Thomas Eshelby (1769–1811),Nelson’s Surgeon

Abstract

Horatio Nelson is an icon of British naval history. His above-elbow amputation by Thomas Eshelby remains one of the most famous surgical procedures ever performed. Yet the surgeon himself remains relatively obscure and uncelebrated. We present a vignette of this young Yorkshireman and reflect on his life and times. Eshelby was a competent and conscientious surgeon and was certainly held in high regard by Nelson. Quite a few documents pertaining to his tour of duty in the Mediterranean and to his later appointment at Plymouth have been archived. These shed valuable light on his professional life, betraying his clinical acumen, his conscientious and pragmatic nature and his demeanour toward both his peers and his superiors. Eshelby was also the patriarch of an enterprising family including three generations of surgeons and others with eponymous discoveries in the fields of geography and science.

Keywords

Thomas Eshelby Horatio Nelson amputation neurostenalgia surgical logbook prison ship

Introduction

Horatio Nelson (1758–1805) sustained various injuries during his gallant and illustrious career.^1–3 The most famous⁴ of these was the amputation of his right arm for an open fracture, performed by Thomas Eshelby off the coast of Santa Cruz, Tenerife in July 1797. The operation and its circumstances have become an oft-retold legend,^5–9 published even in non-English medical journals over the years.^10–12 The authors have previously described the famous patient’s surgery and rehabilitation in contemporary terms.¹³ The purpose of this paper is to probe the surgeon’s life and career, focusing especially on what happened after this famous episode in an effort to redress the ambivalence with which he has been treated historically (Figure 1).

Eshelby’s birth and early life

The Eshelby¹⁴ family was of Breton descent, its progenitor having arrived in the British mainland at the time of the Conquest. Over the ensuing centuries it settled and flourished in North Yorkshire. It derived its surname from Exelby, a village in the present day Hambleton district. Thomas Eshelby was born at Thirsk¹⁵ on 27 February 1769,¹⁶ the fourth child of George Eshelby, a leather merchant¹⁷ and his wife Elizabeth (née Carter). Verbal tradition names his three elder siblings as Margery, Hannah and Richard. Their residence is said to have been on St James Street. Interestingly this area is now called St James Green and a public house called the ‘Lord Nelson’ stands here. Little is known of his childhood or early adult life. There have been suggestions that an illegitimate child born to a woman in Northallerton might have expedited his joining the navy.¹⁷

The Mediterranean campaign

The ‘entrance’ examination for surgeons used to be conducted by a Court of Examiners at Surgeon’s Hall, Lincoln’s Inn Fields (today’s Royal College of Surgeons of England). There were three parts to the examination and only on passing the last part in front of the Navy Commissioners of the Sick and Hurt could a candidate be appointed to a ship. The grade (full surgeon, first/second/third-mate) and posting (size or rate of the ship) were both decided by the examiners in those days. Eshelby reportedly qualified as ‘3rd mate, 3rd rate’ at Surgeons’ Hall on 7 April 1791.² He received his first warrant in 1793¹⁸ and was promoted ‘Surgeon, 4th rate’ on 4 September 1794.

The Royal Navy was active in the Revolutionary and Napoleonic Wars by the time Eshelby entered service.¹⁹ A Navy List published in 1799 mentions 634 surgeons serving predominantly aboard about 400 of the 646 ships in commission at that time.²⁰ Eshelby was appointed to the seventy-four-gun ship Captain. Horatio Nelson had by now been promoted to Commodore and transferred to Captain on 11 June 1796. Nelson commanded from this ship for most of the next year. In May 1797 he was promoted to Rear Admiral and moved to Theseus. He took most of his officers and staff with him, including Eshelby.

