The Victorian surgeon Sir Jonathan Hutchinson was ‘one of the great medical geniuses of his time’, according to his entry in Plarr’s Lives of the Fellows, the biographical reference work curated by the Royal College of Surgeons. Hutchinson had an astonishing range of interests – he was an expert in infectious disease (the world’s leading authority on syphilis), in disorders of the skin, and a walking encyclopaedia of rare conditions, many of which have been named after him. He was also a collector of medical specimens, rocks and fossils, and had a considerable private natural history museum (not to mention an animal hospital) at his country house in Surrey.
Hutchinson lived at a time when surgeons were generalists rather than specialising in one part of the body – and he did a bit of everything, though his many years at the Royal London Ophthalmic Hospital (better known as Moorfields, then and now) showed that he had a particular interest in the disorders of the eye. In 1858 the in-house journal of the hospital, the Ophthalmic Hospital Reports, published this short case report by Hutchinson – a story deemed so extraordinary that it subsequently appeared in several textbooks.
The subject of this case was an outpatient who came under my care, a very healthy man, employed in an iron foundry. It appeared that whilst at work some of the molten metal (at a white heat) had been spurted into his left eye.
The melting point of iron depends on its purity, but this ‘molten metal’ must have been at a temperature of at least 1100C – and possibly even higher.
It had struck the globe over the lower edge of the cornea and the adjacent part of the sclerotic.
The sclerotic – known today as the sclera – is the white of the eye, while the cornea is the transparent layer which covers the pupil and iris. These are delicate structures, and ill suited to being sprayed with white-hot liquid metal.
One of his fellow labourers removed the metal after it had solidified, with some difficulty, on account of its adhering firmly to the charred tissues.
That phrase, ‘charred tissues’, makes you wince, doesn’t it? And these days it’s probably best to leave this sort of thing to the paramedics, rather than trying to remove any shards of metal yourself.
It had in cooling been accurately moulded upon the surface of the globe and the edge of the lower eyelid.
The article includes an illustration – unfortunately it’s too faint to reproduce here, but it shows a thin curved piece of metal, rather like a fragment of contact lens.
So severe a burn might have been expected to induce serious consequences. The affected parts of the cornea and sclerotic, which included the greater part of the thickness of each, but without actual perforation, sloughed off, as also did some of the palpebral mucous membrane.
The palpebral mucosa (or conjunctiva) is the inside lining of the eyelids.
The globe itself, however, did not inflame. In the healing of the scar the pupil was drawn downwards by puckering of the iris at its attached margin, but perfect vision was retained.
Even though the cornea has no direct blood supply (it gets its oxygen from the tears), it heals rather well. But healing causes scar tissue, which can distort natural anatomy. In this case the tension at the surface of the eyeball tugged at the cornea, pulling the pupil out of its normal shape. It does sound, however, as if this defect receded as healing continued.
Some adhesions between the globe and the lower lid resulted, but they do not constitute any material deformity, or occasion the man much inconvenience.
A fantastic outcome, really; I suspect that few doctors would disagree with the proposition that the likely prognosis of ‘getting molten iron in your eye’ is ‘one eye fewer than you had before’.
Miraculous as this case at first appears, it did also remind me of something. In my teens I was given a soldering iron, which I used to assemble various (mostly unsuccessful) electronics projects. If you overload the tip of a soldering iron, you can easily end up dripping molten solder all over the place. I remember my surprise at discovering that when one of these droplets hit a tiled floor, it instantly turned into a thin sheet of silvery foil, already cool enough to handle. The explanation is simple: the droplet flattens as it falls, increasing its surface area and allowing it to cool very quickly.
Of course solder (an alloy of tin and lead) has a much lower melting point than iron: ~200C as opposed to ~1200C. There is no doubt that the metal that hit the unfortunate foundry worker in the face was considerably hotter than the solder I used to drop on my parents’ floor. But the mechanism of injury – tiny droplets flying through the air – is probably what saved him from being blinded or worse, since it may have caused the metal to lose a good portion of its energy before impact.