What Killed Jane Austen?: And Other Medical Mysteries (14 page)

As for Larrey, he became a confidant of Napoleon, was created a Baron and maintained a surgical dexterity until his old age. In his prime, his time for removing a leg—without anaesthetic, of course—was two minutes. At that speed, the fingers of any slow moving assistant would have been in danger, too. He died in 1842, aged 76.

(JL)

My God! What is to become of me? I see nothing desirable but death (Florence Nightingale)

It was 1850 in Victorian England. The despairing young woman had money, position, beauty, brains and education, yet she wanted more. Florence Nightingale’s mission was to serve God by serving others.

During her lifetime she was to fight and win a ‘continual battle against officialdom, medical jealousy, incompetence and inertia’, in the words of her biographer Elspeth Huxley. Before the nursing revolution that owed so much to her, nurses were drudges, famous for drinking and immorality. Doctors despised them, while some took advantage of them.

Overcoming family opposition, she prepared herself by visiting the best nursing schools and hospitals in Britain and Europe.

In 1854, when she was about to take charge of nursing at King’s College Hospital in London, the Crimean War broke out. The British reached the Black Sea, but since there were too few transports to take them to the Crimean Peninsula, they had to leave their medical supplies behind. They could boost their spirits on the long crossing by looking out at the bloated bodies of their comrades—victims of cholera—bobbing in the water.

Many died before ever seeing battle; the victory at Alma brought more casualties. Care of the sick and wounded was hopeless. British war correspondent W.H. Russell’s reports in
The Times
shocked Britain.

The ambulance men were retired veterans, themselves more likely to need nursing than to help others. Both medicine and warfare were still very much male domains. The military had quashed an earlier move to send female nurses, but by now Florence Nightingale’s friends included the Secretary of State for War. At his invitation, she left England with 38 women ‘ranging from Catholic nuns to drunken drabs’.

Both their welcome and their quarters were chilly. Before they could occupy their room, eight nurses had to remove the corpse of an enemy Russian general.

The water ration was just one pint per person per day. Food and medical supplies often didn’t arrive; there were no cots, mattresses, bandages or tables, even for operations. Rats prowled everywhere, the hospital was filthy and the privies were blocked.

In charge of medical services was Dr John Hall, whom Nightingale called ‘a fossil of pure Red Sandstone’. To his superiors he reported smugly: ‘The whole hospital is on a very creditable footing and nothing is lacking.’

Hall’s orders from Britain were to let the nurses enter the hospital, but the orders didn’t state that the nurses should actually nurse! At first the doctors just boycotted the new arrivals. While they waited, Nightingale organised food, kitchens, bandages and linen.

In the first half-hour of the futile Charge of the Light Brigade at Balaclava, two-thirds of the British cavalry were killed or wounded. According to Huxley:

[To reach hospital, the wounded had to survive] eight days’ passage across the Black Sea … in ill-equipped vessels, rolling about the open decks, often without drugs, dressings or even blankets. Then … crossing the Bosporus in Turkish caiques … to be dumped down in the stinking corridors of the two hospitals at Scutari.

To cope with the flood of wounded men, the doctors finally had to admit the nurses.

Operations took place in the wards. Dr Hall opposed the use of chloroform anaesthesia, but luckily his colleagues were more humane. Florence Nightingale wrote:

One poor fellow, exhausted with haemorrhage, has his leg amputated as a last hope, and dies ten minutes after … The mortality of the operations is frightful. We have Erysipelas [infection and fever] We now have four miles of beds, and not eighteen inches apart.

By late 1855, nearly three-quarters of the British army were under medical treatment and unfit for duty. Most were not wounded but sick: malnutrition, scurvy, cholera and dysentery were rife. In winter, the cold steel of their weapons could bring on frostbite.

Within three weeks, four of the surgeons died. Despite a severe attack of ‘Crimean fever’, Nightingale herself visited the front three times.

Long before the discoveries of Koch, Pasteur and Lister, she fought infection with cleanliness and fresh air. Under the hospital lay a blocked sewer. Her pressure forced the authorities in London to send a Sanitary Commission led by Dr John Sutherland. They had the sewer cleared and flushed; they removed a horse’s carcass contaminating the water; from the courtyard they cleared 26 other dead animals.

