Lost and found

nasal operationYears ago I remember watching a TV documentary about the Royal Navy Field Gun Competition, a yearly tournament in which rival teams of gunners race to disassemble and transport a large and immensely heavy antique field gun across an obstacle course, before reassembling and firing it – a process which commemorates a similar feat achieved in combat during the Siege of Ladysmith in 1899.

The competition is physically gruelling and extremely dangerous: many have suffered serious injury while training for the tournament. In the BBC film one of the navy doctors recalled a participant losing a finger after trapping it between a wire and the pulley block he was holding. There was a brief panic as medics tried to locate the severed digit; it eventually transpired that a teammate had put it in a matchbox and pocketed it, intending to show it to his wife when he got home. He was eventually persuaded to return it to its rightful owner, who was duly reunited with his missing member – it was successfully reattached by a surgeon later the same day.

I was reminded of that story when reading this case published in The Lancet in 1823, but dating from some decades earlier. It came from the experience of Rene Jacques Croissant de Garengeot, a French surgeon principally remembered today as the first person to describe de Garengeot’s hernia.

A soldier of the regiment of Conti coming out of L’Epee Royale, from an inn in the corner of the street Deux Ecus, was attacked by one of his comrades, and in the struggle had his nose bitten off, so as to remove almost all the cartilaginous part. His adversary perceiving that he had a bit of flesh in his mouth, spat it out into the gutter, and endeavoured to crush it, by trampling upon it. The soldier, who, on his part, was not less eager, took up the end of his nose, and threw it into the shop of M. Galin, a brother practitioner of mine, while he ran after his adversary.

This is somewhat reminiscent of the notorious Holyfield/Tyson II boxing match – known as ‘the bite fight’ – in which Mike Tyson bit off a piece of Evander Holyfield’s ear and spat it on the canvas.

During this time M. Galin examined the nose which had been thrown into his shop, and as it was covered with dirt, he washed it at the well. The soldier returning to be dressed, M. Galin washed his wound and face, which were covered with blood, with a little warm water, and then put the extremity of the nose into this liquor, to heat it a little. Having in this manner cleansed the wound, M. Galin now put the nose into its natural situation, and retained it there by means of an agglutinating plaster and bandage. Next day the union appeared to have taken place; and on the fourth day I myself dressed him with M. Galin, and saw that the extremity of the nose was perfectly united and cicatrized.

Amazing.  Eighteenth-century surgery did not go so far as antiseptics, so it’s pretty remarkable that the reattached nose did not succumb to infection – particularly given that it had been trampled in the gutter.

The editor of the article in The Lancet attaches a footnote, which is worth including:

Dr. Balfour, of Edinburgh, has published a case of adhesion, almost as extraordinary as that related by M. Garengeot. On the 10th of June, 1814, a man came to him with half the index of the left hand wanting. Dr. B. inquired what had become of the amputated part. The man told him that it had been struck off by the stroke of a hatchet, and that he had never looked for it, but he believed it would be found where the accident happened. Dr. Balfour despatched a man, who accompanied the patient to search for it. In about five minutes, the man returned with the piece of finger, which was white and cold, and looked like a piece of candle. Without the loss of a moment, Dr. B. poured a stream of cold water on both wounded surfaces, to wash away the blood from the one, and any dirt that might adhere to the other, and then applied with as much accuracy as possible, the wounded surfaces to each other. On the 2nd of July the re-union of the parts was complete.

Again, pretty astounding stuff. Fingers don’t reattach easily, particularly if little attention has been paid to the prevention of infection. 

Dr. B. remarks that ‘the finger was, in fact, the handsomest, the man had’; an observation, which reminds us of the predilection of the wag, who, being condoled with on the loss of his leg, replied, that he was sorry for it too, for it was his favourite leg.

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