Abstract and Introduction
Formal "duels of honor" ruled upper-class conduct for centuries. That social pressure could compel a choice of "death before dishonor" seems nearly incomprehensible today. Physicians might have been expected to disdain dueling as contrary to professional ethics, but a few rather colorful physicians did enter the lists. Details of some of the most famous physician duels are summarized in this article.
Dueling is the tie of society. . . . No virtue . . . proved half so instrumental in the civilizing of mankind.
Bernard Mandeville 
Physician Philosopher (1670-1733)
Although rare in the classical era, formal duels among the Germanic peoples were witnessed by Julius Caesar. After the collapse of Rome, the use of court-supervised judicial duels spread throughout Europe, gradually replacing trial by ordeal and simple ambush as means of settling disputes.
During the Middle Ages, mock duels became popular tournament fare. King Henry II, who banned dueling, ironically died of a jousting injury when his visor was penetrated by a lance. The resulting contrecoup subdural hematoma proved fatal despite the ministrations of Ambrose Pare and Antonio Vesalius. Duels became fashionable in the medieval period, and 4,000 dueling nobles are said to have perished in a 10-year period during the reign of Henry IV.
Although more deliberative courtroom proceedings supplanted judicial combat in the 16th century, European gentry continued to avenge insults through duels of honor regulated by elaborate codes of conduct. In the 1600s, after flintlock firing mechanisms replaced erratic matchlocks and wheel locks, pistols superseded swords as the preferred dueling weapon favored as less likely to give unfair advantage to strength or skill. Elegant dueling pistols crafted in England and Ireland from 1770 were single and smooth to limit the morbidity encouraged by multiple shot capability and rifling of the barrel. Duelists generally stood 10 to 15 paces (30 to 45 feet) apart. "Cool and alternate" firing was largely replaced by simultaneous firing on signal after introduction of the percussion cap in the early 1800s lessened chances of a misfire ("flash in the pan"). As long as both opponents were able to continue, and honor remained unsatisfied, three rounds of firing were usually permitted.
Declining a challenge resulted in rejection from polite society after being "posted," as public announcements of cowardice were called. Sometimes a clever riposte or action could circumvent a duel: One amputee sent a surgeon to his challenger with the suggestion that he have a matching amputation before the duel could be called fair. Humphrey Howarth, a member of Parliament and former army surgeon, was well aware of the dangers of foreign material in a wound. He stripped naked in preparing for a duel with Lord Barrymore in 1806, causing the contest to be terminated because of ungentlemanly conduct. Alerting the authorities to a forthcoming duel, a common ploy, was used by Benjamin Rush in 1803 to prevent one of his pupils from dueling.
When a duel was unavoidable, covert steps could be taken to diminish the risks (calculated at 1:6 of injury and 1:14 of death at the height of the dueling mania but falling as low as 1:50 mortality in late Italian duels). Powder could be shorted, an undersize ball selected, or most ingeniously, a realistic-looking ball could be made of mercury to vaporize when fired.
Attending surgeons were advised to prepare their instruments in advance to avoid demoralizing nervous contestants. In addition to treating wounds, surgeons judged whether an injury was sufficient to end the duel. Such pronouncements could be hazardous, since halting a duel before honor was satisfied could result in the physician himself being challenged.
Dueling was closely associated with military culture, and officers were the most common combatants, followed by politicians, lawyers, and newspaper men. Women rarely appeared at duels in any capacity, but in an 1892 duel in Liechtenstein between Princess Metternich and Countess Kilmannsegg, a woman physician, Baroness Lubinska, treated the resulting minor wounds. In the Middle Ages, scholars were thought too weak to duel, and it was considered dishonorable to challenge physicians, philosophers, and astronomers, or for them to accept if challenged.
South Med J. 2000;93(9) © 2000 Lippincott Williams & Wilkins
Cite this: Dueling Doctors - Medscape - Sep 01, 2000.