Dr Sutherland, a pioneer in public health, became her lifelong adviser, disciple and willing slave.

By the summer of 1855, the death rate had dropped from 42 per cent to 2 per cent!

Back in England, Florence never regained her health and could not travel again. Yet for her remaining 56 years, she wrote, published and lobbied people in power to help various underprivileged groups.

Despite medical opposition, she raised £50,000 to found the Nightingale Home for Training Nurses at St Thomas’s Hospital. Within 25 years, the bad old days of nursing were past. Better nursing care supported better medical care.

She died in 1910, at the age of 90. On her death, Lord Stanley, the former chairman of the Sanitary Commission said: No person … within the past hundred years has voluntarily encountered dangers so imminent and undertaken offices so repulsive … in a pure spirit of duty towards God and compassion for man.

(GB)

Toothache is as old as history. Skulls as far back as the Bronze Age show dental decay, including cavities from root abscesses.

Most sufferers of toothache had Hobson’s choice: suffer agonising toothache, or submit to painful extractions, usually leading to toothless misery and hunger. Only a few could afford artificial teeth.

Tombs of the nobility in Tuscany dating from 700 BC have contained partial dentures, some of which were removable. The Roman poet Martial, writing in the 1st century AD, refers to teeth made of bone, ivory and even wood. ‘Maxima has three teeth, all…of boxwood and as black as pitch.’

The Persian physician Rhazes (AD 850–923) was one of the first to recommend fillings, though the alum and mastic he used must have been too soft to last. The Italian university professor Arculanus (1412–84) was the first to refer to gold fillings.

In 15th-century England, the drawers of teeth included barber-surgeons (who also cut hair and let blood), apothecaries, chemists, country doctors, shoemakers and blacksmiths.

They all competed with impostors wearing teeth as necklaces or sewn onto their belts. At fairs and markets these impostors played loud music to drown the cries of their ‘painless’ extractions. A popular saying was ‘to lie like a tooth-drawer’.

Though she said she had faced the Spanish Armada with ‘the heart and stomach of a king’, Queen Elizabeth I dreaded the pain of extraction. In 1578, according to John Strype, Elizabeth passed ‘whole Nights without taking any Rest … her Physicians were consulted … pulling it [the tooth] out was esteemed by all the safest way … to which the Queen was very averse.’

Finally the Bishop of London had to set her a personal example, even though ‘he were an old man, and had not many teeth to spare … She was hereby encouraged to submit to the Operation herself.’

Later, Elizabeth used to pad out her unsupported lips with rolls of cloth.

Hogarth’s paintings show even young adults with few teeth. Until the end of the 19th century, some people had to crush their food with masticators (like large nut-crackers).

Dentures made of ivory or bone soon blackened and decayed; halitosis made outcasts of their wearers.

In the 1790s, Nicholas Dubois de Chemant fitted false teeth made in one solid piece of shiny, decay-proof porcelain. Later, Chemant worked in England with Wedgwood porcelain paste, claiming among his many happy clients Dr Edward Jenner, whom we honour for introducing vaccination against smallpox.

In the late 18th century, tooth transplants became trendy; many poor people offering their teeth for sale. The heroine of
Les Miserables
had to sell first her hair, then her front teeth and finally her virtue.

Anatomist-surgeon John Hunter, whose 1770s treatise
The Natural History of Human Teeth
revolutionised dentistry, advised operators to line up several donors. If the first donor’s tooth did not fit, try the next, and so on. After getting a reasonable fit, tie the transplanted tooth to the adjacent ones. If all went well, the teeth would settle down in a month or two and remain firm for three-to-five years.

But sceptics claimed that ‘transplantings’ were actually replantings; that the operator simply repaired the extracted bad tooth and put it back again!

Live donors offered single teeth for transplants, but for dentures, dead donors were just as good. Even a badly decomposed corpse had valuable front teeth; a single burial vault could yield teeth worth 20 to 30 pounds—a fortune in the 1700s.

A supplier told Hunter’s pupil Sir Astley Cooper: ‘Oh, Sir, only let there be a battle and there’ll be no want of teeth. I’ll draw them as fast as the men are knocked down.’

