/health.htm" Nelson's Health

 

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The following was written by Nelson himself

 

"Wounds received by Lord Nelson:

His eye in Corsica

His belly off Cape St. Vincent

His arm at Teneriffe

His head in Egypt

 

....Tolerable for one war!"

 

 

            Nelson was just twelve, a frail, diminutive schoolboy, of 'puny constitution',  when he proudly decided that he wanted to join thenavy.
            ' Write to my father,' he said to his brother, William, 'and tell him that I should like to go to sea with Uncle Maurice.'
            The matter having been broached to him, Captain Maurice Suckling's reply was :
            'What has poor Horatio done, who is so weak, that he, above all the rest, should be sent to rough it out at sea? But let him come; and the first time we go into action, a cannon-ball may knock off his head, and provide for him at once.'
            Nelson, born in 1758, was one of a family of eleven children, of whom three died young. The delicate health which he manifested as a child pursued him throughout life. He was seldom well indeed. After being for a time with his uncle, he went off in a merchantman to the West Indies, and then on an expedition to the North Pole. Not yet sixteen, he sailed as a midshipman in the Seahorse for the East Indies. Early in life he contracted malaria, most likely during this stay of eighteen months in the East , and frequently afterwards suffered from recurrent attacks of the disease. On March 23rd, 1784, he wrote to his great friend, Captain Locker :
            'On last Friday I was commissioned for the Boreas in Long Reach . . . and, I am sorry to say, that the same day gave me an ague and fever, which has returned every other day since, and pulled me down most astonishingly.'
            Again, on July 311794, he wrote from Calvi to Admiral Hood :
            'This is my ague day, and I hope so active a scene will keep off the fit. It has shaken me a good deal; but I have been used to them, and so don't mind them much.'
            In his letters he was continually making similar reference to attacks of fever, which seems to have been mal. From the East Indies he was sent home a complete wreck in health; the tropical climate having made him seriously debilitated and emaciated. On the voyage back he improved, however; the recovery from attacks of malaria is as dramatic as the suddenness of their onset.
            After passing his lieutenant's examination, he sailed, in 1777, in the Lowestoft for the Jamaica station, and during the three years that he remained there he rose rapidly until he became captain in command of the Janus. It was during this period that he narrowly escaped being bitten by one of the most venomous snakes in the country , and where, indeed, he suffered from poisoning by drinking water from a spring into which some branches of the manchineel apple had been thrown - a subtle poison which was used by the Indians for their arrows. Nelson suffered severely from its effects. The Duke of Clarence, who was then at the Jamaica station, and who became one of Nelson's staunchest friends, considered that his delicate health experienced a severe and lasting injury as the result of this poisoning. This, however, was not so likely to have exerted a permanent effect upon his constitution, as did the very serious illness which he contracted just afterwards on this same excursion against the castle of San Juan in April 1780. Nelson fell a victim to the disease, which was playing havoc among the men during the siege of the castle. The devastating climate, together with the most insanitary and primitive conditions of the place, caused the death-roll both among the men and the natives to be disastrous. Hitherto this disease has always been regarded as dysentery .But at this time the germ theory of disease was undeveloped, and every affection which was associated with persistent diarrhoea was called dysentery .On considering the available data in the light of modem knowledge, I think this disease was most certainly typhoid fever. Here are Nelson's own words :

            'The fever which destroyed the army and navy attached to that expedition, was invariably from twenty to thirty days before it attacked the new comers; and I cannot give a stronger instance, than that in the Hinchinbrook, with a complement of two hundred men, eighty-seven took to their beds in one night and of the two hundred, one hundred and forty-five were buried in mine, and Captain, now Admiral, Collingwood's time; and I believe very few, not more than ten, survived of all that ship's crew.'

            Bacillary dysentery has an incubation period of from two to five days; it is rarely more than three days. In amoebic dysentery there is no definite incubation period. In both recovery from the acute stage is usual, and the mortality is comparatively low; nothing like that described by Nelson. Cholera, too, has an incubation period of but a few days. On the other hand, the period of twenty to thirty days before the onset of symptoms fits in with typhoid, and the high mortality under adverse conditions is in full keeping with the disease. Up to the time of the late war, when effective inoculation against the disease was first universally carried out, typhoid fever had always been a terrible menace to armies. On the day before the castle surrendered, on April 24th, Nelson was recalled to the fleet headquarters at Jamaica, upon his appointment to the Janus, 'an effect which providentially withdrew him, when in a most precarious state of health, from a scene of death '. He was so ill on the arrival of the ship at Port Royal, near Kingston, where the fleet was stationed, that 'they were obliged to take him on shore in his cot; and in this manner he was conveyed to the lodging-house of his former black nurse, Cuba Cornwallis, a well known and respectable negress, who had saved the lives of many naval officers '. From there he was removed to the home of Admiral Parker, the Commander-in-Chief, 'where both Lady Parker and her housekeeper, Mrs. Yates, sat up with him by turns, and even the Admiral himself constantly watched by the bedside of Nelson: so generally and sincerely was he beloved. But his aversion from taking medicine was great; and the only method which these friends could devise, was to send it by the Admiral's youngest daughter, then a child; who afterwards was often recognized by Nelson as his little nurse.' Although he was so extremely ill at this time he maintained his disapproval of the taking of medicines, and these, together with most other ministrations by doctors he always did without whenever he possibly could. Gradually Nelson improved under this careful nursing, but before he was really well his usual irritability at idleness precipitated his return to duty .He fell ill again: and as he had not improved by August, still in the same year 1780, it was decided that he must return home to recover. Dr. Moseley in particular urged the absolute necessity of his immediate return to Europe. He arrived in London in September, having been ill during the whole voyage, and went straight to Bath to put himself under the care of a Dr. Woodward. He had to be carried to and from his bed, and at times suffered the most excruciating tortures. He had strict dietetic treatment, abstained from wine, took medicine prescribed by the doctor three times a day, drank the waters, and had therapeutic baths every other night. The climate of Bath was mild and suited him. On January 23rd of the following year, after having had some four months' treatment, he wrote to Captain Locker:

            'Thank God, I am now upon the mending hand.' 