Nelson’s amputation and its complications

Nearly two months later, just after midnight on 25 July 1797, the Spaniards repelled Nelson’s attack on the Tenerife coast. A grapeshot from the infamous cannon El Tigre struck him on his right arm just above the elbow. He was taken immediately to Sea Horse which was nearest to the beachhead. He refused to board as he did not wish to inconvenience Betsy Freemantle, the ship captain’s wife. The chivalrous Rear Admiral was then returned to his flagship, Theseus, where Eshelby promptly proceeded to do a trans-humeral amputation under a tourniquet.²¹ (Figure 2) The evidence suggests he used silk ligatures instead of the commoner British practice of waxed thread. The ligatures were left long to protrude from the stump so that they could be removed eventually by gentle traction at subsequent dressing changes. Nelson was much distressed by the cold saw against his unanaesthetised flesh and later gave orders to all the surgeons in his Fleet to keep their instruments warm and ready in future encounters. The post-operative management, including analgesia, wound reviews and dressing changes, is documented clearly in the medical journal of Theseus,²² wherein he is referred to as ‘Admiral’, though this was corrected to ‘Rear Admiral’ in the Journal of Sea Horse (Figure 3). Having operated on Nelson, Eshelby and his French assistant Louis Remonier (born 1773) attended to the other casualties. These included a 27-year-old seaman named James Holding, who also required a trans-humeral amputation and was discharged later to Gibraltar Hospital on 17 August 1797.²²

Figure 1.

Photograph of Thomas Eshelby's portrait. Courtesy of Sarah Eshelby (personal correspondence). Ms Eshelby and her sister are descendants of Henry Lowcay Eshelby (youngest son of Thomas and Peggy Eshelby), and reside in Canada. The actual portrait has been in the family as a treasured heirloom.

Figure 2.

The tourniquet used on Nelson, and his spyglass. Courtesy of the Wellcome Trust, London, UK.

Even though the amputation stemmed the haemorrhage and probably saved Nelson’s life, it was not free of complications. Subsequently, the stump became infected and was incised during his lengthy convalescence. It remained painful until the offending ligature finally slipped off five months later.^8,23 Opinions range from ‘heroic’ to ‘botched’ in the different accounts describing the surgical procedure and its long-term outcomes. The evidence points to him incorporating the neighbouring median nerve in one of the ligatures on the brachial artery²⁴ causing neurostenalgia.²⁵ This seems to be the only debatable step^5,6 in an otherwise swift operation that used to be perfomed frequently. Nelson certainly was grateful to Eshelby for his care and wrote to his wife on 5 August ‘I am fortunate in having a good surgeon on board’.²⁷ Eshelby followed Nelson when he boarded Sea Horse on 20 August and accompanied him back to England, arriving at Spithead, Hampshire, on 1 September 1797.

Eshelby’s remuneration

A surgeon’s monthly pay used to be about £5 in those days. Additional payments included 2d per man per month for the ship in which he served and £5 for every hundred men treated for venereal disease, as well as an annual but variable ‘Queen Anne’s gift’.²⁰ Surgeons could be paid additional remunerations for their services. This is suggested by the account that Nelson subsequently sent to the Commissioners for Sick and Wounded Seamen for the expenses incurred in his amputation and subsequent treatment.²⁸ Accordingly, Eshelby was paid £36 for the six weeks he looked after Nelson. His assistant, Remonier, received 24 guineas for his care that included sitting up with the celebrated patient for fourteen nights. Nelson recorded later in a letter on 1 March 1798 ‘paid Thomas Eshelby for amputating my arm, quitting Theseus and attending me to England, £36.0.0’.²⁷

Aboard Sea Horse

Eshelby had succeeded David Fleming, who had been appointed as Sea Horse’s surgeon in 1795, during the debacle off Tenerife. Returning to sea in September 1797, he saw further action in the Channel, the Bay of Cadiz and the larger Mediterranean theatre of war. This included deployment along the coasts of Alexandria (Egypt), Leghorn and Naples (Italy), and continued till August 1801 when this vessel was redeployed as part of a convoy to the East Indies.

