The Curious Case of Mr. Tipple

Held within the College’s archive collection are a variety of patient case documents, ranging from the common to the peculiar. Practitioners often documented their cases for future reference or publication purposes.

One such publication within the archives that is particularly interesting is “An Account of a Case of Recovery: After the shaft of a chaise had been forced through the thorax”.

tipple case

Front cover of Dr.Maiden’s publication.

This book gives an account of a Mr. Tipple, who in 1812 was in a life-threatening accident where a metal shaft perforated his thorax and pinned him to the wall of a building. What makes this case more fascinating is the fact that he survived the accident! Flicking through the book the reader can find the account of the accident, Dr. Maiden’s examination notes, and the results of the post-mortem taken upon Mr. Tipple’s death in 1822.

The first statement within this book is that of Mr.Tipple, who gives an account of the events that led to his injury. He was arriving at the house of his friend at which point the horse pulling his cart became irritable. Trying to calm the horse, Mr. Tipple began to dissemble the cart:

“ I incautiously took off the bridle, as the first step towards disengaging the horse from the chaise and harness: the horse immediately became unruly…the horse made a violent plunge, and thrust me, by the end of the off shaft, against the part of the chaise-house which projects from the clump of out-buildings…at this instant, I felt the end of the shaft perforate my side, under my left arm…and I soon felt the end of the shaft pass from under my right arm, occasioning acute pain…” [1]

tipple illustration

Interpretation of how the shaft penetrated Mr. Tipple’s chest.

The shaft of the chaise had passed all the way through Mr. Tipple’s chest, exiting at about the level of his right arm pit. Witness accounts of the accident state that he was slightly suspended off the ground by the shaft, standing on his toes to relieve some of the pressure in his chest.

tipple case 6

Illustration showing the site of the accident. A) The position of the horse and chaise. B) The situation of Mr. Tipple. C) The end of the shaft penetrating into the chaise house.

Once the shaft was removed, Mr. Tipple entered the house and retired to the guest bedroom, where he removed his shirt and lay back slightly on the bed. It was at this point that he experienced periods of dyspnoea (difficulty breathing) and began to feel faint. The doctor arrived 10 minutes after the accident occurred, and on examining the wounds found there to be an escape of air-filled blood.

In attempt to relieve his difficulty in breathing, doctors frequently drained blood from his body and did so by opening a vein in his right arm. This procedure gave Mr. Tipple immediate rest and his breathing would return to normal. (At this time in history, bloodletting was the go to procedure for a variety of ailments, but in this case it was done to reduce internal haemorrhaging in the chest. The practice of draining the chest via a chest tube was not made popular until the 1950s, which could be why Dr. Maiden let blood from the arm instead).

chaise illustration

Illustration showing the portion of the chaise that pierced Mr. Tipple’s side.

For weeks the situation was the same; Mr. Tipple would experience bouts of dyspnoea and his blood would be drained to relieve the pressure. This continued for the rest of his life, along with periods of cardiac arrhythmia, which ended 10 years after the accident, in 1823.

On examination of the body during the post-mortem, it was visible that the shaft had entered the thoracic cavity between the second and third ribs through the second intercostal space, and exiting on the right hand side via the second intercostal space. The holes in the intercostal muscles created by the shaft had been closed over by a clear membranous tissue to which the lungs adhered. This was most likely scar tissue. The lungs themselves were intact and had not been punctured by the shaft because of its blunt end. The blunt end would not have been sharp enough to actually damage the lung tissue, which would have simply been pushed out of the way. Mr. Tipple’s heart was also untouched by the shaft; however there was some hypertrophy in the region of the right ventricle. This would suggest that Mr.Tipple’s death was a result of heart failure caused by a fibrosis of the lungs. This fibrosis (scarring and stiffening) of the lungs would have been a result of trauma from the accident ten years before. The breathlessness that he experienced after the accident was due to a pneumothorax induced by the sucking chest wound from the shaft penetration.

A curious case indeed, it is a mystery how Mr. Tipple not only survived the trauma, but also the volume of blood that was drained from his body during treatment. Although such an accident could easily recur, (maybe not in the exact same circumstances), healthcare today is much more advanced and more than capable to properly diagnose and treat such cases.

For more details about Mr. Tipple’s case and the above document, feel free to contact us at: library@rcpsg.ac.uk

Many thanks to doctors-in-training, Jenny Crabbe and Rosie Jacks, for their expertise and guidance on this patient case.

 

References

  1. Maiden, W., 1824. An Account of a Case of Recovery after the Shaft of a Chaise had been Forced through the Thorax: to which is now added a statement of the health of the sufferer from the period of his recovery until his decease: with the appearances of injured parts after death. Carpenter&Son: London.

 

Uncovering our Medical Instruments- Lucy Baldwin and Maternity Health

Childbirth has always been considered a miraculous event. Bringing a new life safely into this world is always a momentous occasion and victory. The health of both mother and child is of utmost importance to those involved in maternity health, and the practice as we know it today is the safest it has ever been in history.