            On January 28th he wrote to him again :

            'Although I am much better, I am scarcely able to hold my pen. I shall be happy whenever I am appointed to a ship, for, as you will suppose, I do not sit very easy under the hands of a doctor: although I give myself credit this once, for having done everything, and taken every medicine that was ordered; so that Dr. Woodward, who is my physician, says he never had a better patient. Although I have not quite recovered the use of my limbs, yet my inside is a new man, and I have no doubt, but in two or three weeks, I shall be perfectly well.'

            This weakness of his limbs, which affected especially the left arm and leg, was most probably due to peripheral neuritis, a not uncommon late complication of typhoid. He was now convalescing rapidly. On February 15th he again wrote from Bath to Locker :

            'My health, thank God, is very near perfectly restored, and I have the complete use of all my limbs, except my left arm. I can hardly tell what is the matter with it, from the shoulder to my fingers' ends, it feels as if half dead; but the surgeon and doctors give me hopes it will all go off . . . I must now wish you a good night, and drink your health in a draught of my physician's cordial, and a bolus.'

            After eleven weeks' bathing the peripheral neuritis entirely disappeared, and he recovered full use of his limbs. When he went to settle with Dr. Woodward, the small fee which the doctor requested, called forth a generous objection from Nelson.

            'Pray, Captain Nelson,' exclaimed the worthy physician, 'pray allow me to follow what I consider to be my professional duty. Your illness, Sir, has been brought on by serving your king and country; and, believe me, I love both too well, to be able to receive any more.'

            On March 5th he seemed completely cured, for on that date he wrote to Locker: 'I never was so well in health, since you knew me, or that I can remember.' A week or two later Nelson left Bath, and went up to London to seek a post again. The rush and bustle of London was too exacting upon a man just recovered from a year's serious illness, and in May he was ill again, having lost the use of his left arm and partly of his left leg and thigh - a return of the peripheral neuritis. He consulted a Mr. Adair, a prominent surgeon in London, and as soon as he was recovered went up to Norfolk to have a quiet holiday with his family for a short time. It was not until August 16th that he was appointed to the Albemarle to proceed to Elsinore, whence he was to convoy the fleet home. After the long period in a tropical climate this journey in the severe winter of the North Seas seemed to promise a trying experience for his constitution. He was obliged to remain in Denmark for about a month, and arrived back at Yarmouth on December 17th. 1781. Mr. Adair had told him that a cold climate would be very dangerous to his health, and Nelson himself said : 'Cold weather is death to me' ; yet throughout this cold, damp voyage he continued daily to improve in health. 

            On April 20th of the following year, upon sailing for Quebec, where he had orders to remain the next winter, he wrote to Locker that he was 'quite well; better than for a long time past'. It was feared that the climate of Canada would play havoc with his health; but on this cruise, which lasted over a year, he enjoyed almost continuous good health. On arrival in the St. Lawrence there was no time to re-provision before setting out on a two months' cruise; the crew had been without fresh food of any kind from the time they had left England, and after four months they were all 'knocked up with scurvy' as Nelson puts it. He, himself, however, seems to have escaped. Early in his career at sea Nelson gave up the use of salt, as he thought it was the cause of scurvy, and he never took it afterwards with his food. This disease was the terror of sailors on a long voyage, although certain effective prophylactics had already become recognized. 'Lime-juice had been employed; but the principle of vitamins was, of course, not yet formulated. Cook, on his voyage to Australia in 1769-70, had used fresh foods as a preventive with wonderful efficacy. After this two months' cruise, Nelson returned to Quebec, on September 17th, and spent a month there. He wrote to his father :

            'Health, that greatest of blessings, is what I never truly enjoyed until I saw fair Canada. ... The change it has wrought is truly wonderful.'

            Not only did he find in fair Canada a most congenial climate, he also found there a fair lady, who very deeply touched his inexperienced heart. He was, indeed, in the very act of striding ashore, the moment before his ship sailed from Quebec, to ask her hand, when a more sophisticated and less impulsive friend took him by the arm, and prevailed upon him to return to the ship. Such occasions have occurred to all of us about this age. Nelson was just twenty-four, he had risen to the position of captain, and now found himself in a country whose climate and mode of life were ideal to his health, with an 'amiable American lady' in possession of his heart. Perhaps to his own loss in happiness, but to Britain's incalculable gain in glory, Nelson decided against the easier course; he left Canada and the lady, to continue the more arduous life of duty and of fighting. After a cruise to New York and the West Indies, he brought the Albemarle back to England in July 1783, and paid off. He wrote to Locker :

            'After all my tossing about in various climates here at least I am arrived, safe and sound.'

            For some nine months he remained ashore, most of the time at St. Omer in France. His health still remained good during all this time. He became enamoured there of the daughter of an English parson, but it was rather amour sans ailes, and soon forgotten on his return to England and appointment to the  Boreas. On the day he received his appointment he had another attack of malaria, as already mentioned. He sailed, however, for the Lesser Antilles station in the West Indies in March 1784, where he remained for three years. It was during this time, actually on March 11th, 1787, that his marriage took place to Fanny Nisbet, the widow of Dr. Josiah Nisbet, by whom she had had one son. While in the West Indies Nelson's health began to give trouble again. It was obviously hot climates and not cold that disagreed with him. At times he became very poorly in general health, and then he developed some chest trouble, which was suspected to be tuberculosis. At the end of 1785 he wrote to Fanny Nisbet :

            'The country air has certainly done me good service. I am not getting fat, my make will not allow it: but I can tell you, and I know your tender heart will rejoice, that I have no more complaint in my lungs ...and not the least pain in my breast.'

