A CARING SURGEON

THE DOCTOR'S BAG

the blog about the medicine and surgery of yesteryear

Dr Keith Souter aka Clay More

SURGEON BENJAMIN HOWARD - a caring surgeon

Some people know exactly what they want to do in life. Benjamin Douglas Howard decided early in life that he wanted to be a missionary and make  difference to many. Although he never actually achieved this he did travel around the world and made a difference to many lives as a surgeon.

He was born in 1836 in Chesham in England, the fourth of five children. Both parents died early and he and a brother were brought up and schooled in the town. Upon leaving he worked as a decorator in Luton, about twenty-five miles away.

Benjamin Douglas Howard (1836-1900)

At the age of 17 years he emigrated to America and began studies in medicine at Williams College in Massachusetts. His intention was to become a medical missionary. He did not complete his studies, however, but changed direction and medical institution, qualifying  from the College of Physicians and Surgeons in New York in 1858.

Having read Uncle Tom's Cabin and been deeply moved by it he moved to Missouri and obtained a position as a clerk in a slave market in order to understand how such an inhumane  system could operate. Horrified by what he saw he  used his position and became actively  involved in the Underground Railroad, helping slaves escape to Canada. When he was discovered he was forced to flee for his life.

Civil War 

In May 1861 he was commissioned as Assistant Surgeon in the 19th Regiment of the New York Volunteers, later known as the Third New York Light Artillery. In August he joined the Army of the Potomac.

During the Battle of Antietam in 1862 he was called upon to treat General Israel Richardson, who was mortally wounded, and also Major General Joseph Hooker, who was wounded in the foot while standing up in his stirrups.

From 1861 he had started operating on abdominal wounds using what he described as hermetic sealing. This involved closing the wound with sutures, then covering the wound too seal it. He was  impressed with the results and thought that by applying the same method to chest wounds he could save many lives.

In 1863 he was acting director of the Department of the Ohio. He wrote a letter to Surgeon General William Hammond advocating treatment for chest wounds using his method of hermetic sealing.  This involved closing the wound with steel sutures then overlaying it with layers of linen and lint, soaked in collodion, to effectively produce a hermetic seal.

One of the problems with chest wounds is that they can produce a sucking injury.  This means that as the patient breathes, air is sucked into the chest cavity through the wound. The increasing air inside the thorax but outside the lungs  then produces extreme breathlessness as the lungs start to collapse.

The operation  was controversial, but proved very popular with a lot of surgeons, since the immediate dyspnoea (shortage of breath) was relieved. Patients were operated on immediately, then sent back down the line to recover.

However, partly because he did not fully understand the mechanism of sucking injuries, and since the germ theory of disease was as yet unknown, it was subsequently found that the operation had a high mortality rate. Post mortem examinations found that many patients developed lung abscesses or empyema, where pus accumulates in the chest.

The Howard Ambulance

Howard also developed a field ambulance that greatly improved the transport of wounded soldiers. It was well sprung with cushioned seats and compartments for water and medical supplies.  Its lower-able flaps made the moving in and out of stretchers much more comfortable for the wounded.

These ambulances were economical to build and the design was taken up by other countries including the French Army after the war. They did, however, require four horses to draw them and the design was later superseded by lighter ambulances. 

Visiting Professor and Artificial Respiration

After the war Howard took up the post of Professor of Surgery in New York and also visiting professorships in Ohio and Vermont.  His ideas were much in  vogue and he was invited to lecture in Europe and Africa. 

In 1871 he wrote a paper The Direct Method of Artificial Respiration, or the Treatment of Persons  Apparently Dead from Suffocation by Drowning or from Other Causes.

He put this into practice in New york, training lay people as well as medical professionals and it was taken up across the USA. 

In the 1880s he returned to England for a time and was instrumental in establishing the London Ambulance Service. 

Then in the June 18, 1881 issue of the British Medical journal,(BMJ) he wrote an updated paper The Direct Method of Artificial Respiration for the Treatment of the drowned, Still-birth, etc. It is illustrated with likenesses of himself demonstrating the technique. 

Prison Research

In the 1880s and 18902 he turned his attention to prisons and the treatment of inmates. This led to research visiting prisons in  England, Europe, Russia and the USA. He wrote two books Life with Trans-Siberian Savages, published in 1893 and Prisoners of Russia: A Personal Study of Convict Life in Sakhalin and Siberia, published posthumously in 1902.

He lived in New York until 1898, but moved to New Jersey where he died from liver disease in 1900. He made his mark in life as a doctor, if not as the missionary that he had intended to be in his early life.