Post Mortem: A Medical Analysis of
Looking back at events of the 18th Century through 21st Century eyes, it can sometimes be difficult to understand exactly what transpired. This is especially true in the case of the Job WILLIAMS court martial.
Since neither of us have a background in medicine, and the practice of medicine was quite different 225 years ago than it is today, it was natural to wonder after reading the testimony in this case whether the list of things that might have contributed to the death of Lieutenant Peter Augustus TAYLOR shouldn't include the actions of the surgeons themselves!
To find out, we turned to our friend, Mike Williams (presumably no relation of Job WILLIAMS!) of the British Detached Hospital, a reenactment group belonging to the Brigade of the American Revolution, and asked him to provide some insight into this case from both a modern and an 18th Century point of view.
Few people are more knowledgeable about medicine as it was practiced in the 18th Century than Mike, and while he is not a physician, he does work for the University of North Carolina Hospitals in Chapel Hill, NC.
Mike, in turn, called on his friend, Dr. Marshall McCoy, Associate Professor of Emergency Medicine at the U.N.C. Hospitals, for confirmation of his theory and help with some of the modern medical terminology that applies to the case.
We gratefully acknowledge the contributions of these fine gentlemen to our understanding of the cause of poor Lieutenant TAYLOR's untimely demise.
Here is what Mike had to say...
The late Lieutenant TAYLOR died of a classic closed head injury - most likely a subdural hematoma.
When the brain receives an injury, it can bleed, causing two types of injuries. The first, the Epedural Hematoma, is a very fast acting injury.
This injury causes rapid bleeding in between the inside surface of the skull and the dura (the membrane surrounding the brain). Since there are arteries in this area, any bleeding is quick and causes dramatic damage from pressure.
The other type of injury is the Subdural Hematoma.
This injury occurs in the area between the dura and the brain. Since the blood is carried in veins in this area, the blood flow is less and there is less pressure. With this kind of injury, damage is gradual and slow.
This is, based on the symptoms reported, the type of injury that Lt. TAYLOR had.
Dr. McCoy told me that the symptoms described are typical of such an injury: nausea, fixed pain in the head, and shivering fits. This indicates that pressure is building and starting to cause damage to the brain.
The pressure will continue to build until the brain is forced down, distorting the brain stem and the cerebellum. With damage in this area, there is little chance for the patient to survive.
Now looking at the treatments that the doctors gave, they were all based on good sound 18th Century medical theory.
The first treatment stopped the flow of blood, and the second removed an area of scalp to see if there was damage to the skull.
The Lieutenant was bled, which lowered his blood pressure and slowed the bleeding in his head. He felt better.
When the symptoms returned, his skull was trepanned, which means that holes were bored in the skull to allow the pressure to escape. The Lieutenant felt better.
Once again the pressure built up, and the Lieutenant started showing the same symptoms again.
The doctors again attempted to trepan, but this time, because the damage was so severe, or the bleeding had gotten worse, or they could not get previous blood clots off the brain, it didn't have any effect and he died.
You will notice that there was a great deal of focus on what the Lieutenant ate, drank and did after his injury. We of the 21st Century can't understand why this focus.
It's quite simple. It was the latest theory of medicine of this time.
Remember that this was the age of reason and that the standard theory of the humors had been done away with by most of the progressive doctors of the time.
Due to study in the medical schools of the time it had been discovered that stimuli of nerves caused contraction of the muscles. This led the leading doctors of the day to conclude that all illness was caused by either too much, or too little, stimulation of the nervous system.
Now where this ties into the poor Lieutenant's case...
He had had a shock to his system. (Two chairs across the head will do that to a fellow!)
So that his system has a proper chance to recover, the doctor will proscribe rest and a low diet like gruel. This prevents excessive stimulation and allows the body's nervous system to heal and recover.
The Lieutenant obviously did not follow instructions since he was eating gravy that would obviously overly stimulate his digestive system. Alcohol was considered a stimulant to the whole body.
Not following the Doctors' sage advice could have contributed to the Lieutenant's untimely demise based on the best 18th Century theory.
And it is possible that the Lieutenant really did speed up his own death. Drinking, fighting and other such activities are not real good for a person with a head injury.
It is possible that the injury from the blows suffered from Captain WILLIAMS might not have caused the Lieutenant's death, without his other activities.
The injury could have stopped bleeding on its own, then another blow could have started the bleeding again. The consumption of alcohol, or even a sudden rise in the patient's blood pressure, could have started the bleeding again.
In the final analysis, there is no way to be sure without a good autopsy.
Click here for ---> More On-Line Courts Martial
The On-Line Institute for Advanced Loyalist Studies