            He had had a very trying time at this station, and in June 1786 his health broke down seriously. On September 27th, while still at English Harbour in the Boreas, he wrote to Locker :

            'I have only a faint recollection of any thing which I did. My complaint was in my breast; such an one as I had going out to Jamaica. The doctors thought I was in a consumption, and gave me quite up but that Great Being, who has so often raised me from the sick bed, has once more restored me, and to that health, which I very seldom enjoy .'

            It is extremely unlikely, however, that Nelson had tuberculosis. Certain other diseases may be shaken off even by men of somewhat feeble constitution, if they possess that quality of mind and of body which is often referred to, not inappropriately, as 'wiry'. Tuberculosis of the lungs, however, would undoubtedly have taken off a man of Nelson's constitution, had it ever become implanted there. The terrible climate, his malaria, and the distress and worries in which he became involved just at this time probably accounted for the marked deterioration in his health. In June 1787 he sailed in the Boreas for home, his health being 'in a very precarious state'. Instead of being allowed to repair ashore immediately to recuperate, his ship was kept at the Nore until December as a 'slop'. It was a very disagreeable summer that year, and Nelson developed a severe cold with sore throat and fever. In a letter to Locker he says :

            'It is not kind in one's Native air to treat a poor wanderer as it has done me since my arrival. The rain and cold at first gave me a sore throat and its accompaniments: the hot weather has given me a slow fever, not absolutely bad enough to keep my bed, yet enough to hinder me from doing anything; and I could not have wrote a letter for the world; now the wind has set in to the westward, and the air is cool, I am quite well again.'

            The ship paid off in December, and for the next five years, till the end of January 1793, Nelson re- mained ashore. During practically the whole of this time both he and his wife stayed with his father at the parsonage at Burnham Thorpe in Norfolk, where he was born. His father was in very poor health. Nelson's mother had died when he was but nine years old. Once ashore his health soon improved. In May, five months after leaving the rigours of sea life for the comforts of home, Nelson writes : 

            'As usual, my health is got up again: after the doctors telling me, they could do nothing for me, dame Nature never has failed curing me.'

            During the whole of this time ashore he kept well, and enjoyed the longest spell of good health in his life. He led a care-free open-air existence, gardening, hunting, and shooting, with a wife to look after him, who, if she was rather cold and undemonstrative in her affection, was at least attentive. Constitutionally Nelson was completely unsuited for seafaring; his initial frailty made the demands of shipboard life doubly exacting; in small boats he was always sea- sick; and the severity of tropical climates, in which he was so frequently obliged to remain, taxed his strength. Ashore, I find he enjoyed good health always, though being long on land made him discontented and unhappy.
            After repeated applications for a ship he was, at long last, given the Agamemnon on January 30th, 1793, and in June sailed for the Mediterranean station. Before he again saw England, he was deprived of the sight of an eye, had lost an arm, and had met Lady Hamilton.
            It was at the siege of Calvi, in Corsica, that he lost the sight of his right eye. At seven o'clock in the morning of July 12th, 1794, a shot struck his battery right beside him, sand, splinters, and stone striking him with great violence in the face and chest. His face was bruised and cut, especially around the right eye. He writes:

            'Although'the blow was so severe as to occasion a great flow of blood from my head, yet I most fortunately escaped, having only my right eye nearly deprived of its sight.' 

            I think the true interpretation of the nature of the injury which caused this immediate blindness is that the concussive violence of the blow upon the side of the head and face produced detachment of the retina. For several reasons the supposition that the injury was a perforating wound of the eye with the possible lodgment of a foreign body in the globe is untenable. Nelson himself says: 'Except for a very slight scratch towards [sic] my right eye, I have received no hurt whatever.' He also mentions: 'my head being a good deal wounded and my right eye cut down.' 'Cut down' does not mean that the eyeball was wounded; it means that the skin near the eye was cut ; as we would now colloquially say, 'He cut his eye.' Had he received an actual wound of the eyeball severe enough to cause destruction of the sight from the moment of injury, Nelson certainly would have been incapacitated for more than but a few hours. Yet I find that even the same day he attended to some of his duties, in the evening wrote a letter to the Commander-in-Chief, Admiral Hood, and the next day was at his post as usual. Moreover, with a perforating wound of the eyeball of that severity, it is hardly likely that the surgeon would have so failed to recognize the gravity of the local injury as to have given it as his opinion that there would be return of sight. With a detached retina, and in the absence of ophthalmoscopes, the appearance of the eye might have led him to expect such an improvement. A wound of the globe so grave as to destroy the sight at once would have probably prompted the surgeon to enucleate the eye; but Nelson's eye was never removed. On the other hand, with detachment of the retina, due to the blow over the eye, immediate blindness could have been produced without any apparent injury to the eyeball itself. He would still have been able to 'distinguish light from darkness' as he says he could. And further the subsequent condition of the eye definitely confirms this diagnosis of the nature of the injury. In a letter to his wife Nelson says: 'the blemish is nothing; not to be perceived, unless told'. Had there been a perrorating wound serious enough to cause immediate blindness, there would most certainly have resulted some visible disfigurement, such as opacities in the cornea, a torn iris or synechiae, or traumatic cataract, all of which are quite apparent lesions. Ten days after the injury, when, although the wound on the face had healed, the sight still remained lost, any hope of a return of vision was dispelled, and Nelson wrote to Admiral Hood: 'I don't think I shall ever have the perfect sight of it again.' The vision was, in fact, permanently gone. He also says: 'The pupil is nearly the size of the blue part ...I don't know the name.' This merely means that as the optic nerve atrophied due to the detachment of the retina in the blind eye, the pupil, as usual, became widely dilated. Eventually, after about six months, the eye was 'in almost total darkness'. In the course of years the sight in the left eye began to fail. Such impairment not infrequently occurs as a sympathetic manifestation in the opposite eye. For the rest of his life Nelson 'always wore a green shade over his forehead, to defend his eye from the effect of strong light'. The opinion given after his death by Mr. William Beatty, Surgeon of the Victory at Trafalgar, was that, had Nelson lived, the impairment of vision in the left eye would have progressed until eventually he should have become totally blind. In December 1804, over ten years later, Nelson himself wrote in a letter to his friend, Davison:

            'My eyesight fails me most dreadfully; I firmly believe that in a very few years I shall be stone blind. It is this only, of all my maladies, that makes me unhappy.'

