The Battle of Trafalgar Special, Part II: Nelson’s Wounds
Dr Sam Willis explores the many wounds that Nelson received in his life, as well as his fatal wound received at the Battle of Trafalgar. Sam speaks with Michael Crumplin, a retired consultant general and upper gastro-intestinal surgeon and Honrary Curator and Archivist at the Royal College of Surgeons of England. Nelson was so damaged by a life of naval service it has been calculated that he would have received a total degree of disablement at 140% if assessed for war pension today: his right eye was damaged by flying earth at siege of Corsica in 1794; he developed a ‘fist-sized’ hernia when hit by flying timber at the battle of St Vincent in 1797; his arm was amputated after being hit by a musket ball at Tenerife, also in 1797; his forehead head was struck so hard, and cut so badly by flying debris at the battle of the Nile in 1798 that he thought he was gong to die. And then, at the Battle of Trafalgar in 1805 he was shot by a French marksman, the ball breaking his spine and puncturing a lung.
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From the Society for Nautical Research in partnership with Lloyd’s Register Foundation, I’m Sam Willis, and this is the Mariner’s Mirror Podcast, the world’s number one podcast dedicated to all of maritime history. Welcome everybody to the Mariner’s Mirror Podcast and the first of two episodes on the history of the Battle of Trafalgar. Today we are going a bit grisly and gruesome by exploring the history of Nelson’s death at Trafalgar from a medical perspective. To find out more, I spoke with the one man who knows more about the medical details of Nelson’s death than anyone else. His name is Michael Crumplin and he is a retired consultant general and upper gastrointestinal surgeon. For over 50 years, Mick has taken an interest in military naval and surgical history, although specialising in the French wars 1792 to 1815, he has also had interest in earlier and later conflicts. He writes and lectures nationally and internationally, and also advises students, researchers, authors, and the media. He has published five books many articles, and has acted as medical advisor for diverse media programmes and publications. His principal purposes with history are to promote interest in the human cost of war and the evolution of healthcare in the armed services. He is an honorary curator and archivist at the Royal College of Surgeons of England. And what he tells you about Nelson’s wound received on board the decks of HMS Victory from a sniper high in the rigging of the French ship Redoutable will probably make you feel sick. So you may need to sit down for this one and get a nice glass of water ready. And here is Mick.
Mick, thank you so much for talking to me today.
Sam it’s a great pleasure to be with you.
Let’s start more broadly with the Royal Navy rather than just talking immediately about Nelson, the Royal Navy, obviously a particularly high risk service. What were the great threats to sailors and marines at sea during the French wars?
Well, perhaps unsurprisingly, shipboard accident, foundering, drowning, fire, climate threats, deficiency diseases, infections, and of course, battle injuries. But it’s interesting that of, of around 103,000 sailors and marines that perished in these wars against France, only around 6%, 6000 died from battle trauma.
That’s a tiny amount. I think people will be very surprised by that were you surprised when you discovered that?
Yes, I was. In the army, the equivalent is 20% die of battle injury. So it’s rather than three times that of the Navy.
And what what were these? What were these kind of diseases that people were getting then, what was so dangerous to them?
Well, there were infective diseases in the West Indies, malaria, yellow fever, dysentery was universal, really, it happened to all sailors and soldiers. And this is due to uncleanliness. And there was typhoid, and of course, typhus, when there was crowding, and a lot of louse, infection of the clothing and so forth. So yes, and of course, seasonal illnesses, pneumonia and so forth. So there are a lot of challenges to men.
Yeah, but today we’re going to talk specifically about wounds because Nelson is such a fantastic subject to talk about because he was injured, seemingly more than many other people. Why was he so susceptible to being injured in battle?
Well, that’s a good question. I mean, obviously, if you read many biographies as I have a you fully understand quickly that he was widely involved all over the world in his campaigning, his travels took him to at risk areas, both from disease and injury. But his fatalistic and extremely bold leadership style and his personality being with his men made him often eschew standard tactics. And he, for instance, often lead boarding parties, took part actively in combined operations and set very many bold examples to his men and a close involvement and relationship with his crews put him in the firing line for disease, climate and of course injury.
I was always interested with Nelson that he, he suffered from malaria a bit which he got early on in his life. And so that’s one I know about what other sort of illnesses plagued him during his career.