However, there was a time when childbirth was considered a death sentence for the expectant mother [1], and maternity healthcare was based on class, on where the mother ranked in the public hierarchy. Not only was the likelihood of the mother dying during childbirth much higher than it is today, the life expectancy of the child was much shorter, although this varied depending on where the child was brought up. Yes, the process of childbirth has changed tremendously in the past 200 years and this change has been brought about by those fighting for better maternity healthcare.

One man that vastly improved the survival rate of mothers was Ignaz Semmelweis, an unsung hero of antisepsis. Working as an obstetrician at the Vienna General Hospital in 1846, Semmelweis noticed a difference in mortality rates between the two maternity clinics there. Where the clinic run by midwives had a mortality rate of around 4%, 10% of mothers died after giving birth in the clinic run by teaching staff of the University of Vienna [2]. These mothers were dying of a condition known as “childbed fever”.

Semmelweis took it upon himself to solve this mystery. The difference between clinics, he discovered, was in hygiene- the medical students would attend their patients straight after performing autopsies and would not have washed their hands or clothes efficiently in between sessions. This meant that the wounds and reproductive tracts of the recovering mothers were being contaminated, resulting in childbed fever and ultimately death.  The concept of contamination was not yet understood at this time in history, thus explaining Semmelweis’ difficulty in identifying the root of the problem.

When Semmelweis discovered this, he put in place the practice of handwashing with chlorinated lime in both clinics in 1847. Obstetricians were to wash their hands before and after examining patients in the first clinic, as well as the midwives in the second clinic. With this change in hygiene, the mortality rate of the first clinic dropped to around 1% within two months. However, Semmelweis was not recognised for his astounding work due to his unpopularity in the research field. The lack of belief from his contemporaries drove him insane, which resulted in his admittance to a mental institution in 1867. Semmelweis sadly died of blood poisoning, from the contamination of a wound caused by the institution staff [3]. It has only been after his death that his work has been recognised and praised.  His work paved the way for Lister’s contribution to antiseptic practices in medicine.

Another name often associated with maternity healthcare is Lucy Baldwin. Lucy Baldwin, Countess Baldwin of Bewdley, was the wife of Stanley Baldwin, the prime minister of the United Kingdom from 1923-1924, 1924-1929, and 1935-1937. Although some may remember Countess Baldwin as a Prime Minister’s wife, Baldwin was an active writer and campaigner for equal maternity health care for all women. Having six children of her own, Baldwin was all too aware of the importance of maternal care during and after childbirth.

In the early 1900s, the rate of maternal deaths was incredibly high and little was being done to reverse the statistics [4]. Baldwin supported the work of the National Birthday Trust Fund to improve the care of pregnant women, and had an important role in obtaining equal access to anaesthesia for all mothers regardless of their financial income. Her great efforts lead to the introduction of self-administered anaesthetic machines into many hospitals across the country [5]. She had close ties with maternity health in Glasgow, having opened a New Infant Health Visitors Association centre in Bridgeton, and paved the way for the employment of the first anaesthetists at the Glasgow Royal Maternity Hospital in 1930 [6]. Named after her in her honour, a Lucy Baldwin Gas-Oxygen Analgesia Apparatus can be found with the College’s museum collection, [Fig 1].

2003.74_Lucy Baldwin apparatus 4

The apparatus would include a face mask, which was connected to the machine through a tube. The midwife could then manipulate the dial to alter the percentage of oxygen within the gaseous mixture. The machine would be mounted onto 4 wheels for easy movement between patient beds.

Although Baldwin was not medically trained herself, she used her position and the resources available to her to fight for equal rights in healthcare.

For more information on the Lucy Baldwin Gas-Oxygen Analgesia Apparatus, feel free to contact us at: library@rcpsg.ac.uk

 

References

  1. Cellania, M., 2013. The Historical Horror of Childbirth. Mental Floss. [online] Available at: http://mentalfloss.com/article/50513/historical-horror-childbirth
  2. Semmelweis, I., 1861. Etiology, Concept, and Prophylaxis of Childbed Fever.
  3. Carter, K.C., 1994. Childbed Fever: A Scientific Biography Of Ignaz Semmelweis. Transaction Publishers: New Jersey.
  4. Schafer, E., 1998. Schafer on Williams, ‘Women and Childbirth in the Twentieth Century: A History of the National Birthday Trust Fund 1928-93’. Humanities and Social Sciences Online. [online] Available at: < https://networks.h-net.org/node/24029/reviews/29853/schafer-williams-women-and-childbirth-twentieth-century-history>
  5. Blakeway, D., 2011. The Last Dance : 1936 The Year Our Lives Changed. Hodder Paperbacks: London.
  6. Dow, D.A., 1984. The Rottenrow: The History of the Glasgow Royal Maternity Hospital 1834-1984. The Parthenon Press: Lancashire.