Eshelby documented all his cases in the ship’s journal quite meticulously.²⁹ The format followed in these journals is intuitive and quite similar to modern day medial and surgical logbooks. Each page is divided vertically into these six sections:

‘Mens names, ages and qualities’

‘When and where put on the sick list’

‘Statement of the case when put on the list’

‘Symptoms and treatment while under care’

‘When discharged to duty, died, or sent to the hospital’

‘Remarks’

All of Eshelby’s entries are chronological and even the dates without entries are mentioned. The treatments given are written concisely, along with details of where and when the patients were discharged. In instances where he came across discharged patients months later at a hospital ship or onshore hospital, he revisited and updated the relevant entries in the journal. Each year’s journal concludes with a ‘summary’ section and general remarks by the surgeon. These summaries have been abstracted into Table 1 using the ‘disease descriptors’ as used by Eshelby (Table 1). The ‘case load’ over the four-year period is quite diverse and interesting. The most frequent presentations to the sick bay include ‘wounds and accidents’ (including injuries suffered in battle, 168 cases), venereal illnesses (164 cases) and pulmonary disease (160 cases). Eight deaths have been reported on the sick bay during this period.²⁹

Table 1.

Summary of patients presenting to Sea Horse’s sick bay 1797–1801.

‘Nature of the disease or hurt’	20 August 1797–19 August 1798			20 August 1798–20 August 1799			21 August 1799–18 August 1800			19 August 1800–29 August 1801
‘Nature of the disease or hurt’	Listed	Discharged	Sent	Listed	Discharged	Sent	Listed	Discharged	Sent	Listed	Discharged	Sent
Continued fevers	29	19	10	6	5	0	66	56	9	47	44	3
‘Fluxes’	13	13	0	22	20	1	13	12	0	6	6	0
Scurvy	3	3	0	1	1	0	4	4	0	2	0	1
Ulcers	21	8	13	13	12	1	10	5	5	18	12	4
‘Wounds and accidents’	82	59	22	22	22	0	37	30	6	27	25	1
Rheumatism	15	11	4	23	21	0	15	11	4	6	3	3
‘Pulmonic inflammation’	24	16	7	29	25	2	53	45	7	54	50	4
Intermittent fevers	1	1	0	4	4	0	4	4	0	5	5	0
‘Catarrrhs’	34	34	0	31	31	0	–	–	–	–	–	–
Icterus	4	4	0	–	–	–	–	–	–	–	–	–
Ophthalmia	3	3	0	5	5	0	–	–	–	–	–	–
Dysuria	3	1	1	2	1	1	–	–	–	–	–	–
‘Liver, venereal and gonorrhea’	55	48	7	24	23	0	50	47	3	35	31	4
‘Cynanche tonsillaris’	14	14	0	23	23	0	–	–	–	–	–	–
‘Chlorea morbus’	–	–	–	10	10	0	–	–	–	–	–	–
Other complaints	20	18	2	15	15	0	37	35	1	53	43	10
Total	321	252	66	230	218	5	289	249	35	253	219	30

Abstracted from the Medical Journal of Sea Horse. Courtesy of the National Archives, Surrey, UK.

The following ‘general remarks’ at the end of the 1799–1800 journal illustrate Eshelby’s epidemiological skills:

The crew of this ship have not been attacked with any alarming complaints except in November last when the ship was docked at Sheerness. Several were taken ill with Typhus fever, were sent to the hospital ship whenever the weather would permit, where several of them died. It appeared to arise from the company being put into a vessel by no means proper to receive them, not being fitted as a hulk and much smaller than the Sea Horse. Several were obliged to sleep over the ballast which was wet and stinking and no pumps to pump the water out with. This happened during my absence on admiralty leave.

Several were attacked with Cholera Morbus in July last when laying in Leghorn roads. It generally yielded to emetic cathartics, and large opiates after their operations, saline mixtures and diluting drinks. I don’t know what to suspect as the cause. Whether the water, the great plenty of fruit and vegetables, particularly cucumbers, or the intense heat of the day, and exposure to the land wind by night. I have known the same complaint prevail, after eating fat fresh beef soup, particularly on board the Captain, in blockading this port in 1796. When we were supplied with no other article from that place whatever. The same happened on board this ship on the coast of Egypt, when we were supplied with bullocks at sea.

