Dne 25. 2. 1865 vyšel v londýnském časopise The Lancet krátký dopis Josepha Bella z Edinburghu, napsaný v reakci na příspěvek On the Treatment of Gunshot Wounds od dr. W. R. E. Smarta, otištěný v The Lancet 18.2.1865. Smartův příspěvek byl reakcí na druhou část recenze knihy A Manual of Military Surgery, for the Use of Surgeons in the Confederates States Army (Second Notice) by J. Julian Chisolm, M.D., vydanou v The Lancet 21.1.1865. Americký chirurg Chisolm v knize reflektoval své zkušenosti vojenského lékaře Konfederace v americké občanské válce, jež v roce 1865 vrcholila. Joseph Bell
v dopise připomněl, že některé chirurgické postupy, jež dr. Smart považoval za objevné a inspirativní pro lékaře ve Spojeném království, se objevily v třetím
a čtvrtém svazku Larreyových Mémoires de chirurgie militaire, et campagnes.
Z životopisu je známo, že Dominique Jean Larrey (1766-1842) začínal lékařskou dráhu před vypuknutím Velké francouzské revoluce, později se zúčastnil mnoha Napoleonových vojenských tažení, dvakrát byl raněn, v pruském zajetí unikl popravě, od níž ho zachránil jeho bývalý student medicíny, toho času pruský vojenský lékař. Larrey jako chirurg působil ještě dlouho po Napoleonově pádu. Jeho rozsáhlá publikace Mémoires de chirurgie militaire, et campagnes vycházela v Paříži, třetí svazek v roce 1812, čtvrtý svazek v roce 1817. Některé Larreyovy poznatky z oboru chirurgie zařadil Joseph Bell do své knihy A Manual of the Operations of Surgery for the Use of Senior Students, House Surgeons, and Junior Practitioners, jež poprvé vyšla v roce 1866. Joseph Bell vzpomněl Larreyho také v Harveian Oration, vydané v The Scottish Medical & Surgical Journal, Edinburgh 1897, vol. 1, č. 10 (October), s. 895. Joseph Bell uvedl, že Larrey neváhal amputovat těžce zraněné končetiny, čímž navázal na anglického chirurga Richarda Wisemana (1622-1676), jenž tyto amputace precizně popsal a odvážně prováděl. „Wiseman´s views as to the importance of true primary amputation in hopelessly injured limbs are admirable, as distinctly set down, and boldly acted on, as by Larrey more than 100 years later. His descriptions of the arrangement for, and the performance of, amputation are made in advance of his time.“ (cit. s. 895). Richard Wiseman se k amputacím vyjádřil ve spise Severall Chirurgicall Treatises (London 1676): „A Scotish Souldier was brought to me out of the field at the Battel of Worcester shot with a Musket-bullet into the Elbow-joint, which fractured not onely the ends of the Radius and Ulna, but likewise that of the Adjutorium. Upon fight whereof I called Will. Clarke (now a Chirurgeon at Bridgenorth) and other my Servants about me, to cut off the Arm, and the while I endeavoured to encourage the Souldier to endure it. In answer thereto he onely cried, Give me drink, and I will die. They did give him drink, and he made good his promise, and died soon after; yet had no other Wound then that. By which may be perceived the danger in delaying this work to the next day, when the foresaid Accidents have kept them watching all night, and totally debilitated their Spirits. Which happens not, if it be done in heat of Fight; for then, while they are surprized and as it were amazed with the Accident, the Lim is taken off much easier: and if it be the Arm, some of them will scarce be kept in the Hold while the Ship is close engaged in Fight. In the heat of Fight I cut off a man’s Arm, and after he was laid down, the Fight growing hotter, he ran´up, and helpt to traverse a Gun. And a Walloon earnestly begged of me to cut off his shattered Leg: which whilst I was doing, he cried, Depeche vous connons vendrone a terre mous bioron. Also others have urged me to dismember their shattered Lims at such a time, when the next day they have prosest rather to die. But amongst us aboard in that Service it was counted a great shame to the Chirurgeon, if that Operation were left to be done the next day, when Symptoms were upon the Patient, and he spent with Watchings, &c. Therefore you are to consider well the Member, and if you have no probable hope of Sanation, cut it off quickly, while the Souldier is heated and in mettle. But if there be hopes of Cure, proceed rationally to a right and methodicall Healing of such Wounds; it being more for your Credit to save one Member, then to cut off many.“ (cit. s. 420)
