Coping with pain

"'Tis but a scratch"

An interesting post from the Museum of Civil War Medicine, about Major Richard Snowden Andrews, of the Maryland Artillery. Not Napoleonic obviously, but perhaps relevant to the discussion about pain and wounds generally.

"...The shrapnel ripped through his intestines and left him nearly disembowelled. He had presence of mind to know the severity of his wounds and to carefully fall from his horse. Officers raced to his side and helped Andrews keep pressure on this open wound. Medical officers, including Dr. Hunter H. McGuire, arrived on the scene and deemed the wounds mortal, as nearly all wounds to the abdomen were considered at the time.

Two surgeons from Georgia were ordered to care for the stricken Andrews. They described the ghastly wounds: “[He] was completely disembowelled, his intestines covered with dust, hen-grass, sand and grit.” The doctors told Andrews they could do little to help him, that his wounds were fatal. Andrews, still conscious, lashed out at them: “If you damned doctors would do something for me I’d get well. I once had a hound dog that ran a mile with its guts out and caught a fox, and I know I am as good any damned dog that ever lived, and can stand as much.”

Andrews was stretchered to a field hospital nearby. He was in great pain the entire time. A local surgeon was procured, as all the military surgeons were busy with surgical patients. This doctor took the time to clean out the wound. Andrews’ wife described the process: “He washed out grit and bits of cloth from the wound and proceeded to sew it up, using the only needle he had, which was a rusty one… Then he was placed on the bed, and there was no further treatment possible, except applications of cold water.”

“It was in the course of four or five weeks that the great chasm in his side was sufficiently healed for him to sit up, and in six weeks he was dressed and on the porch, and able to move about slowly on crutches. At this time he was drawn down on one side; and he was unable to stand erect for a year and more. His indomitable courage and his fortitude and cheerfulness were unfailing throughout, strengthening all those about him with the hope of his ultimate recovery.”

Text Credit: National Museum of Civil War Medicine www.civilwarmed.org

@Hans - Karl Weiß The illustrations turn enough stomachs already. There is quite a bit of infection apparent. The “Scratch-and-Sniff” edition I think would have limited appeal! None of them look too happy. The amazing thing is how many survived.

Oh, sweet Jesus...

It wasn't just soldiers who had to endure pain. Here's Fanny Burney's Description of her breast cancer surgery (performed by the Dr. Larrey, BTW):

"My dearest Esther, - & all my dears to whom she communicates this doleful ditty, will rejoice to hear that this resolution once taken, was firmly adhered to, in defiance of a terror that surpasses all description, & the most torturing pain. Yet - when the dreadful steel was plunged into the breast - cutting through veins - arteries - flesh - nerves - I needed no injunctions not to restrain my cries. I began a scream that lasted unintermittingly during the whole time of the incision - & I almost marvel that it rings not in my Ears still! so excruciating was the agony. When the wound was made, & the instrument was withdrawn, the pain seemed undiminished, for the air that suddenly rushed into those delicate parts felt like a mass of minute but sharp & forked poniards, that were tearing the edges of the wound - but when again I felt the instrument - describing a curve - cutting against the grain, if I may so say, while the flesh resisted in a manner so forcible as to oppose & tire the hand of the operator, who was forced to change from the right to the left - then, indeed, I thought I must have expired."

Olde Tyme Mastectomy (wesclark.com)

With reference to the amputation procedure and to fortitude under the knife, if we return to the case of Lord Uxbridge after Waterloo, Deputy Inspector John Robert Hume, Wellington’s own surgeon, wrote this account on 19th June, 1815. On the evening of yesterday after having seen Colonel Gordon put to bed, Captain Seymour came to see me to say that, the Earl of Uxbridge had been wounded, he was afraid badly, in the knee…

I found on inspection that a grape shot had struck him on the right knee close to the lower edge of the patella and entered on the inside of the ligament, and having torn open the capsular ligament had made its exit behind externally fracturing the head of the tibia, cutting the outer hamstring in two. The capsular ligament was filled with fragments of bone and cartilage like gravel, but there was no swelling whatever of the joint or limb. His lordship was perfectly cool, his pulse was calm and regular as if he had just risen from his bed in the morning, and he displayed no expression of uneasiness though his suffering must have been extreme; but what struck me as most remarkable was his excessive composure though he had been on horseback during the whole day and personally present in almost every one of the many charges made by the cavalry during the battle, he was neither heated nor did he display the least agitation. There could hardly be a doubt of the expediency of amputating the leg but as I was not personally known to his lordship I conceived it was a duty I owed to his family and to himself to do nothing rashly or without evincing to all the world that amputation was not only necessary but unavoidable. I therefore without giving a decided opinion applied a piece of lint wet with cold water over the knee and having desired his lordship to repose himself for a little I went out to endeavour to collect as many medical officers as I could meet [with] that they might see the wound and assist me in the operation…

