The Case of the Fearless Mariner With a Mortal Chest Wound

Albert B. Lowenfels, MD; William A. Liston MD; David Burris, MD

Disclosures

November 21, 2008

Introduction

The patient was a 47-year-old male who sustained a wound to his upper thorax and chest from a bullet fired by an enemy sniper during a fierce maritime battle. Fired from an elevated position, the bullet entered the upper part of the patient's left shoulder. He fell instantly, and was carried to a less exposed location on a lower deck.

Medical and Family History

Family and Medical History

The patient was 1 of 11 children. His mother died of unknown causes when the patient was 9 years old, leaving his father, a rector who was apparently in good health, to raise the children. As a child, the patient had been frail. As an adult, he was slim and short and had recurrent attacks of a debilitating fever, which began when he traveled to the tropics. At age 36, he sustained facial injuries from flying stones and sand during a battle and he lost vision in his right eye, except for the ability to tell light from dark. Three years later, at age 39, during another battle he sustained a bullet wound to his right elbow, necessitating immediate amputation of his right arm above the elbow. At age 40, another bullet struck his forehead, causing a concussion and a 3-inch gash in the forehead.

Final Illness

After his injury during his final battle, he was examined on a sheltered lower deck. Findings were as follows: He was in acute distress. He had a scar on his forehead and the pupil of the right eye was dilated. The bullet had entered the anterior part of the left shoulder, but there was no visible wound of exit. He complained of acute chest pain and the inability to feel any sensation below the nipples and was unable to move his lower extremities. He was coherent, could speak rationally, but was short of breath. He had a weak pulse and he believed he had received a mortal wound.

Over the next few hours, his condition deteriorated. His pulse became rapid, then imperceptible. He complained of great thirst for which he was given liquids. His physicians noted that his extremities and face became cold. Although rational, he became agitated. He never regained motion or sensation in the lower part of his body, and he died approximately 2 to 3 hours after the injury.

Who was the patient?

  1. Chester W. Nimitz

  2. David G. Farragut

  3. Horatio Nelson

  4. Robert E. Peary

View the correct answer.

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