Richard Wiseman popsal celou řadu chirurgických zákroků, mezi nimiž nechyběly operace hlavy. Ve spise A Treatise of Wounds (London 1672) zaznamenal operaci lebky desetileté dívky, u níž se po úrazu utrpěném v prvním roce života nevytvořila lebeční kost, nýbrž pouze chrupavka, jejímž postupným rozkladem došlo k adhezi tvrdé mozkomíšní pleny (dura mater) a povrchového periostu (pericranium), dvou membrán, jež u zdravého jedince rozděluje lebka (cranium). Wiseman uvedl, že se s takovým případem nesetkal a nenašel jeho popis v dostupné literatuře. Ke konzultaci přizval londýnské chirurgy Charlese Scarborougha a Waltera Needhama. Operace byla úspěšná, pacientka se vrátila do běžného života. Wiseman však předpokládal, že dívka dosáhne pouze trpasličího vzrůstu. „A Gentlewoman falls with her little Daughter, A Child of half a year old in her Arms, the Mother is hurt, and the Child a little scratcht on the left side of her head; it’s viewed by a pretender to skill in such things, and slighted as inconsiderable , but from that time the Child grew indisposed and vomited often, especially after the receiving its sustenance, & as it grew able to speak complained of
a pain in her head, and through her often vomiting she languisht: After Ten years a small Tumor appeared in that part
of the head where it had been hurt by the fall so many years before: They now again consult and bring the Child to me,
a very starveling; I viewed the tumor: and felt in it a pulsation, which at first I thought an Aneurisma: but pressing my finger more into it, I felt the brain without any skull, the breadth of an old English shilling: This at first a little amused me, but upon by consideration of the fall and symptoms succeeding, it was evident to me, that by the fall the skull was fissured , and being of a thin Cartilaginous substance at that time of her infancy, had been by length of time mouldred away and from that Erosion the Dura Mater inflamed, and thrust out from within; and by adhesion to the Pericranium had become one body; It is usual for parts inflamed to adhere to the next adjacent part: This I supposed the case: The presage here was a sudden death if the cure was not attempted, and in the attempting it she was in great danger: To begin this by a Circular Incision from the compass of the skull, was not difficult; but then to separate these two membranes, the Dura Mater from the Pericranium, or this from that (they being become one body) was a difficult work even in a dead body, here in a weak Child much more, where the bloud would be apt to blind me, and the impatiency of the Child would make it hazardous; this work requiring a steadiness: Then I consider’d of a Caustick, and having predicted the danger either in leaving it to die by its malady after a few weeks, which was certain, or in attempting the cure doubtfully; I referred it to them: They had consulted before, and were not ignorant of the danger the Child was in by its disease; Therefore they readily put the care of managing this great work to me, and lodged it near me, in Suffolk-buildings: I presently caused the hair to be shaved off from about the grieved part, applied the most gentle Caustick I could propose; and at such time as
I thought it might have made its way in the Superficies of the Calvaria, I took it off, and with a Caustick-stone rubb’d into the Musculous part of it; then I washt out the salts well with Wine first, then Milk, after that with warm Oil, then with a Knife cut into the Eschar, and Embrocated the part warm, and drest it up with Ung. Basilic, with Ol. Ros. and applied my Emplaster over all and roul´d up the part with good Compress and Bandage: that night the was seized with a fit of Convulsions, Vomited, and was very ill; Dr. Fisher was sent for, he prescribed her a Cordial-Julep, proper in that her case, and relieved her: The next morning I took off dressings to look upon the part, and raised up the hairy scalp round from the skull through my Eschar, which gave the wound a breathing, and discharged a little Ichor; from this time her vomiting ceased, she had no more Convulsive fits, she began to be more lively than in Ten years before: We kept her in bed warm and close, with a slender diet, allowing her only Spoon-meats: Her Physician took care in what concerned her health by Internals: I proceeded to hasten digestion, and by Fomentation and the like to cherish the native heat of the part, and as the Calvaria separated, so I endeavoured digestion sometime, otherwhile detersion interchangably; as the one medicine corrupted so the other deterg’d: It was a nice work to separate the Pericranium from the Dura Mater, but I happily effected it, while the latter slough was separating, the Callus rising up in the mean time: The Patient being free of all the former ill symptoms, and brisk, and in a sure way of recovery. I invited Sir Charles Scarborough and Dr. Walter Needham, who did me the honour to see her. It was a rare case, not mentioned by any Author, nor scarce to be seen again: Since that time the bone Exfoliated, the Dura Mater incarned, and the wound cicatrized and contracted to a very narrow compass. The Child returned to her friends perfectly in health, is a witty Girle, but it's doubted she will be but a dwarf.“ (cit. s. 128-130)