Well, I suppose if you count seasickness is an ailment that was often the bane of his travels. He suffered a lot with colds and sore throats, and did you know write quite freely about his diseases and challenges. And he had, of course reactive depression and anxiety, as many men would do, and he was quite open about that too in his letters. And he was very down, for instance, after losing his right arm at Tenerife, and after his eye injury and Corsica, and his anxiety before fleet actions and his concerns over money, appropriate rewards and Emma Hamilton’s future were quite understandable and pressing challenges to a man of his burdens and responsibilities. Yes, he suffered from recurrent attacks of malaria, dysentery, failing vision. Of course, he had that injury to his right eye and Corsica, but he developed early cataracts. He had an oral epulis, which is a little fleshy lump in his mouth, which he was accused of being venereal, which it certainly wasn’t he had that removed. He had typhoid probably with a peripheral neuropathy, after his Nicaraguan adventures, and very nearly died. So that really took him months to get over. And of course, he also suffered from occasional headaches and chest pains, which many people have speculated over. I think he suffered from reflux and esophageal spasm, giving him central chest pain that was especially obvious before the Battle of Copenhagen.
A huge variety of ailments. Do you think he was troubled? It’s gonna be a tricky question this Mick do you think he was troubled more by his psychiatric problems than his physical ones? But you’ve just listed a whole host of very troubling physical problems?
Yeah, I mean, I think. Anne Mary Hills was a GP and Nelson expert in his mental illness. I’ve spoken to her quite a lot. And I think there is a lot of evidence that every time he got injured, he got very down. And I think that again, he expressed his feelings to Emma and others, and his wife. And it was quite plain that his anxiety and depression were quite foremost throughout his career, really. But I suppose these challenges and worries were often experienced by many other naval officers, not just Nelson, but promotion patronage, not getting the rewards he deserved. Fights over prize money. They all got him down. And latterly, of course, he was so concerned and very worried about his, the future of Emma and his daughter.
Yeah, I think it’s interesting that the his mental illness problems were were linked to his physical ones as well. And it’s probably unhelpful to try and divide those two up. Is that right?
Yes, I think that’s right. I mean, after his relatively minor head injury and mild concussion after the Battle of the Nile, a lot of people have blamed that head injury for causing his misjudgment his problems with the Court of Naples and so forth. But he was in a very disparate and dichotomized society. And he was falling in love with Emma, and he was exhausted after his Nile and the chase after the French fleet. So it’s very difficult as you say to separate things. And Blair easily blamed the head injury, but there were many other factors that would have taken Nelson in a psychiatric way.
Yeah, while we’re just talking about this before we go on to his physical wounds. He’s a fascinating character, because you can read him two ways one of which is is you read him almost as a, as a deeply insecure boy. He’s almost like a child in the some way. He reacts to things, but in other aspects, he is he is the most confident person that you’ve ever come across. And to have those two in the same person. I think it makes him particularly fascinating.
It is interesting, isn’t it? Because he certainly had flashes of glory and intent to defeat and huge confidence for the moment when it was needed. You’re quite right.
Yeah. So how many injuries did Nelson receive or the ones we know about anyway?
Well, the ones that are recorded was six in all and the last one, of course, being fatal. He had a minor cut on the back and bruising when he was overseeing the bombardment of the town of Bastia in Cap Course. In Calvi, he received a penetrating eye injury by a bit of grit probably, causing damage to his iris and it may well have cost him essentially his sight although he always claimed he could have some vision in that eye light and dark differentiation for example. And of course, as I said before he gradually got cataracts and needed eye protection. At St. Vincent when he crossed the St. Nicholas onto the San Joseph Spanish ships during the Battle of Cape and Vincent. He received a shard of wood striking him in the right flank or right groyne which caused terrific bruising. And this bruising cut off the blood supply to an area of muscle. And I think he had a sort of lumbar or just superior to the groyne hernia through which bowel protruded occasionally he probably wore a sort of corset to keep it back in place, but he did complain about that in his life. Then, at Tenerife, a musket shot from a Spanish gun, injured his right arm and he had an amputation above the elbow, by surgeon Ethalby on HMS Theseus. And then the Nile, he received a fragment of langridge which is metal debris shot from a French gun, which cut him on over over the right eye over his injured eye. And there was a flap of skin that probably fell down a little, but bleeding obscured his vision, and he thought he was going to die after this, but in fact, there was no skull fracture, no retrograde amnesia. He was instantly conscious and his, his wound was sutured up by the surgeon on the orlop deck. And then of course, finally, we have the fatal wound of his chest at Trafalgar. So those are the six injuries that affected him during his career.
My immediate response to all of those list of injuries is that Nelson It must have been in bits by the end of his life. Do you think people realise just how physically demanding being a naval officer in the wars against France actually was?