            On July 31st, a few weeks after this injury, Nelson had another bout of his malaria, and spoke of it in a letter, already quoted, to Admiral Hood. He was still at Calvi, and the great heat and insanitary surroundings were causing almost universal illness amongst the men. Greater devastation resulted from illnesses than from the enemy's fire. In a letter to His Royal Highness the Duke of Clarence, dated 'August 6th and 10th " Nelson says:

            'The climate here, from July to October, is most unfavourable to military operations. It is now what we call the Dog-days, here it is termed the Lion Sun; no person can endure it: we have upwards of 1000 sick out of 2000, and the others are not much better than phantoms. We have lost many from the season, very few from the enemy. I am here the reed amongst the oaks; all the prevailing disorders have attacked me, but I have not the strength for them to fasten upon: I bow before the storm, whilst the sturdy oak is laid low. One plan I pursue, never to employ a doctor; nature does all for me, and Providence protects me.' 

            However, if typhoid was one of the prevailing disorders, he was immune to that now, having already had the disease. In the winter his general health ilnproved again, and during the next year, 1795, he kept fairly well. On January 27th, 1796, Nelson wrote to his wife; 'My health was never better.' Then illness, never far away, seized on him again, and a new set of symptoms developed. On March 25th he wrote to Mr. Drake, the British envoy at Genoa:

            'I do not know when I have been so ill, as during this cruise but I hope a good opening to the Campaign will set me quite to rights.'

            This indisposition was aggravated by the worry and unsatisfactory progress of operations in the Mediterranean. On June 3rd of the same year, in a letter to Sir John Jervis, he states:

            'When I am actively employed, I am not so bad. My complaint is as if a girth were buckled taut over my breast, and my endeavour, in the night, is to get it loose.'

            I find it difficult to interpret the true significance of this, as several explanations suggest themselves. The references are scanty, but perhaps the most likely cause is arteriosclerosis involving the coronary arteries, and producing the symptoms of angina pectoris. Nelson was now thirty-eight years of age. His life had been an arduous one. He had never taken much alcohol; but had frequently suffered from infective diseases. His health, never good, was now beginning to show signs of premature senility. Another possible explanation of these symptoms is a girdle pain due to early spondylitis deformans.
            On February 14th, 1797, Nelson was engaged in the Battle of St. Vincent. In this encounter, besides several bruises, he was struck on the left side of the abdomen. Although he made light of it, the injuries were bad enough to call for a visit from the surgeon, for after the battle Nelson says: 'My bruises were now looked at and found but trifling.' He also wrote to Sir Gilbert Elliot :

            'Amongst the slightly wounded is myself, but it is only a contusion and of no consequence, unless an inflammation takes place in my bowels, which is the part injured.'

            The wound must have been a fairly severe one, for as late as 1804, the side still troubled him at times. A 'lump' appeared at the site, 'brought on occasionally by violent coughing'. It was sometimes as large as a fist. This would seem to have been a local weakness of the muscle of the abdominal wall, at the part injured - an incipient ventral hemia.

            Then came Teneriffe, and the loss of his right arm. On the eve of the attack, Nelson called his stepson, Lieutenant Josiah Nisbet, to his cabin. The lad appeared armed and ready to go ashore in the boats, the moment the order for attack was given. Nelson earnestly begged him to remain behind, saying:

            'Should we both fall, ]osiah, what would become of your poor mother ? The care of the Theseus falls to you; stay, therefore, and take charge of her.' 'Sir,' replied Nisbet, 'the ship must take care of herself. I will go with you to-night, if I never go again.'

            Just before midnight on July 24th, 1797, the small boats put off from the ships, Nisbet accompanying the Admiral. About half-past one a.m. (July 25th) on the blackest of nights, Nelson was wounded in the right arm by a musket-ball, just as he was stepping out of the boat, and preparing to dash with his men on to the mole at Santa Cruz, under a very heavy fire from the citadel. The sword which he carried into action had been given him by his uncle, Maurice Suckling, and as it fell from his right hand he caught it desperately with his left. Young Nisbet heard him exclaim: 'I am shot through the arm. I am a dead man.' He placed him in the bottom of the boat. The brachial artery had apparently been divided, for the blood gushed most profusely from the wound. Nelson began to feel faint, and this was aggravated by the sight of the quantity of blood that he was losing. Perceiving this, Nisbet concealed it from view with his hat.

                'He, then, with great presence of mind examined the state of the wound, and holding the shattered arm so as to stanch the blood, took some silk handkerchiefs from his neck and bound them tightly above the lacerated vessels; but for this attention, Nelson, as he afterwards declared, must have perished. Mr. Nisbet was assisted by a seaman of the name of Lovel, one of the Admiral's bargemen, who having torn his shirt into shreds, constructed a sling for the wounded man.'

            That was excellent first-aid treatment. He was rowed back to the Theseus; but on coming alongside, refused all assistance to get on board. 'Let me alone,' said he, 'I have yet my legs left, and one arm. Tell the surgeon to make haste and get his instruments. I know I must lose my right arm, so the sooner it is off the better.' In a letter which one of the midshipmen, Mr. Hoste, wrote to his father, he says :

            'At two o'clock, (The actual log of the Theseus, signed by Captain Ralph Willett Miller, gives this time as half-past three) in the morning, Admiral Nelson returned on board, being dreadfully wounded in the right arm with a grape shot. I leave you, Sir, to judge my situation, when I beheld our boat approach with him who I may say has been a second father to me, his right arm dangling by his side, whilst with his left he jumped up the ship's side, and displayed a spirit that astonished everyone.'