Marriage

Sea Horse was laying anchor at Spithead in the summer of 1801. Eshelby was now 31 years old and still single. Not much is known of his betrothal to Peggy Douglas (1779–1839) save that the marriage took place on 20 July 1801¹ 6,30 at St Mary’s Church, Portsea, Hampshire. Portsea was part of Portsmouth and Eshelby’s family continued to own property on King Street well into the mid-nineteenth century. Thomas and Peggy had seven children, including five sons and two daughters. Of these only two sons and one daughter were surviving when Peggy breathed her last on 4 December 1839 at Portsea. She was buried there and her effects were bequeathed equally to her surviving children.³¹

Peggy’s brother was a naval commander named John Douglas (1772–1842). Incidentally, he had participated in the attack on Tenerife (1797) as a captain and had also lost an arm in the debacle.

The Plymouth years

Eshelby was assigned to the hospital prison ship Le Caton in July 1804.³² This was a 64-gun French vessel³³ originally captured by Admiral Hood in April 1782 at the Mona Passage.³⁴ It had been moored in Hamoaze Bay, just off Saltash near Plymouth.³⁵ It served as an offshore hospital to the nearby prison ships³⁶ including Brave, El Firme, San Ysidro, San Nicolas, Hector, Generaux, L’Oiseau, Bienfaisant, Europe and Panther. All these vessels had been captured from the French and Spanish in previous battles. Le Caton could accommodate up to 600 men while the prison ships could hold, between them, more than 5000 prisoners of war in total at any one time. Le Caton also served as an adjunct to the local on-shore naval hospital on Mill Bay.³⁷

A few of Eshelby’s letters (c1809–1810) have been archived at Plymouth City Council.³⁶ These are addressed to Captain Edward Hawkins (1765–1839) who was Superintendent of the Prison Ships from June 1808 to November 1813. Hawkins lived aboard Brave (sometimes spelt Braave) for four years and then moved to Duncan House at Saltash.³⁸ These letters provide valuable insight into the day-to-day issues and affairs faced by Eshelby in the discharge of his duties. (Figures 4 and 5). These include weekly updates on the health and illness of the prisoners and his staff as well as suggestions for improvement. They also give an idea of the logistical and managerial practicalities of running a hospital ship service in the face of continuing war, including ‘bed management’, resource appropriation and personnel assignment and so on.

Figure 3.

Eshelby’s operation note, from the Medical Journal of Theseus. Courtesy of the National Archives, Surrey, UK. ‘Compound fracture of the right Arm by a musket ball passing thro’ a little above the Elbow; an Artery divided; the Arm was immediately Amputated, and the following give [sic] him, R_x; Opii gr. ij. f. Pil. statim s. Rep. Pil. Opii gr j-Rep. Pil. Opii gr ij hora s.s.’

Figure 4.

Letter from Thomas Eshelby to Captain Hawkins, dated 6 May 1809. Courtesy of Plymouth City Council.

Figure 5.

Letters from Thomas Eshelby to Capt Hawkins, dated 30 May 1809 and 21 May 1809. Courtesy of Plymouth City Council.

The Plymouth City archives contain a list of the salaries paid in 1810–1811 to different officers, clerks and stewards on these ships.³⁹ Eshelby is recorded to have received his salaries quarterly, earning £66 13s 1½d (1 January to 31 March 2010), £67 7s 11d (1 April to 31 June 2010), £68 2s 9d (1 July to 30 September 2010) and £68 2s 9d (1 October to 31 December 1810) respectively. Owing to his seniority, he earned 5s per day more than the other prison ship surgeons. These included, in order of seniority, Joseph Fleming (Bienfaisant, appointed 17 March 1779), James Long (San Nicolas, appointed 7 Apr 1783), Charles Cudlip (L’Oiseau, appointed 1783), John Lind (Europe, appointed 1793), George Bellamy (Hector, appointed 19 May 1795), John Hallett (El Firme, appointed 1797), Ralph Palin (Genereaux, appointed 1801) and Robert Crow (San Ysidro, appointed 1801).

