THE DOCTOR'S BAG
Dr Keith Souter aka Clay More
I was researching about the Chisolm chloroform inhaler recently ( as a Scottish doctor I feel compelled to use our way of spelling) when I went off on one of those distracting tangents that make research so much fun. So in this blog I am going to talk about the Wind of the Ball Theory postulated in the early very early nineteenth century to account for unexplained deaths on the battlefield. They were attributed to the wind of the passing cannonball and the mysterious force it had to kill without necessarily producing signs of impact or injury.
But first a biographette and a thumbnail description of his great invention.
Dr Julian John Chisolm (1830-1903)
Julian John Chisolm, often referred to as John Julian Chisolm or as J.J. Chisolm was born in Charleston, South Carolina in 1830. He obtained his MD medical degree from the Medical College of South Carolina in 1850 then travelled to Europe to study medicine and surgery in Paris and London.
He returned to Charleston in 1860 and took up the post of Professor of Surgery at the Medical College. He kept the position throughout the War and in 1861 published the first edition of his textbook A Manual of Military Surgery for the Use of Surgeons in the Confederate States Army.
He was one of the few competent surgeons at the start of the War (it was the steepest of learning curves for surgeons on both sides), but his book gave detailed instructions. His experience was based on personal observations of many wounds treated in both civilian and military hospitals admitted form the battlefields of Europe. The book was updated twice during the War.
The Chisolm Inhaler
During the war chloroform took over from ether as the anaesthetic of choice. It was administered by using a piece of cloth, which was fashioned into a cone, onto which the chloroform was administered. This was found to be wasteful, since much of the chloroform evaporated. Hence it was unscientifically and crudely given and could also affect anyone see in the enclosed space used as an operating theatre. In a field hospital that may have been a tent.
With the Union Naval blockade the supplies of chloroform were drastically reduced. Stimulated by that, and by the wasteful and hazardous way it was traditionally given he invented his inhaler. It consisted of a flattened cylinder, measuring 2.5 by one inch, with two tubes which could be inserted into the nostrils. The chloroform was dripped into a perforated disc onto a cloth inside the inhaler. It reduced the amount needed to a mere ten per cent.
It was not until the latter stages of the war that he invented this ingenious device, and he invented it because of necessity.
But as I said, while reading his Manual of Surgery I came this fascinating offshoot.
The Wind of the Ball Theory
Ever since men went to war with guns military surgeons had reported of deaths on the battlefields with no apparent cause. No wounds visible, yet internally sometimes catastrophic damage. Such things are mentioned in medical writings in the sixteenth century.
A Doctor D Ellis wrote a paper about this in the Edinburgh Medical Journal of 1812 entitled Observations on the nature and cause of certain accidents which sometimes occur in battle, and have been usually ascribed to the 'wind of a ball.'
This wind of the ball, was thought to be the wind that accompanied the flight of a cannonball, but which came to be associated with musket balls and the Minie ball.
Ellis wrote about delayed death of a soldier, that he had witnessed firsthand.
"A shot passed above the head of a man who should have been with his comrades in a trench. The surgeon examined him immediately, but found no injury. From the state of the pulse, however, the surgeon deemed it necessary to send the man to the hospital, and although no external injury could be discovered, the man died in less than 48 hours after the accident."
He goes on to describe another case.
"Another delayed death occurred when the victim of a minor wound "died ....in a few days, not, as was conceived, from the effects of the injury done to the arm, but from the '"wind of the ball.""
Such deaths the military officials and the medical authorities attributed to the wind of the cannonball.
A French surgeon, Felix Larrey, who was a military surgeon and physician to Napoleon lll postulated that the phenomenon was due to the physics of the cannonball motion, which he described as travelling first by rectilinear movement and then by curvilinear motion. By this it seems he was trying to describe the falling of the cannonball towards the end of its trajectory. He used this to try to account for the lack of external damage to the human body by postulating that as the velocity diminished as it neared the ground, its curvilinear motion, by which he meant its rotation, would cause it to roll around the body without leaving a mark. This he equated with the way a wheel would pass over a limb or body, instead of forcing a way through it.
Felix Larrey (1808-1895)
Ellis was not convinced by this and could not imagine that a cannonball other projectile could move so slowly around the body, leaving no mark, yet still caused death. He did not accept Feix Larrey's physics. instead, he said:
"these accidents appear altogether different from those produced by the operation of ordinary mechanical agents; and bear, in all their circumstances, a much nearer resemblance to th effects of...the action of atmospheric electricity."
This theory did not last long, however, and it was supplanted by that of another by Doctor P Forbes, also writing in the Edinburgh Medical Journal of 1812. He proposed that it was not wind at all, but a vacuum that was created by the passage of the cannonball. This would suck the air from the body, and also produce its effect:
"The consequences of which is a sudden expansion of all the fluids in the stomach and the blood in the blood vessels, and the rupture of both."
Not wind, but a vaccuum?
Well, let me now show you what Doctor Chisolm had to say.
"Cases not unusually occur on the battlefield in which the abdominal contents might be severely crushed without apparent external injury. It is the toughness and elasticity of the skin which gives rise to the exploded theory of the wind of a ball destroying life: and such cases as those we are now considering were formerly brought forward as instances of the fatal effects of the vacuum following the wake of a cannonball.
Observation has shown that a knapsack might be torn from the back, a hair struck from the head, an epaulet from the shoulder, or a pipe from the mouth, without leaving a trace of injury; while on the other hand, viscera might be reduced to a jelly, or bones crushed, without a visible bruising of the skin. It is the ball itself, and not the wind, which produces these disorganisations. from the blow of a spent cannonball or fragment of a shell the liver might be lacerated, intestines torn, blood vessels opened, spleen fissured, or kidney ruptured, without an external wound. Severe shock and collapse mark the extent of injury received' and should the patient rally fro this condition, which is rare, violent inflammation will soon destroy life. Although we follow vigorously the treatment laid down above, we very seldom have the satisfaction of saving the patient."
He gives a clinical case of a Sergeant who sustained such an injury at the Bombardment of Battery Wagner, but I will spare you the actual details, part from to say that they illustrate the catastrophic internal injuries that can occur despite no external wounding.
Chisolm then goes on:
"The amount of destruction effected by a spent ball is often surprising. the uninitiated on the battlefield will attempt to stop, with the foot, a cannonball rolling on the ground, and which is just about exhausting its force, perhaps with only momentum sufficient to carry it one or two feet further, yet it crushes the limb put out to oppose it. Baudens, in warning persons to avoid cannonballs, however slowly they may be rolling, mentions the case of a grenadier of the guard, sleeping on his side on the ground, who was instantly killed by a spent cannonball, the blow from which lactated the vertebral column. The ball came with so little momentum that it rilled itself up in the hood of the soldier's overcoat, where it was found. It was just about to stop when it struck. One or two feet further, and its entire force would have been exhausted."
Lucien Jean-Baptiste Baurens (1804-1857) was a French military surgeon, who was himself a staunch advocate of chloroform.