            The surgeon of the Theseus was a young man named Thomas Eshelby, who had joined the ship by warrant on May 27th, 1797. He examined the arm. Eshelby's own entry in the 'Medical Journal of His Majesty's Ship the Theseus '(i) for July 25th, reads:

            'Admiral Nelson. Compound fracture of the right arm by a musket ball passing through a little above [sic] the elbow an artery divided.'

            Amputation through the middle third of the arm by the circular method was immediately performed. There were no anaesthetics then in use; the operation was therefore carried out with a few rapid sweeps of the knife, two silk ligatures being applied to secure the arteries. At that time it was the practice for the ends of all ligatures to be left long, and brought out through the wound so that they should act as a drain for the infective discharges, which almost invariably occurred and also that they may be capable of ready removal when they had separated by natural processes. As soon as the operation was over the surgeon prescribed: 'Opii gr. ii. ft.Pil. statim.s.' The opium was repeated twice that day. Indeed, Nelson took an opium pill every night at bedtime for some weeks afterwards.

            The surgeon's Journal for July 26, reads: 'Rested pretty well and quite easy. Tea, Soup, and Sago. Lemonade and Tamarind Drink.'

            For July 27th : 'Had a middling night. No fever.' 

            July 28th : 'Dressed the stump. looked well.'

            There was apparently some fever on this day, for decoction of cinchona was ordered.

            On July 31st, the Journal says: 'One of the ligatures came away; looks well.'
            On August 1st : 'Continued getting well very fast, stump look'd well, no bad symptoms whatever occurred. The sore reduced to the size of a shilling, in perfect good health one of the Ligatures not come away.'

              Two days after the arm had been amputated Nelson had written a letter with his left hand to Sir John Jervis, the Commander-in-Chief, asking if he might be given 'a frigate, to convey the remains of my carcase to England:' and perfectly legible the writing is.(ii) There are then no reports on the progress of the stump for some three weeks. On August 20th, Nelson came on board the Seahorse to be taken back to England. 

            On that day Eshelby examined and dressed the wound, and in the Journal of the Seahorse(iii) for that date he writes :
            'I was appointed from the Theseus, to attend the Admiral to England, . . . one of the ligatures not come away. Twitching Pains at times, particularly by night. I gave the following: R.Haust. Salin.c. Tr. Opii. gtt.xl. h.s.sumendus et rep. pro. re nata. Dress'd with Cerat Lap Calamin and dry lint: he, landed at Portsmo. 1st. Sept. would not suffer the ligature to be touched.'

            The arm was dressed on his arrival on board the Seahorse, but during the voyage home of twelve days 'Nelson would not permit the surgeon to examine his arm, and his sufferings and irritation were at times very great.' On arrival in England he went straight to Bath, where his father and Lady Nelson were staying, and put himself under the care of a surgeon named Nicholls. After about a fortnight he decided to come to London for treatment. While in Bath, his wife, at Nelson's earnest desire, was always present when the surgeon dressed the arm, in order that she might learn to do the dressing herself. This she constantly undertook afterwards.

            'On arrival in London he was attended by Mr. Cruikshanks, and his nephew Mr. Thomas; by Mr . Jefferson who had been surgeon of the Agamemnon, and, at the request of Mr. Bulkeley, one of the two surviving officers who had been on the San Juan expedition, Mr. Moseley was afterwards called in. But the wound becoming still more painful and his spirits very low, it was also shown to other eminent surgeons, and amongst the rest to Mr. Keate; who strongly recommended that the cure should be left to time and nature, it was accordingly preferred to more violent methods.'

            Soon after coming to London he wrote to Earl St. Vincent, under date of September 18th :
            'This day am not the least better than when I left good Dr. Weir ; and Cruikshanks has me now in hand.'

            During October he stayed at the lodgings of a Mr. Jones at 141 Bond Street. There was still constant pain in the arm, night and day, and he took laudanum in order to get sleep. The wound was infected and discharging, and as a result Nelson had a mild fever. There was no clinical thermometer in those days, and fever was determined by the hand, or the term was merely used to describe the group of symptoms, such as headache, flushing, and sweating, with which it is usually associated. On October 2nd, writing from Bond Street, Nelson says: 'My arm from the unlucky circumstance of a nerve being taken up with the artery is not yet healed nor do I see any prospect of the ligatures soon comeing away.'(iv) On October 6th he wrote to Earl St. Vincent: 'My poor arm continues quite as it was, the ligature still fast to the nerve, and very painful at times.' In the short memoir of his life, which, in 1799, two years later, Nelson wrote for the guidance of M' Arthur, he states: 'By some unlucky mismanagement of my arm, I was obliged to return to England.'

            'Now this story of the inclusion of a nerve by the surgeon in one of the ligatures which were applied at the time of the amputation has been credited by every biographer since. No suggestion whatever was made of such a contingency until two months after the operation. Then, just subsequent to his having been the subject of a consultation by several surgeons on coming up to London, Nelson spoke of it in his letters for the first time. Obviously one of the surgeons had mentioned this in his presence as perhaps a possible
cause of the pain. How easy it is for a word from us, I uttered casually and perhaps without due deliberation, to be taken up literally and undiscriminatingly, and repeated with quite an unintentionally false significance. There is neither justification nor reason for the acceptance of such an explanation; for even if the nerve - probably the median, though possibly the ulnar - had been ligatured either purposely or inadvertently, that would not, in itself, have occasioned pain in the stump. Some surgeons, at the present day, even consider it advisable actually to crush and ligature all large nerves in performing an amputation. This deliberate procedure they employ in order to minimize or prevent pain. Some use silk too. As no deep ligatures are removed nowadays, those on the nerve remain. Moreover, the pain after amputations which is nervous in origin, is usually of a special type, the patient having a sensation as if the pain were located , in the hand or foot which has already been removed. Such sensations strike the patient as being so extraordinary he invariably remarks upon it. Nelson makes no such comment; he constantly complains of his stump locally. In any case, some pain often occurs in an amputation stump for a few months, even where the operation has been most carefully carried out and the ultimate result perfect. In Nelson's case, however, sepsis occurred in the stump, and the wound remained open, discharging pus, and being a focus for the absorption of poisons, for over four months. What further explanation than this is needed for the local pain ? The leaving of the ligature in the wound helped to keep up the infection, and, of course, the sinus could not close while it remained there. Why the surgeons did not pull it away I cannot imagine. Whatever structure it was tied to would have sloughed through long since, so that a slight tug must have freed it, and any risk of secondary haemorrhage from doing this was long past. On December 4th the ligature virtually fell out, for it is reported to have come away with the slightest touch. Even before this the pain had practically gone, for Nelson was already sleeping soundly. As soon as the ligature came away the wound promptly healed. In less than a week, Nelson was himself again. On December 8th he sent a note of thanks to St. George's Church :