The Prison at Princetown on Dartmoor did not open until 1812 in order to accommodate on dry land, but in a very windy environment, those held previously in the hulks at Plymouth.

Eshelby and Beatty

Eshelby’s timely intervention had probably saved Nelson’s life but he recorded it in his characteristic unemotional and matter-of-fact manner in the ship’s medical journal. History certainly does not fête him as ‘Nelson’s surgeon’. That honour has been lavished on Sir William Beatty (1773–1842), the Senior Surgeon aboard Victory at the battle of Trafalgar in 1805.⁴⁰ Beatty referred to himself as such in his famous narrative of Nelson’s death, the publication of which he described as an obligation he owed to the British nation.⁴¹

Interestingly, both Eshelby and Beatty had been appointed as Ship Surgeons in the same year (1793), Eshelby being a few months senior to the Ulsterman.¹⁸ Beatty was subsequently promoted to ‘Physician of the Fleet’ and was based on shore at Plymouth. He stayed there until August 1815 when he was placed permanently on half-pay.⁴² For six years (1805–1811) Eshelby served subordinate to Beatty though Beatty’s duties were mostly administrative and inspectorial with little day-to-day liaison with hospital ship surgeons.

Death

The salary list for January to March 1811 mentions under his due amount ‘Mr Eshelby died 19th February 1811 no demand made for his pay [sic]’.³⁹ The Naval Chronicle (1811) elaborates further on his sudden demise in its obituary section:

Suddenly of a fever, caught in his professional duties, on the 19th of February, Mr Thomas Eshelby, surgeon of his Majesty’s prison-hospital-ship, Caton, at Plymouth (lately of Portsea), leaving a disconsolate widow pregnant, and five young children, to deplore the loss of a most excellent husband, and exemplary father. He was surgeon of the Sea-horse, at the attack on Tenerife, in 1798, and amputated the arm of the late Lord Nelson.⁴³

Eshelby was only 41 years old at that time and was buried at Stoke Damerel, Devon on 23 February 1811.¹⁶ He was succeeded by FM Chivers who was appointed on 10 May 1795, two years his junior.

Progeny

Thomas Douglas, the Eshelbys’ eldest son, was born on 6 July 1802 at Portsea.¹⁶ He followed in his father’s footsteps and was appointed a naval surgeon on 7 July 1828.⁴⁴ He served on board Scylla under John Hindmarsh’s (1785–1860) command. He died at Malta in 1831, unmarried and without issue, leaving his property and effects to his two sisters,⁴⁵ Ann-Maria (1808–1890) and Sophia (1810–1836).

Thomas’ younger brother William (1805–1827) served as a Naval lieutenant aboard Rose and died at Malta four years before his elder sibling.

Another brother, John Douglas (1803–1850), opted against serving in the Navy and earned his living as a merchant at Liverpool.¹⁶ John’s son Douglas William Eshelby (born 1839) trained as a surgeon like his grandfather and practised in Gloucestershire.⁴⁶

The youngest brother, Henry Lowcay Eshelby (1811–1855), was also a Liverpool merchant.¹⁶ He and his wife Mary Pemberton (1821–1904) had three sons and four daughters. The eldest son, Henry Douglas (1845–1905), was a respected actuarian who wrote a book on his family’s genealogical descent to the seventeenth century.¹⁴ Henry Douglas’ grandson John Douglas (1916–1981) gained fame for his colossal work on mechanics and materials science.⁴⁷ Henry Lowcays’ other son Alfred Lawton (1846–1871) served as a lieutenant in the Royal Navy. Eshelby Island, just off the coast of Queensland, Australia, is named after him.⁴⁸

Footnotes

Author biographies

SK Khan is Specialist Registrar in Trauma & Orthopaedics, Northern Deanery, Newcastle upon Tyne, UK (Sameer.khan@doctors.net.uk).

I Saeed is Core Trainee in Medicine, Northern Deanery, Newcastle upon Tyne, UK.

MD Brinsden is Surgeon Commander, Royal Naval Medical Service, and Consultant Orthopaedic Surgeon, MDHU, Derriford Hospital, Plymouth, UK.

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