There was but one opinion amongst us, so having prepared the dressings etc, we returned into the room where I announced to Lord Uxbridge said the operation being found necessary the sooner it was performed the better. He said ‘Very well I am ready.’ I disposed the assistants as I thought best calculated to avoid confusion and having applied the tourniquet I took the knife in my hand. Lord Uxbridge said ‘Tell me when you are going to begin.’ I replied ‘Now, my Lord.’ He laid his head upon the pillow and putting his hand up to his eyes said ‘Whenever you please.’ I began my incision without retracting the integument nor in the usual way with one circular sweep. but with my knife I made one cut above from within outwards describing a small segment of a circle and in the same manner below, beginning at the inner point or horn of the upper and keeping as nearly parallel as possible. I finished the incision by joining the two points on the outside of the thigh. I then retracted the skin as much as possible and with a few strokes of the point of the knife had integument sufficient to cover the end of the stump. With one stroke of the knife I divided the muscles all round to the bone and having retracted them on both sides I took the saw. I had sawn nearly through the femur but the person who held the leg being over apprehensive of splintering the bone raised up the limb so that the saw being confined could not be pushed backwards or forwards. I did not perceive what the cause was and said angrily ‘Damn the saw’, when Lord Uxbridge lifting up his head said with a smile ‘what is the matter?’ *These were the only words he spoke and during the whole of the operation he neither uttered groan or complaint nor gave any sign of impatience or uneasiness. I had only two arteries to tie, namely the femoral and a small cutaneous branch. The stump was dressed in the usual manner and his Lordship having drank a very small quantity of weak wine and water was undressed and made as comfortable as the miserable bed upon which he was stretched would allow him to be. His skin was perfectly cool, his pulse which I was curious enough to count gave only 66 beats minute. and so far was he from exhibiting any symptoms of what he had undergone in his countenance that I am quite certain had anyone entered the room they would have enquired of him where the wounded man was.

*Note there is no reference to Lord Uxbridge's enquiring as to the sharpness of the knife- or, given Hume's moment of difficulty, more probably the saw. This was alluded to by his ADC, Lieutenant George Wildman, 7th Hussars, who was present:. "He never moved or complained: no one even held his hand. He said once perfectly calmly that he thought the instrument was not very sharp.” (Quoted in 'One Leg, The Life and Letters of Henry William Paget, First Marquess of Anglesey, KG 1768–1854 p.150)

This topic is highly complex - pain and how to deal with it - is in my view (personal experience as a GP) highly individualistic and a lot of factors influence this, such as social - economical - cultural back ground. Persons of 200 years ago, would have had to cope differently as persons of today in the "first" world, also compared to today persons living in more "primitive" environment.

I would agree that humans living 200 years ago had a different attitude to death, as well as pain and experienced this differently than us living today, like how many people did you see dying in front of you? How often did you refuse pain killers and dealt with pain in a different way??

In the 1977 book 'The Face of Battle', John Keegan wrote of the battles of Agincourt, Waterloo and the Somme (1916). In each battle section he dealt with wounds and the various impact of each time periods weapons on the human body. Well worth reading.

Of possible interest:

Military surgery as national romance: the memory of British heroic fortitude at Waterloo

James Kennaway

War & Society Volume 39, 2020 - Issue 2, Pages 77-92

Abstract

This paper shows the ways that tales of stoicism during surgery at the Battle of Waterloo came to be a significant part of the ideological framework of Romantic Militarism. Celebrating the killing of enemies clashed with ideals of politeness, but hailing a soldier’s powers of endurance in surgery was an acceptable way of extolling courage, framing lived experience of agony into narratives of exalted pain, masculine fortitude and quasi-religious patriotic feeling. In Britain, an extensive discourse emerged about the supposed Britishness of surgical sangfroid at Waterloo, providing a narrative of national superiority in the decades of imperial expansion that followed.

Military surgery as national romance: the memory of British heroic fortitude at Waterloo (nih.gov)

Sylvain Tesson in "Berezina" briefly discusses the issue of Napoleonic man and modern man and their reactions to adversity.

I think today, we have means to ease pain, but people during "our era" didn't and therefore had no expectation of anything but enduring pain.

Thank you, David. Very much appreciated. I will have a look 😀

@geordie.ent if you haven’t seen it yet, @mickcrumplin ‘s talk : https://youtu.be/WRmkj7CwdEQ His book of the same title is pretty fantastic too

I doubt physiologically they were better prepared. As David says, a certain 'stoicism' was expected, but we probably only hear about the examples where people endured the pain without comment, precisely because it would have been so remarkable. Equally, I guess those who screamed and shouted, or fainted, as we would all expect, probably just didn't get recorded because it wasn't all that suprising. There is also probably something in the idea some of these things have been exaggerated over time.

I think I remember reading somewhere, though I can't remember where, that a good surgeon could carry out an amputation in a couple of minutes - can anyone confirm that?

Just a small thing @geordie.ent - can I ask you to update your profile so that it states your full name? Just go to round circle on the top right of the menu at the top of the page, and click the drop down box. You'll see a 'My account' option, where you can edit your details - its just one of those forum rules for transparency. No big deal, but thanks in advance.

To be fair, Lord Uxbridge did at one point ask if the knife was not a trifle blunt.

Most of what I know on this subject I gleaned from the work of @mickcrumplin Undoubtedly though, stoicism as a concept was much more highly prized in the period than it is today. What would be regarded in modern parlance as ‘toxic masculinity’ was very much the norm. This would not just mean that open displays of pain would be frowned upon, but also go unrecorded.