Part 9: Trauma

“The healthy scepticism which medical training induces, the desire to prove every fact, and only reason from such proved facts – these are the finest foundation for all thought.”
– Sir Arthur Conan Doyle –

The next important class of disease in the sieve is trauma. This is usually an easy branch of diagnosis to reach – more often than not the patient will be very forthcoming in telling you about where and how they got hurt. The challenge lies in working out what exactly has happened to the patient’s anatomy at the site of their trauma… and getting this wrong could have life-threatening consequences.

Different doctors deal with different amounts of trauma – some physicians rarely see it, while emergency doctors deal with a lot of it – and some surgeons deal with almost nothing else. However, no matter who is managing the patient, the consistent use of systems and methods is always evident. The importance of ABCs for instance – Airway, Breathing, Circulation, is well known to anyone taking the most basic resuscitation course.
Ambrose Pare (1510-1590). Pare was born in North-West France and began his medical career as a lowly barber-surgeon in the provinces. However, after joining the army he quickly rose to become one of the most influential surgeons of all time, writing twenty books gleaned from experience in more than twenty military campaigns. One of his most notable contributions was to stop the practice of bathing gunshot wounds in burning oil, which was thought to be the best treatment for bleeding. Pare made this discovery on one particularly bloody occasion when he ran out of oil. He quickly made a concoction of egg whites, oil of roses and turpentine, and bandaged it tightly on the wounds to seal them. The wounds healed better than ever before.
Pare was a man noted for humility, famously stating in regard to bandaging wounds instead of cauterising “Je le pansais, Dieu le guerit.” (“I bandaged them but God healed them.”) He also fathered a son in 1583, aged 73.

Thomas introduced many ideas regarding the correct setting of bones and is remembered as the father of orthopaedics in England. His greatest invention was perhaps the ‘Thomas Splint’ for reducing femoral fractures. The invention was not widely used until after his death, but quickly came into general practice during the battles of World War I. The splint is credited with reducing the mortality of compound fractures of the femur from 80% in 1916 to less than 8% in 1918.
Hugh Owen Thomas (1834-1891). Hugh Owen Thomas came from a long family line of bone setters on the Island of Anglesey in North Wales – this tradition had passed from father to son for generations. His father moved to Liverpool, and determined that his son should break from tradition and have a proper medical education, and so Hugh studied at Edinburgh and University College, London. On graduation, he returned to Liverpool, preferring working for the poor in the slums of the city than for the affluent middle classes of Victorian England.