Many people wore dentures containing teeth taken from young men slain at Waterloo. This was before the days of disinfectants, but perhaps some people boiled the teeth before recycling them!

The first satisfactory dental cement (a zinc oxyphosphate) appeared in 1869. Soon after came the dentist’s drill, and a wax for taking impressions.

Now permanent repairs became possible, but at first, filling of roots involved contamination with germs. As Dr Bremner says, in his
Story of Dentistry
: ‘Frequently the teeth under the well-constructed bridges would abscess and develop pus-discharging fistulae, but few dentists were disturbed.’ It was the patients who were disturbed.

In 1911, a London physician, Dr William Hunter, saw several patients with puzzling ailments. Some had had extensive restoration work (contemptuously called ‘American dentistry’) that was dirty and showed unhealthy roots. The media added fuel to the flames of dissent. Describing the bridges as ‘mausoleums of gold over a mass of sepsis’, Dr Hunter suggested removing the bridges and the roots holding them. Of the few patients who agreed to having their bridges and underlying roots removed, quite a number found their ailments improved.

Doctors started thinking about the links between teeth, gums and the bloodstream. They felt that a tooth abscess may spread infection to other parts of the body. That was well and good, but some doctors blamed teeth for any puzzling illness. Patients indiscriminately had their teeth pulled, their mouths wrecked and their faces disfigured, and often without improvement to their health.

Eventually, X-rays saved the day by showing which teeth did warrant removal.

Over the centuries, poorly fitting, insecure dentures have caused untold misery. Not only could they slip out in company, but they often hindered eating!

In Parliament Benjamin Disraeli tormented poor Lord Palmerston, saying: ‘[His dentures] would fall out of his mouth when speaking if he did not hesitate and halt so … ’

Even in late Victorian England, refined women often ate alone in their bedrooms. Then they would replace their dentures to sit elegantly at dinner, seemingly living on thin air.

A dentist fitted a fashionable lady with a partial row of human teeth mounted on ivory. Four years later, she returned with a very sore mouth, and her new teeth solidly fixed with tartar to her own—she had never removed her false teeth, lest her family know her secret.

During a world cruise Ulysses Grant, president of the United States from 1869 to 1877, lost his teeth overboard; after which he gave up public speaking.

But a sailor visiting the Solomon Islands met a far worse fate. He avoided being eaten by cannibals, only to see his false teeth fall overboard; when he jumped in after them, the sharks ate him.

(GB)

A man from Australia, one from Switzerland, and one from England. Not an ethnic joke, but the Far-Eastern Sledge Team. It was part of the 1911–14 Australasian Antarctic Expedition, set up to explore that part of Antarctica closest to Australia.

Douglas Mawson, Australian explorer, geologist and physicist was leader of this sledge team and of the whole expedition. He was 30 years old, and had already spent two years with Ernest Shackleton’s ‘Farthest South’ expedition in 1908–09.

Of the six sledge teams, Mawson’s had the farthest to go. His companions were the 28-year-old ski champion—mountaineer Xavier Mertz and 22-year-old Lieutenant Ninnis of the Royal Inniskilling Fusiliers.

Mawson, Mertz and Ninnis left the Commonwealth Bay base camp on 10 November 1912. They had 17 husky dogs hauling three sledges, each about 3.5 metres long; their load was over 770 kilos. On days, they covered up to 30 kilometres. But often gales up to 120 kilometres per hour stopped them from marching at all.

Ninnis suffered a bout of snow-blindness, and then an agonising finger abscess, which Mawson lanced with a pocket knife.

By 14 December they had abandoned one sled after using its supplies. Mertz was singing cheerfully while leading on skis, with Mawson second, riding one sled. Suddenly Mertz stopped singing and held up one stock to signal a crevasse. Mawson called a warning to Ninnis in the rear and went on.

A little later, Mertz and Mawson looked back, but they could see no trace of Ninnis, his dogs or his sled! Where Mertz had signalled a crevasse, there was now a gaping hole, over three metres wide.

Secured by a rope, Mawson leaned out over the edge. Well out of reach, on a ledge 45 metres below, he could see only two dogs, the tent and food packs. Below the ledge, nothing but darkness. Could Ninnis somehow still be alive? They took turns to hang over the edge and call him. But after three hours, they could hope no longer.