Ve spise Severall Chirurgicall Treatises (London 1676) popsal Richard Wiseman ošetření vojáka, jemuž v roce 1645 za anglické občanské války v bitvě u Tauntonu dělostřelecký granát utrhl část hlavy, přesto zůstal naživu. „At the Siege of Taunton one of Coll. John Arundell’s men in storming the Works, was shot in the Face by Case-shot. He fell down, and in the Retreat was carried off among the dead, and laid into an empty house by the way until the next day: when in the Morning early, the Colonell marching by that house heard a knocking within against the Door. Some of the Officers desiring to know what it was, lookt in, and saw this man standing by the door without Eye, Face, Nose or Mouth. The Col. sent to me (my Quarters being nearest) to dresse the man. I went, but was somewhat troubled where to begin. The Door consisted of two Hatches, the uppermost was open, and the man stood leaning upon the other part of the Door which was shut. His Face with his Eyes, Nose, Mouth, and forepart of the Jaws, with the Chin, was shot away, and the remaining parts of them driven in. One part of the Jaw hung down by his Throat, and the other part pasht into it. I saw the Brain working out underneath the lacerated Scalp on both sides between his Ears and Brows. I could not see any advantage he could have by my Dressing. To have cut away the lacerated Parts here had been to expose the Brain to the Air. But I helpt him to clear his Throat, where was remaing the Root of his Tongue. He seemed to approve of my Endeavours, and implored my help by the Signs he made with his Hands. I askt him if he would drink, making a Sign by the holding up a Finger. He presently did the like and immediately after held up both his Hands, expressing his Thirst. A Soldier fetcht some Milk, and brought
a little wooden Dish to pour some of it down his Throat: but part of it running on both sides; he reacht out his Hands to take the Dish. They gave it him full of Milk. He held the Root of his Tongue down with the one Hand, and with the other poured it down his Throat, (carrying his Head backward,) and so got down more then a quart. After that I bound his Wounds up. The dead were removed from thence to their Graves, and fresh Straw was fetcht for him to lie upon, with an old Blanket to cover him. It was in the Summer. There we left that deplorable creature to lodge, and while we continued there, which was about 6 or 7 days, he was drest by some of the Chirurgeons with a Fomentation made of Vulnerary Plants, with a little Brandy-wine in it, and with Stupes of Tow dipt in-our common Digestive. So we bound him up.“ (cit.
s. 402-403)
Vojenští lékaři Dominique Jean Larrey a Richard Wiseman byli v oboru chirurgie mistry. Dělilo je téměř sto padesát let, jeden byl Francouz, druhý Angličan. Mnohé je však pojilo. Oba jako lékaři působili mnoho let, mnohdy přímo na válečném poli nebo na válečné lodi. Oba, dobrovolně nebo z donucení, ošetřovali vojáky vlastní i nepřátelské armády. Oba upadli do zajetí a oba se z něj díky svým lékařským schopnostem ve zdraví dostali. Oba měli vypravěčský talent a oba své bohaté poznatky publikovali, zvláště ve snaze pomoci svou zkušeností a radou kolegům chirurgům, a to i těm v příštích generacích. Jedním z nich byl Joseph Bell.
* Text je součástí eseje Poznámky k příběhům Sherlocka Holmese.
** Všechny zdroje jsou níže v plném náhledu. Wisemanův text, publikovaný v angličtině 17. století, jsem přepsal do současné transkripce.
*** Přílohou je foto Josepha Bella, Dominiqua Jeana Larreye a Richarda Wisemana.
Dominique Jean Larrey Richard Wiseman
Zdroje:
Joseph Bell, F.R.C.S., On the Treatment of Gunshot Wounds. To the Editor of The Lancet. The Lancet, no. 2165, 25 February 1865, s. 217.
W. R. E. Smart, On The Treatment of Gunshot Wounds. The Lancet, 18 February 1865, s. 179.
A Manual of Military Surgery, for the Use of Surgeons in the Confederate States Army by J. Julian Chisolm, M.D., Professor of Surgery in the Medical College of South Carolina. Surgeon in the Confederate States Army, &c. Third Edition, Columbia: Evans and Cogswell. 1864. (Second Notice.) The Lancet, 21 January 1865, s. 64-66.
Mémoires de chirurgie militaire, et campagnes, de D. J. Larrey, Paris 1812, tome III, s. 258.
Mémoires de chirurgie militaire, et campagnes, du baron D. J. Larrey, Paris 1817, tome IV, s. 240.
Joseph Bell, Harveian Oration. The Scottish Medical & Surgical Journal, Edinburgh 1897, vol. 1, č. 10 (October), s. 895.
A Treatise of Wounds. By Richard Wiseman, One of His Majestie´s Serjeant-Chirurgeons. London, Printed by R. Norton for Richard Royston 1672, s. 128-130.
Severall Chirurgicall Treatises. By Richard Wiseman, Serjeant-Chirurgeon, London, Printed by J. Flesher and J. Macock for R. Royston and B. Took, 1676, s. 402-403.
Severall Chirurgicall Treatises. By Richard Wiseman, Serjeant-Chirurgeon, London, Printed by J. Flesher and J. Macock for R. Royston and B. Took, 1676, s. 420.
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