            'An officer desires to return thanks to Almighty God for his perfect recovery from a severe wound, and also for the many mercies bestowed upon him.'

            Except that there was always a slight rheumatic affection of the stump in any sudden variation of weather, Nelson never had any further trouble with his arm. He used to consider his stump a supplementary barometer. When he was perturbed he would be seen moving the stump agitatedly to and fro. 'The Admiral is working his fin,' the men would say.

            On December 13th he was pronounced fit for service, and early in 1798 sailed in the Vanguard for the Mediterranean again - back to see Lady Hamilton and to fight the Battle of the Nile. At this battle, in Aboukir Bay, during the thick of the fight on August 1st, 1798, Nelson received a very severe head wound, being struck on the upper part of the forehead on the left side, by a piece of langridge shot. He was convinced that he had received a mortal wound; but when, taking his turn with the other suffering men, he was examined by the surgeon, it was found that only the scalp was involved, and the skull uninjured. There was a rectangular cut, and a large flap of the skin of : the forehead which was stripped away cleanly from the bone hung down over his left eye. The right being blind, Nelson was in darkness. The surgeon, 'Mr. Jefferson assured him, on probing the wound that there was no immediate danger'. He then 'bound up and dressed the wound.' Previous to this, Nelson had always been in the habit of brushing his hair well back off his forehead, as in the portrait which Abbott painted of him at the time he was recovering from the loss of his arm. In later years Nelson is always depicted with his hair trained down over his forehead, apparently to hide the scar which resulted from this wound. After his death a young officer of the Victory, who had cut off some of Nelson's locks as a momento of the hero, spoke of 'the hair that used to hang over his forehead, near the wound that he received at the Battle of the Nile.' (v)

            Now I think Nelson's symptoms during the month following this injury clearly point to his having suffered from a severe concussion of the brain. He himself thought that the skull had been fractured. In the first place, it is stated that at the moment he was struck he fell unconscious, and that Captain Berry caught him in his arms as he was falling. Then on August 9th, while still at the mouth of the Nile, Nelson sent a letter to the Governor of Bombay, which contained the statement: 'If my letter is not so correct as might be expected, I trust your excuse, when I tell you, my brain is so shaken with the wound in my head, that I am sensible I am not always as clear as could be wished.'  The next day Nelson wrote to Earl St. Vincent: 'My head is ready to split, and I am always so sick: in short, if there be no fracture my head is severely shaken.'  Nearly a month after the injury the terrible headache still persisted, for, in a letter dated 'August 19th, 26th,' he states: 'My head is so wrong I that I cannot write that I wish in such a manner as to please myself.' All these symptoms clearly indicate an initial severe concussion of the brain.

            Still suffering from the effects of it, Nelson set out about the middle of September for Naples. On the way he was stricken with what was possibly a bad attack of influenza. On September 20th he wrote to Earl St. Vincent :

            'For eighteen hours my life was thought to be past hope; I am now up, but very weak both in body and mind, from a cough and this fever. I never expect, my dear Lord, to see your face again.'

            In his greatly debilitated state of health, the influenza had attacked him more severely. It had not only 'near done my business' but had reduced him to a very despondent mood. On arrival at Naples, he went to the home of Sir William Hamilton, the English envoy, and was nursed back to health by Lady Hamilton herself. He had first met her in 1793, when, soon after arriving with the Agamemnon in the Mediter- ranean, he was sent to Naples with dispatches. Sir William Hamilton told his wife that he wished 'to introduce a little man to her'. Even if he was little, and very frail as well, he was at that time intact of limb. As he presented himself to his old friends upon this visit he was indeed a different man. He was without one arm, without sight in one eye, had an injury in the abdomen, was debilitated and old beyond his years due to his various and frequent illnesses, and now had come straight from the Nile with a terrible wound on the forehead and a physical wreck on account of his recent concussion. Those who look with disapproval upon Nelson's attachment to Lady Hamilton have stated, with a great show of magnanimity, yet more as an excuse for their own narrow censoriousness than in sincere extenuation of Nelson's attitude, that, as a result of this injury to the head, he was not quite himself at the time. Such an explanation is unwelcome, even were it called for. Nelson's regard for Emma needs no defence. The affectionate nature and charm of Lady Hamilton required the existence of no such circumstance in order to create its deserved impression. Nor, indeed, was the added advantage which the position of nurse confers upon an already attractive woman necessary to make Nelson aware of her many talents and accomplishments.

            During the greater part of 1799 Nelson was engaged in the affairs of Naples. He was not in the best of health, but was never laid up. The mental activity required, and the anxiety and worry of offices in which he became involved, served to distract his attention from his indisposition. He was now very fondly attached to Lady Hamilton. In March 1800, when he was at Malta, his health was causing him much misgiving, and he is said to have been suffering from 'an internal complaint to which he had been long subject'. In the middle of the month, in spite of the disapproval of his Commander-in-Chief, he returned to Palermo, and from there he wrote to his friend, Sir Thomas Troubridge : 

            'It is too soon to form an opinion whether I can ever be cured of my complaint. At present I see but glimmering hopes; and probably my career of service is at an end.'

