The spear and the eucalyptus tree

In 1891 The Lancet printed this case report by Andrew Ross, a doctor who some years earlier had been practising in the small Australian settlement of Molong in New South Wales: 

On Dec. 25th a messenger arrived requesting my attendance on one “Harry,” an aboriginal, who had, in an encounter with another of the race, arising through some quarrel over a “gin”… 

An old and derogatory term for an Aboriginal woman. 

…received a most dangerous spear wound in the abdomen or epigastric region, and leaving the spear, which was eight feet in length, embedded in the body to the depth of about seven inches. I at once proceeded, to the spot, which was about three miles from Molong, but on my arrival found the patient had in the meantime been removed to the adjoining hotel. His mate was attending to him, and was patiently engaged in holding the projecting handle of the spear in a line as near as possible corresponding with the original blow, in order, I presume, to prevent any further mischief arising until my arrival. I was subsequently informed, however, that several rude and ineffectual attempts had been made to withdraw the spear, but their efforts were foiled owing to the barbs – two in number and three-quarters of an inch in depth, the third just projecting at the mouth of the wound – being entangled in some portion of the internal viscera.

The wound was bleeding freely – probably as a result of the unwise attempts to extract the spear.

He was a young man of about twenty-six, with a good constitution. At first I was a little puzzled to decide on the best course of procedure to adopt in such a case; for on slightly moving the handle I could evidently discover that two at least of the barbs, as they were very sharp and pointed, had fairly become fouled on some portion of the internal viscera, and therefore to attempt to extract it as it had entered was not only to increase the danger by involving and lacerating other parts, but to render a chance (though at best a poor one) of recovery perfectly hopeless.

This is what makes barbed weapons so dangerous: removing them can do even more damage than the original injury.As the instrument, as I stated, had penetrated to some considerable depth, I resolved at last to extract it, if possible, from behind, low down in the lumbar region, so as to readily admit of the flow of any discharge which might subsequently ensue.

To clarify: Dr Ross’s plan was to make a new incision in the man’s back, grab the end of the spear with a pair of forceps and pull it out that way, rather than back through the entry wound in his stomach. A daring idea.

To this end I lost no time in providing myself with a small tenon saw and a pair of forceps, which I borrowed from a neighbour. After fixing the spear in the direction I wanted to extract it, and giving it to one of the attendants to hold, I commenced to saw it through close to the neck of the third barb (as seen in the accompanying engraving) and the mouth of the wound, and then steadily but firmly pressing my finger against the cut end. I then made a sufficient incision at the point behind, and by the aid of the forceps succeeded in extracting the spear, with but very slight haemorrhage. I next sponged, adjusted, and stitched the edges of the wound together, and applied a broad bandage.

All credit to Dr Ross: the ‘obvious’ treatment of simply pulling the spear out might have killed his patient, and quickly. The landlord of the hotel generously offered a free room to the wounded man, but it seems the accommodation was not to his taste:

At my next visit, the following day, I found the patient was not used to such comfortable quarters, and had during the night managed to make his escape from the room unobserved, and had joined his mates, who were camping in a bush paddock a short distance from the hotel. On learning this I repaired to the camp and found the deserter, minus the bandage, better than I expected to find him, the wound free from discharge, and little or no pain or swelling. He refused to take any food, and occasionally moistened his mouth with weak tea or thin arrowroot. I continued the sedative medicine and left him.

A few days later the patient began to show signs of complication – probably infection. Then he took matters into his own hands.

On the 28th I found the plaster and the whole of the stitches had been removed, and the original or anterior wound wide open and gaping, accompanied by a quantity of ichorous serum oozing from the orifice.

‘Ichorous’ = a purulent liquid discharged by a wound.

He had taken no medicine since my last visit. The posterior wound to all appearance had healed. His “gin” was sitting by his side, attentively bathing the wound and swollen abdomen with a few of the most tender under-shoots and leaves of the red gum tree (Eucalyptus nostrata, so common in the bush of Australia), wrapped together in the form of a wreath, and every now and again dipped into a “billy” (a tin vessel capable of holding from half a gallon to a gallon) of hot water containing the infusion of the gum leaves, which was constantly kept warm by the fire.

Dr Ross was pessimistic about the prognosis for his patient, given that he had now decided to use a folk remedy rather than Western medicine.

In consequence of this unexpected interference, and the untoward appearance of the wound (now greatly enlarged owing to the swelling), the slight chance of his recovery seemed now to be completely taken out of my hands; for to attempt to again close the wound under the circumstances would not only have been futile, but adding to the danger, as the swelling had so rapidly increased that the man now seemed quite helpless, and the pulse sinking. I was somewhat, then, reluctantly forced to abide the issue of what seemed not only a clumsy, but an unnatural and cruel sort of application.

Nevertheless, the doctor was determined to follow his patient’s progress, merely leaving him some opium to help with the pain.

On returning on the following morning, to my surprise I found what I had previously regarded as a useless application had not only lessened the size of the wound, but had had the effect of also considerably reducing the swelling in the abdomen. Seeing such promising results, I of course offered no further objection to the use of this evidently strange application to the wound, and simply continued the opium. On the 29th I was still further pleased to find that the patient had rallied and was in good spirits, the wound gradually closing up, and very little discharge. On the sixth day (the 30th) I found the abdominal wound closed; and with the exception of the swelling, surprising to say, it looked almost as well as it did when first dressed, and so far everything was progressing favourably.

To Dr Ross’s surprise, his patient continued to improve, and when he visited him in early January, a mere week after the injury, the wound had healed.

On the 10th he called on me at my surgery, after walking a distance of three miles. He was still improving. By the 12th the tribe had left their camping-ground, and had proceeded thirty miles further into the interior of the bush. I saw no more of the invalid until he called on me some weeks after, and then he appeared to be hale and hearty, but quite unable to endure the fatigue of riding, an occupation he often expertly followed.

A patient who seemed likely to die was restored to something like full health. Dr Ross was in no doubt as to the reason for his recovery.

The patient some years afterwards died, I am informed, of pulmonary consumption, a disease very prevalent among the aborigines. Gum leaves made into an ointment possess most remarkable and powerful healing properties; so also with the eucalyptus oil, which of late years has become a very popular external and internal remedy in Australia.

Eucalyptus has long been used medicinally in many parts of the world. The most serious threat to this man’s life was infection – and at the time that this article was published there was a great deal of interest in eucalyptus oil as a possible antiseptic.  There were several books on the subject, including Nature’s Hygiene, which argued for its routine use in Western medicine.

Interestingly, there has recently been a resurgence of academic research into the antimicrobial properties of compounds found in the plant.  See here and here for two studies published in the last year which found some evidence for antibiotic activity in eucalyptus derivatives.