Chicago, Illinois, United States
In 1966 as a young surgeon who had just completed his residency, I was drafted into the United States Army. Following basic training at Fort Sam Houston, I was sent to Vietnam, where I became the Chief of Surgery of the 12th Evacuation Hospital in Cu Chi. The 12th Evac was a 300-bed hospital within the base camp of the 25th Infantry Division and was in a very active war zone. During my tour of duty in 1966 and 1967, I operated upon hundreds of wounded soldiers. My comments thus draw from that experience.
I operated upon and cared for of hundreds of patients with bullet wounds during my time in Vietnam. I never heard a soldier talk about an electric shock feeling, like being struck by lightning. Most describe either being knocked to the ground or just looking down and seeing that they had been shot. This would be followed, after several seconds, by intense pain at the site of the wound. Orwell’s “electric shock” must have been due to the sudden shock to the right recurrent laryngeal nerve and the right brachial plexus as the bullet passed through the adjacent tissues of his neck. The feeling may have been similar to the sudden pain experienced by stimulating the ulnar nerve when you bang your “funny bone.” Of course, in Orwell’s case, the sensation would have been much worse because of the number and central location of the nerves affected.
He was lucky that neither the trachea, esophagus, carotid artery, nor jugular vein was injured. My guess is that the bullet went through the anterior and lateral aspect of the neck, only striking the sternocleidomastoid muscle and other soft tissues. The injury to the recurrent nerve and the brachial plexus was most likely due to swelling and bleeding from the soft tissue injury. That would also explain why he recovered his voice and arm functions. Even some of the blood in his throat may have been the result of blunt force trauma. I agree with the comments that such a bullet path could only have occurred with his head turned, which is why the bullet passed laterally through the anterior soft tissues. Had he been facing the rifle, the tract would have been anterior to posterior and probably would have killed him.
The comment that the speed of the bullet does not affect the amount of tissue damage is not what was taught in basic training. Smaller, lighter bullets fired with a higher velocity carry much more energy. This energy transfers to the tissues as the bullet passes, resulting in the death of tissue surrounding the actual path of the bullet. Once weapons manufacturers recognized that fact, guns that shot heavy bullets were replaced by rifles like the AR-15 or the M16, which fired smaller, lighter bullets at much greater velocities. During basic training, the injury to solid tissue was demonstrated by firing a high velocity bullet through a large gelatin block. Extensive fracture lines caused by the energy transfer emanated from the bullet tract itself. We were taught how to recognize irreversibly damaged tissue surrounding the bullet tract using four “C”s: color, circulation, consistency, and contraction. Since retained dead tissues are a perfect culture media, careful exploration and debridement was mandated for these wounds.
In Vietnam, we saw the damage high velocity missiles caused. Multiple fractures within solid organs like the liver, spleen, and kidney occurred in addition to massive muscle death in areas like the thigh. These wounds were carefully explored and extensively debrided.
Since Orwell was shot with a lower velocity bullet, tissue death surrounding the bullet tract did not occur. Therefore, even though his wound was not surgically explored, it was not fatally infected, unlike the wounds of many other soldiers.
An aspect I found interesting is that if he had suffered the same wound in our time, he would have had a mandatory exploration of the neck. In Vietnam, all penetrating wounds of the neck were explored, and I assume that dictum was continued in later wars as well. In Orwell’s case, an extensive exploration exposing the trachea, cervical spinal nerve roots, and brachial plexus would probably have done more harm than good and might have left him with some permanent damage to his voice and arm.
Overall, I loved Dr. Franklin’s explanations of the Spanish Civil War. I never understood why so many Americans felt a need to become involved in that war.
George Orwell and the Spanish Civil War: A brush with death, James L. Franklin
STUART M. POTICHA, M.D., Associate Professor Emeritus of Surgery, Northwestern University Medical School