            The trouble in question often alarmed Nelson, 'as he attributed it to sudden and violent spasm'. He had attacks of it at intervals afterwards, including one just before Trafalgar. This 'internal complaint' was  

probably the severe dyspepsia from which he suffered about this time. He often sat writing for hours together, and this, combined with the anxiety and the grave depression of spirits to which he was then disposed, aggravated these distressing attacks of indigestion. They disappeared when he took exercise and reverted to a more active life.

            It was about this period, too, that he began to suffer from 'frequent fits of gout; which disease, however, as well as his constitutional tendency to it, he totally overcame by abstaining for a space of nearly two years from animal food'. He lived mostly on vegetables, milk, and water. He was, indeed, always a very moderate eater, and drank very little wine. He was generally in bed before nine o'clock.(vi)

            At last, after nearly three years' absence, he returned to England, arriving on November 9th, 1800, accompanied by Sir William and Lady Hamilton. It was soon afterwards that the separation from his wife occurred. The following March he was off again, this time to the Baltic. At the Battle of Copenhagen Nelson went unscathed, and it was there that he put the telescope to his blind eye, and exclaimed: 'I really do not see the signal', when the order to leave off action was hoisted. Except for occasional coughs and colds he suffered no physical disability during this campaign. He frequently spoke of feeling unwell, but he 'owed his bad health more to chagrin than to any other cause'. He was in a very depressed and melancholy condition after the battle; while in action he was happy and well. The incessant anxiety, the distress over the separation from his wife, and a sense of ingratitude on the part of his country lowered his spirits, and he asked to be relieved of his command, and returned to England on July 1st, 1801. He bought his house at Merton (now part of Wimbledon) soon afterwards, and there, in the company of Sir William and Lady Hamilton, he spent the greater part of the next two years, the happiest period of his life. In April 1802, Nelson's father died, at the age of seventy-nine; and the next April Sir William Hamilton, also an old man, followed.

            In May 1803, Nelson sailed to the blockade of Toulon, as Commander-in-Chief in the Mediterranean. During this period, up to the time of his return to England two years later, he was showing evidence of the toll which had been taken on his constitution by the strenuous and exacting life he had led and the frequent illnesses from which he had suffered. At the age of forty-six he already looked many years older. On May 30th, 1804, Nelson wrote from Toulon to Dr. Baird :    

            'The health of the fleet cannot be excelled, and I really believe that my shattered carcase is in the
worst plight of the whole of them. I have had a sort of rheumatic fever, they tell me. I have felt the blood gushing up the left side of my head. . . .I am now better of that, with violent pains in my left side, and night sweats, with heat in the evening and feeling quite flushed.'

            This is due to his raised blood-pressure with arterio-sclerosis. The anginal pain from the involvement of the vessels of the heart returned at intervals. Nelson continues : 

            'The pain in my heart, not spasms, I have not had for some time. Mr. Magrath, whom I admire for his great abilities every day I live, gives me excellent remedies.'

            He had apparently become more partial to doctors. In spite of this marked deterioration of his health and his failing sight, his application to the affairs of the fleet and his strategic acuity were unabated, and in spite of so many wounds 'not a scrap of that ardour , with which he had hitherto served his king, had been shot away' as he once wrote to the Duke of Clarence. Notwithstanding his activity and ingenuity in searching for the French fleet, he had to return to England on August 19th, 1805, without having found it.
            Nelson went straight to his home at Merton, where Lady Hamilton and his daughter Horatia were. His health was better after coming ashore; but he was to enjoy this respite for only a little more than three weeks. He told Lady Hamilton and his sisters that he thought his work was done, and that he had decided to leave further campaigning to younger and more robust men, while he would retire to enjoy what laurels he already had, and take a well-earned rest. But Lady Hamilton knew him too well not to perceive the want of conviction in his words. When dispatches arrived locating the French fleet, Nelson's impatience at inactivity was not to be concealed from her. She spoke to him softly, with that understanding and nobility of mind which had been a constant inspiration :

            'However we may lament your absence, offer your services. They will be accepted, and you will gain a quiet heart. You will have a glorious victory and then you may return here, and be happy.'    

            He looked at her with tears in his eyes. 'Brave Emma! - Good Emma! - If there were more Emmas , there would be more Nelsons.'

            On September I4th he sailed from Portsmouth in the Victory - sailed to Trafalgar. It was in the height of the battle, on October 2Ist, 1805, that Nelson received his fatal wound.(vii) At a quarter-past one after noon, while walking with Captain Hardy near the middle of the quarter-deck, he was struck on the left shoulder by a musket-ball, fired from the mizzen-top of the Redoutable at a range of not more than fifteen yards. The ball struck the epaulette on his left shoulder, and penetrated his chest. Nelson instantly fell with his face upon the deck. Captain Hardy, on turning round, saw the serjeant of marines, Secker, with two seamen, raising him.

            'They have done for me at last, Hardy. My back-bone is shot through,' murmured Nelson.

            He was carried below to the cockpit. 'Ah, Mr. Beatty!' said he to the surgeon of the Victory, 'you can do nothing for me. I have but a short time to live: my back is shot through.'

