Casualty 1800’s

By mike henderson on 4 Nov 2010

This month human osteologist Don Walker talks about the analysis of nineteenth century trauma victims from the Royal London Hospital.

The Royal London Hospital in Whitechapel, East London is a venerable institution with a rich history of serving the local community, and was featured in a series of historical medical dramas produced by the BBC (‘Casualty 1906’ and ‘Casualty 1907’). The hospital was founded in 1740, and opened on its current site in 1757.

One of the functions of the hospital was as an accident and emergency department accepting ‘special cases necessary to the preservation of life’. Emergency treatment would have saved the lives of many, but the less fortunate would never leave the hospital alive, with the poorest being buried in the hospital grounds.

MOLA excavated 170 burials from the Royal London Hospital grounds, and some of the skeletons revealed evidence of injuries from which they never recovered.

Unhealed spiral fracture

In one example, the skeleton of a 26–35 year old male had an unhealed spiral fracture of the mid-shaft of the right femur (upper leg) (Fig 1). Such a fracture would have required considerable force, probably causing extensive soft tissue damage. The fracture was probably an open, or compound fracture, where the bone was exposed through the skin. In modern times such injuries are often found in young adult males, due to participation in activities with risks of high impact collisions and falls from height (Galloway 1999, 180). Doctors at the London Hospital would have admitted the man on the basis of this life-threatening injury.

Unhealed spiral fracture

Close inspection of the fracture site revealed the early stages of healing in the form of new bone growth, which represents initial callus formation. This indicated that the individual died within approximately three weeks of receiving the injury (Lovell, 1997, 145) (Fig 2).

There are a number of serious complications associated with femoral mid-shaft fractures, some of which may have contributed to the death of this individual. These include blood loss, arterial injury, fat embolisation, shock, infection, as well as associated life-threatening injuries to the viscera or cranium (Resnick 2002, 2870–2). Prior to the availability of antibiotics, infection was common in open wounds and fractures, and this would certainly be a candidate for the cause of death of this man.

There are frequent contemporary reports of victims of accidents being sent to the London Hospital. In one account from The Times of 11th August 1806, a group of bricklayers who were sitting on top of a newly completed house and celebrating their achievement with a gallon of beer, fell to the ground, “one of whom was killed on the spot, and the others were taken to the London Hospital, one of whom has died since the incident, and the other two are not likely to recover” (The Times, Aug 11, 1806). The study of the skeleton of the young man found within the hospital cemetery tells us he suffered a life-threatening injury from which he unfortunately never recovered.

Perimortem compression fracture

In a further example of unhealed injuries, a 26–35 year old female from the hospital cemetery had fractures to some of the vertebral bodies of the spine, possibly due to a fall onto the feet or buttocks (Galloway 1999, 95) (Fig 3; Fig 4).

Perimortem burst fracture

In this case, there was no evidence of healing at all, suggesting that she died immediately or soon after the incident (known as ‘perimortem’ injury). From an osteological point of view, the illustrated vertebrae provide good examples of unhealed bone lesions, with sharp edges and an absence of new bone growth or repair.

Galloway, A (ed), 1999 Broken bones: anthropological analysis of blunt force trauma, Springfield, IL
Lovell, N C, 1997 Trauma Analysis in Paleopathology, Yearbook of Physical Anthropology 40,139–70
Resnick, D, 2002 Diagnosis of bone and joint disorders, Philadelphia
The Times, Aug 11, 1806; pg. 3; Issue 6813; col C

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