cause mental distress, and vice versa – as Lauder Brunton demonstrated with this anecdote:
Many years ago the janitor of King’s College, Aberdeen, had rendered himself in some way obnoxious to the students, and they determined to punish him.
King’s College, Aberdeen, founded in 1495 and now part of the University of Aberdeen, is one of the most ancient universities in Scotland. The janitor was the college employee responsible for opening and shutting the main gate, and ringing the chapel bell to summon students for their daily services. Goodness knows what he had done to offend them, for their revenge was gratuitously cruel.
They accordingly prepared a block and axe, which they conveyed to a lonely place, and having dressed themselves in black, some of them prepared to act as judges, and sent others of their company to bring him before them. When he saw the preparations which had been made he at first affected to treat the whole thing as a joke, but was solemnly assured by the students that they meant it in real earnest.
A prank that had already gone far enough, you’d think. But apparently not:
They proceeded to try him, found him guilty, and told him to prepare for immediate death, for they were going to behead him then and there. The trembling janitor looked all round in the vain hope of seeing some indication that nothing was really meant, but stern looks everywhere met him, and one of the students proceeded to blindfold him.
The students now reached the climax of their practical joke. But it wasn’t quite as hilarious as they had imagined it would be:
The poor man was made to kneel before the block, the executioner’s axe was raised, but instead of the sharp edge a wet towel was brought smartly down on the back of the culprit’s neck. This was all the students meant to do, and thinking that they had now frightened the janitor sufficiently, they undid the bandage which covered his eyes. To their astonishment and horror they found that he was dead.
It’s possible that the story is apocryphal, of course, but many later textbooks quoted it as an example of death caused by simple terror. The lecture in which Thomas Lauder Brunton told this anecdote is notable for other reasons, too. His conclusion was that the conditions surgeons described as ‘shock’ or ‘syncope’ were often caused by low blood pressure, which tended to result in loss of consciousness. This is close to today’s definition of circulatory shock, and his approach to treatment – which entailed increasing the blood pressure with drugs or by increasing cardiac action – was decidedly modern in its outlook.