Probably most of the British population hadn’t understood all his injuries because they weren’t written about or recorded in great detail. A lot of it was was private. But I think that, one has to remember that at these times, an attack of influenza or attack of dysentery, or child bed fever would soon end your life. And these men were very used to early death. The average age of a mattelot in 1805, I think was about 42 years. So they were used to suffering and death and deprived living. Whereas, we are not, we have great expectations, whether they were tougher than us, I guess they were because of the work on a ship or that in the fields was physically very demanding. But no, I don’t think most people realise what he’d been through in terms of his injuries and illnesses until much later in history.
Yeah. His hernia I’ve always been interested in, this is, this is what he received at the Battle of St. Vincent from a piece of flying debris, a splinter but it was probably a foot long piece of wood. And he described it as trifling to his wife, but we also know it was the size of a fist. So if you imagine having a little a hernia and how sore a small like a 10 p piece hernia might be. His was the size of a fist. And that must have been incredibly uncomfortable. Do we know which were the injuries that troubled him the most?
Well, yes, there was that. And of course, people forget that he went into urinary retention after his injury, which either means that his kidney was damaged and bled or his bladder was injured and bled and he had clot retention of urine, but he overcame that he managed fortunately to pass his urine without catheterization, but that painful bulging the size of a fist, he did occasionally complain of in his letters during his life. I think he must have worn some sort of bandage around his waist to keep it in place. You could put a pad over the affected area to keep it in, what we call it these days are trust. So that was his hernia. It did occasionally fortunately it never obstructed, he never got bowel obstruction. But he did after his amputation in 1797. Get severe neuropathic pain after the removal of his arm because whether or not Ashelby and his assistant Rimonier failed to see that a suture ligature around the brachial artery had included part of the median nerve is uncertain. There is no doubt that some surgeons would include a nerve but sometimes during this era to prevent bleeding from the surface of the nerve which can be quite troublesome. I think his failing vision added to his already damaged right eye as things went on particularly between the 1803, 1804 Mediterranean times and also the hypersensitivity of his forehead. If you if you look at some of the pictures of Nelson his hat is distinctly off his right forehead. And of course he complained a lot of headaches after his head injury suffered in the Battle of the Nile. So those were the things that troubled him prior to death mainly.
There’s a there’s a pub near me Mick, called, in Topsham called the Lord Nelson and they advertise their goods by saying for food and drink that won’t cost you an arm and an eye rather then an arm or a leg, which I always thought was very good.
No I was just going to say that it’s interesting that the court of examiners at the Royal College of Surgeons which I had the privilege to lead at one stage, were responsible for awarding pensions and their criteria was simple the loss of an eye or equivalent or the loss of a limb. But you didn’t get tow pensions. As far as I know, Nelson only got his pension for his eye, which was pretty generous. But I don’t think he got a pension again for the loss of his arm.
It’s a really good point, It was really good for whether they added up. So he managed to survive this long which it having listed all the injuries that seemed to be a bit of a miracle that he was still standing at Trafalgar. How old was he when he died?
Well he was only 47 which is what five years younger than Wellington was at Waterloo. So it gives you some idea so many men would have died at this age officers tended to live longer, for obvious reasons, their cleanliness, their better food, their better medical treatment, and so forth.
Yeah, well, let’s, let’s fast forward then to Trafalgar. What were the what were the circumstances of Nelson’s final wounding, the injuries?
Well, he was of course situated on the most exposed part of a warship that is on the upper deck, he was on the quarter deck, and he was wearing as admirals would and did the dress coat of a senior officer with his all its medals and awards and so forth, so he could have been a target if he was seen. Now, around three, while about half to three quarters of an hour after victory cross the combined enemy line. Victory became soon entangled with a rigging of a French 74 call the Redoutable and he was pacing the quarter deck with Hardy. As they turned away from a companion way Hardy noticed the Victory was, that on the deck of the Victory that Nelson was no longer there, and probably a random shot. Because with movement and smoke it it’s tempting to think it wasn’t an aimed shot, but it could have been rang out from the muzzle on top of the Redoutable which was really above the quarter deck. And the ball was fired from about 20 metres and then on top of the Redoutable at an angle of about 40 degrees up and penetrating the left side of Nelson’s body, but it was only 11 degrees off the lateral line. So in other words, it came in very much from the side into his chest. Now if we look at the ballistics of this wound, assuming that the French musket was reasonably loaded with decent powder, the force of this ball striking Nelson’s chest was around 200 joules. Well, what does that mean? Well, it’s around twice the force required to break a man’s thigh bone with a musket ball. So it was a powerful strike. And that makes it almost 100% certain that the track of the ball was a straight one. In other words, the ball wasn’t deflected when it went into the chest. We confirm the track of the ball years ago by placing a skeleton the same height as Nelson on the spot where he fell and we got a cherry picker. And we got a chap with a musket which was laser loaded. And we tracked the shot through his body and then placed a plastic rod and it was indeed a straight line when you look at the anatomy and the track of the ball, as described later. So that was interesting. And that was well these were the circumstances of his final wounding.