            The back was examined, but nothing was visible there externally. The Reverend Dr. Scott, chaplain of the ship, gave him lemonade to quench his great thirst - the thirst of a man who was bleeding to death. Every minute he felt a gush of blood within his breast ; his breathing became short and difficult, his pulse weak, small, and irregular. There was great pain in the spine at the point where he had felt the ball strike it from within, after having traversed his chest. Nelson was lost. A large blood-vessel had been severed in the thorax, and the lung was pierced. Calling the surgeon back, he spoke to him again :

            'Ah, Mr. Beatty, I have sent for you to say, what  I forgot to tell you before, that all power of motion and feeling below my breast are gone; and you very well know I can live but a short time.'  
            Evidently the mid-dorsal spine had been wounded. The surgeon verified this on examining the extremities, and replied: 'My Lord, unhappily for our Country, nothing can be done for you.'
            Then walking aside to hide his emotions, he heard Nelson murmur: 'I know it. I feel something rising in my breast, which tells me I am gone.' As he said this it is stated that Nelson put his hand on his left side, so that the brachical plexus at the shoulder must have been uninjured for him to have been able to use the arm. But the torn vessel was bleeding rapidly and filling the thoracic cavity with blood, for the '

'something rising in my breast' was the haemorrhage. His pain was so distressing that he wished he were dead, and  'Yet,' said he, 'one would like to live a little longer too. ...What would become of poor Lady Hamilton if she knew my situation ?'
            England, Emma, and his daughter Horatia were alone in his thoughts now. By half-past three he became very low; his breathing was oppressed and his voice faint. Nelson whispered: 'Drink, drink! fan, fan! rub, rub!'
            At four o'clock he became speechless, and soon afterwards Beatty , on taking up his hand, found it cold and the pulse gone from the wrist. Upon the surgeon's feeling his forehead, which was likewise cold, His lordship opened his eyes, looked up, and shut them again. And at half-past four, with Dr. Scott gently rubbing his breast, and Mr. Burke, the purser, supporting his shoulders, Nelson expired. He had survived three hours and a quarter after being wounded; and he died with the consciousness of victory, for within a quarter of an hour of his injury Hardy had sent him word that Trafalgar had been won.
            Nelson's body was conveyed back to England, preserved in a cask of brandy; and on December 11th, the day before the Victory sailed from Spithead to the Nore, Beatty performed a post-mortem examination, which reveals the exact lesion that caused death and explains the symptoms of the dying man. At the moment of being struck Nelson was standing on the quarter-deck facing partly towards the enemy and partly towards the stern of his own ship; the French ship Redoutable was right alongside the Victory, on the starboard side, and heading in the same direction; the ball was fired by a man in her mizzen-top. Therefore the direction of the ball in relation to Nelson would have been from above, from the left, and from slightly in front of him. It 'struck the fore part of His Lordship's epaulette; and entered the left shoulder immediately before the processus acromion scapulae, which was slightly fractured'. From this determination of the direction of the ball at impact, the course which it then took through the chest can be understood:

            'It descended obliquely into the thorax, fracturing the second and third ribs: and after penetrating the left lobe of the lungs, and dividing in its passage a large branch of the pulmonary artery, it entered the left side of the spine between the sixth and seventh dorsal vertebrae, fractured the left transverse process of the sixth dorsal vertebra, wounded the medulla spinalis, and fracturing the right transverse process of the seventh vertebra, made its way from the right side of the spine, directing its course through the muscles of the back, and lodged therein, about two inches below the inferior angle of the right scapula. On removing the ball a portion of the gold-Iace and pad of the epaulette, together with a small piece of His Lordship's coat, was found firmly attached to it.' (viii)

            Beatty goes on to state that :
            'The immediate cause of His Lordship's death was a wound of the left pulmonary artery , which poured out its blood into the cavity of the chest . . . The injury done to the spine must of itself have proved mortal, but His Lordship might perhaps have survived this alone for two or three days.'
As for the various organs examined at the post- mortem, Beatty says that they were all healthy and           
sound, with no sign of 'inflammation or disease '. 'The heart was small and dense in its structure; its valves, pericardium, and large vessels were sound, and firm in their structure.' This is still consistent with early arteriosclerosis involving the coronary arteries of the heart. 'The lungs were sound, and free from adhesions.' So there was no sign of tuberculosis, active, passive, or healed. 'The liver was small, and in its colour natural, firm in its texture, and every way free from the smallest appearance of disorganization.' No amoebic abscess there. 'The stomach, as well as the spleen and other abdominal contents, was alike free from the traces of disease.' So there was no gastric ulcer associated with the dyspepsia - no mal enlargement of the spleen. These post-mortem findings prove consistent with the foregoing account of Nelson's medical life. The diseases from which he suffered - malaria, typhoid, angina pectoris, dyspepsia, and gout - may leave not a trace of their presence.
        After this examination the body was embalmed, and eventually, on December 2Ist, placed in the coffin, which Captain Hallowell had presented to Nelson in 1799, made from the mainmast of l'Orient, the French flagship, which was captured at the Battle of the Nile.
        At last they laid Nelson in St. Paul's, where

'After life's fitful fever, he sleeps well'

 

(i) For the full text of this Journal I am indebted to Sir D' Arcy Power, who has let me have the copy, which he made from the original at the Public Record Office.

(ii) A facsimile of this letter is in Clarke and M'Arthur

>(iii) Found in the ' Statistical Report of the Health of the navy for the year 1902.' H.M. Stationery Office, 31st July, 1903 : ' Report of Journals of Medical Officers examined at the Public Record Office 1793 to 1856.'

>(iv) This letter, originally in the possession of Mr. C. Fraser-Mackintosh of Invemess, was first published (in facsimile) in the Lancet, July 24th, 1897.

>(v) Admiral Mahan : Life of Nelson, the Embodiment of the Sea  Power of Great Britain. 2 vols. (Sampson Low, Marston & Co., London, 1897.)

(vi) In some letters of Dr. Leonard Gillespie, Physician of the  Fleet in 1805, published in the Medical Magazine, January 1895 there are given several intimate pieces of information about Nelson.

(vii) Data from William Beatty, M.D. : 'Authentic Narrative of the Death of Lord Nelson. With Circumstances preceding, attending and subsequent to, that Event.' London, 1807. Resumés of this were sent by Beatty to several journals and private persons.  

(viii) A drawing illustrating the ball which killed Nelson, together with an account signed by W. Beatty and dated December 15th, 1805, on H.M.S. Victory, is given in a volume of The Medical and Physical Journalof 1805, which is preserved in the library of the Military Hospital at Shorncliffe.

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