The nature and effects of traumatic wounds in naval battle, Part 1

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This is the first in a series of articles on wounds in naval battles.

{cbavatar}Boatswains_and_Bacteremia{/cbavatar}For a population, war means death and maiming of friends, family, and neighbors, often in mass numbers. For men (and now women) at sea, particularly before the advent of modern medical science, war meant truly horrible experiences difficult to talk about. But if we’re too understand the lives of men below decks, and their officers on the quarterdeck, we should examine the dangers they faced from a medical point of view. In part one of this series, I will use the Battle of Trafalgar in 1805 as my case study. (In part two, I’ll discuss the Battle of Jutland in 1916.) At Trafalgar, 8,500 people were killed or wounded. How did this happen?

Losing your head
Consider first the cannon ball. During the Age of Sail, cannon shot was composed of a large, round metal spheres of varying weights. A cannon ball caused severe damage to any crew unlucky enough to be within its path of destruction. What types of wounds would these sailors suffer? Most prominently, and most ghastly, was outright decapitation. This occurred from time to time, and though horrific, was likely the most merciful way to meet one's end in battle. Separating the head, and therefore the brain and its attachments to the spinal cord through the brain stem, robbed the body of any sense of pain, injury, or fear, because this means of death was almost instantaneous.

Bleeding to death
Conversely, if the cannon ball struck an upper or lower limb, there was a great possibility of having the limb severed by traumatic amputation. You could live for period of time without an arm. However, the presence of the brachial artery within the most proximal part of the arm (the part nearest the shoulder) would create an immense amount of blood loss upon traumatic separation.

This artery, which is often used when we have our blood pressures taken, is the direct extension of the subclavian artery, which runs under our clavicle (or collarbone), which in turn is one of the branches of our ascending aorta. The ascending aorta is the artery which distributes blood directly from our heart to the various other intermediate arteries of our upper body, and finally to our tissues to nourish them with the oxygen and nutrients necessary for life.

As you might imagine, due to its proximity to the heart, the brachial artery receives a large amount of blood, and at relatively high speed due to the heart's pumping effect. Death from blood loss was a likely result of this kind of traumatic injury. In the leg, an analogous artery, the femoral, would likely be severed if the separation occurred above the knee, leading to a similar means of death.

Pain in traumatic amputation
Though gruesome, these previous results say nothing of the nerves potentially severed by cannon shot. Extending from the side of the vertebrae in the neck is a bundle of nerves known as the brachial plexus. This series of nerves runs the entirety of the arm, from the shoulders and armpit to the fingertips. Lesion, or in this case complete severance of these nerves, would mean excruciating pain. A similar nerve bundle, called the lumbar plexus, exists in the leg. It extends from the lumbar vertebrae at the base of the spine before becoming the sacrum and coccyx. This type of startling, sudden, and violent pain can, in and of itself, cause sudden death.

Fight for survival
These traumas, apart from decapitation, would seem to be always fatal. But the body is an amazing matrix of functions interconnected to provide support for components affected by grievous injury. Even when horribly injured, the body fights to survive. Blood loss causes, as a compensatory mechanism, an increased heart rate in order to bring blood (which is now lesser in quantity) to the tissues. The skin will assume a blue hue due to blood shunting in the opposite direction, in order to increase its availability for the internal organs. Rate of breathing increases in kind as the body's mechanism to increase the level of oxygen in the blood, and the wounded man would likely sweat profusely as a result of the increase in sympathetic stimulation (the nerve impulses that cause the heart to beat faster and the breathing rate to quicken).

Collectively, these symptoms are known as hypovolemic shock; a lower volume of blood within the body.  Should the sailor survive the initial infliction of traumatic wounds, the massive blood loss, unless properly controlled, would shortly result in shock and a rapid decline in the likelihood of survival. Unfortunately, it’s clear that this was the case at Trafalgar for the worst of the wounded. But we know they sometimes did survive, as the one-armed Lord Horatio Nelson and many other examples prove from other battles throughout history.

In my next post, I will continue with a discussion of the nature of grapeshot and splinter wounds.  Additionally, one of the greatest and most notorious killers of the age was that of infection from septic wounds, giving rise to the period's most infamous of treatment techniques: the amputation.

Jared Wasser is a medical student who blogs at Boatswains and Bacteremia.{jcomments on}{dybanners}14,0,,,3,65{/dybanners}