What was the nature of the wound itself? What do we know about it?
Well, that’d be a small entry wound as the ball passed in front of the shoulder. Entering the chest taking with its tiny fragments of epaulette and coat with it. It broke the second and third ribs, it descended into the left thorax, passing through two large segments of the left lung. And this would of course, cause air and blood to leak into the chest cavity. The ball then smashed through the spinal column breaking out the sixth and seventh vertebrae, and the spinal cord was divided. And then the missile exited the chest and went on to come just alive below the right shoulder blade or scapula. So that was the track of the ball.
I mean, he didn’t didn’t, he didn’t die immediately. He survived for three and a quarter hours. What was the clinical progress of the admiral over that period?
Well, he knew that he’d received a fatal wound and this was acknowledged by both himself and William Beatty, his surgeon on Victory, and he recognised the effect of the traumatic spinal cord transection and consequent paraplegia, because he’d witnessed a sailor suffering from this problem during the return part of the recent chase of the enemy combined fleet back and fro across the Atlantic. So he suffered much pain from his spinal wound which radiated around the chest wall, and he had no sensation or movement below the line of his nipples. He was increasingly having bouts of faintness and weak weakening from the loss of blood with decreasing flow to his brain. His pulse became weak, thin and rapid. He complained of blood gushing into his chest, which, in fact was blood, fluid level in his chest sloughing around within the blood space in his cavity. He became extremely anxious about the progress of the battle, and later of the care that the nation would take of Emma Hamilton and his daughter, and prayed for a victory and how many ships he’d taken and so forth. But as hypovolaemic shock became more evident, Nelson became fainter, pale and slightly sweaty.
What treatment was he given, what was he given to manage it?
To be honest, very little. In fact, he was made comfortable on a pile of sales forward and the all up deck and was supported by Walter Burke, the purser and with the pain from his spine radiating around the chest wall, he asked for his chest to be rubbed by the ship chaplain, the Reverend Alexander Scott. So his pain was only managed as a form of by a form of counter irritation, not by adequate analgesics. He didn’t seem to receive any opiates. Severely traumatised patients became very thirsty, he was given lemonade and Cordial to drink Cordial was a mixture of wine and water. I was surprised that he didn’t get any opiates because they don’t always cloud your your judgement at all. I’ve had quite heavy doses of morphine. And you know, you can still think pretty clearly. But I think he possibly refused this because he didn’t want his judgement and sensorium clouded at such a critical event as this. So the treatment was minimum, one quite surprising, really.
Yeah, very surprising. I mean, to criticise. But what do you think might have been done better at these times?
Well, I think he should have had some laudanum. The trouble is morphia was not isolated in pure form. While had only been recently isolated in pill form, I think was about 1804 in Germany, so the dose was difficult, but he could have had some laudanum, I’m sure, or opiate, you could say that he could have had a trocar and cannula which is a silver tube with a metal introducer inside it with a sharp tip placed into his chest to drain off air and blood. And that would have eased his breathing. And there is one possible reason why Beatty might not have done that, he might not have had the kit, although it was available at this time. But if you drain off the blood, it sometimes continues. Because if you leave the blood building up to a degree in the chest, and then the blood pressure falls, the bleeding eases off. And if you continue to let the blood out this effect is not seen. But really, at these times little else could have been done. So my criticism is minimal. Really.
Yeah. I mean, I the one thing I keep coming back to is is I’m just surprised he survived that long with such major injuries to his chest and his spine and we’re all about internal bleeding. So how did he survive for that long?
Well, if I can sort of go forward a bit, Beatty describe the main left main pulmonary artery has have been injured or a major branch of it. And I think he would have succumbed sooner from haemorrhage because although these are very low pressure vessels, it’s a huge vessel and the bleeding would have ended his life quite quickly. But if you look at the angle of the passage of the musket ball at around 11 to 15 degrees off the lateral, I think the ball passed behind the pulmonary ligament, which contains these major vessels. Therefore, it wasn’t a very major vessel that had been divided. But of course, Beatty had to be fair and give a reason for death. And he did so quite correctly. Nelson died of blood loss from injuries, bleeding from the chest wall and his lungs and so forth. He gave his reason that such a large vessel damage so near the heart, would have been fatal. But that’s very non physiological, one can’t accept that, and bleated did not have the information that we have today. And of course, the bleeding occurred mainly from blood vessels around the ribs of the damaged vertebral column, and of course, from smaller lung vessels.
So how can we explain his death in modern terms with the contemporary information available?
Yeah well, I think this is a very interesting exercise, and one that’s often done by military medical historians. We know that he died of blood loss and his symptoms and the post mortem evidence showed all this and we know the track of the ball. But we do know also that if you look at plenty of contemporary accounts of Army and Navy personnel who suffer non exiting chest wounds, they do survive a high proportion of them, with trouble along the way, of course, but the thing is, the difference here is that Nelson’s spinal cord was transected. Now with the cord run nerves that control the calibre of arteries and veins. If these nerves are destroyed, then the blood vessels cannot contract and shut down. So diminishing the capacity of the circulation. And the advantage of that is that blood can be diverted away from muscles, bow, skin, and thus enabling blood to go to the heart, brain and kidneys to preserve life. Now, when Beatty opened the chest at post mortem, he discovered the straight track of the ball, he observed that Nelson’s organs were generally healthy, but he was surprised that the lesser amount of blood in the chest cavity than he had expected. Now, it’s undoubtedly that Nelson did die from this blood loss, but had his autonomic nervous system not being damaged and he could have shut down his vessels. So compensating for this blood loss, which would have ceased, he might well have survived. So it was the combination of moderate blood loss which could not be compensated for because of the spinal cord injury, that he died.
Alright, here’s a question for you. I’m not sure many people consider this. What what would his life have been like had he survived?
And quite honestly, I think utterly miserable. He’d have been wheelchair bound. With intermittent frequent catheterization would have led to repeated urinary tract infection, infections, eventual renal failure and death. His bowel function would have been disturbed, he would have got constipation. And soon enough, he’d have developed stinking ulcerated areas on his buttocks and legs. He would have gone through weight loss and malnourishment. And no doubt extreme depression would not have given him the survival that he would have been prepared to endure.
No, that’s profoundly shocking, isn’t it? What would have been his management today?
Well, the scene of the injury there a high proportion of paramedical support would have been available. Incidentally, it’s interesting that 10% of matelots in the Navy were taught tourniquet control even then, but this support would have dressed his wounds pressed on the injury probably stabilised his back when they realised that he was paraplegic. And he would have been moved to a non fixed wing aircraft a Chinook or whatever. And there he would have been given an analgesic, ketamine or opiates, an IV drip set up his airway protected, and his spinal image managed by a mobilisation they would have inserted a chest strain and watch the bleeding because if that continued or became heavier, then you could hand him over to a general or chest surgeon who had carried out a thoracotomy to control the bleeding, repair any damage, etc. His paraplegia would have been managed as a specialist centre to protect his skin, his muscles, his bladder, and his psyche. With no doubt, massive efforts put into rehab, and there would have also been of course intensive support for any residual PTSD.
Do you think it was better that he died?
Undoubtedly. And he died at a time that gave his legend and heroism, the status that he enjoys today, not something that belongs to the poor or Duke of Wellington, perhaps with a different personality, living to a much longer age and getting into political strife, undoubtedly, of Nelson had survived. I think he would have been in significant trouble with his domestic situation. But who knows?
Yeah, no, I think I agree. I agree with that. He was very talented at getting himself into muddles when it came to politics and relationships and with no no fleets to manage and no enemy to bring down I think he might well have waged war against himself and would have won.
Thank you so much for talking to me today.
Now, if you enjoyed that, please make sure you hop over to the website of our great and esteemed colleagues at the Navy Records Society. Their website is Navyrecords.org.uk, where members can read Mick’s recent article on Nelson’s death, which includes William Beatties account of Nelson’s post mortem. Otherwise do please follow us the Society For Nautical Research on social media. In particular, please seek out the Mariner’s Mirror Podcast on YouTube where you will find an ever growing library of the most wonderful innovative video is presenting our maritime past in entirely new ways. Please spread the word about the podcast please tell your friends But above all, please join the Society For Nautical Research. It doesn’t cost very much but your subscription fee will help support this podcast will help publish the Mariners Mirror Journal will help preserve our maritime heritage and as a paying member you get to come to our annual dinner on board HMS Victory. What a treat that is and you can find everything we do now and have done in the past at snr.org.uk
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