Shackleton’s Medical Kit
Frank Wild, Ernest Shackleton, Eric Marshall and Jameson Adams on their return from reaching within a hundred miles of the South Pole. Photo taken by James Murray (1865–1914).
When I arrived at Halley Research Station, on the Caird Coast of the Weddell Sea and only a few hundred miles from the South Pole, to take up the job of base doctor, I found a message from my boss sent from 14,000 kilometres away. ‘Any second thoughts?’ he asked. ‘Because for ten more months, no one is getting in and no one is getting out.’ He made Halley sound like a custodial sentence, though he knew I had freely, even enthusiastically, chosen the isolation it imposed. Before my departure he’d overseen my training in orthopaedics, pharmacy, dentistry, anaesthetics, neurosurgery, radiology and ophthalmology. It was a cram course in the super-specialization of modern medicine. ‘You’re unlikely to need any of this stuff,’ he told me during the longer tutorials. ‘But you never know . . . ’
As a teenager I had been entranced by stories from the so-called ‘Heroic Age of Antarctic Exploration’; of Shackleton’s astonishing survival, and Scott’s piteous death. I wanted to see for myself the continent that each had described so beautifully. As a teenager I had been entranced by stories from the so-called ‘Heroic Age of Antarctic Exploration’; of Shackleton’s astonishing survival, and Scott’s piteous death. The view outside my new office window didn’t disappoint; it was like the earth on the first day of creation, a glittering world beneath a firmament of light. In the sky above, frozen water molecules mingled and bonded with the air in a strange alchemy, transmuting the sun’s rays into haloes and rainbows. There was never any darkness; our ‘day’ would last three and a half months. For the first few weeks, surrounded by such luminance, thoughts, memories, ambitions and emotions washed through me unsnagged; I had the sense of a deep reordering within. There was no boredom in this emptiness, just an awareness of something expanding as if the aperture of my mind was widening for a long exposure. A whole year lay ahead with no clinics, no waiting room, no pager and hardly any patients.
My training up to that point had overemphasized the technical, it veered away from risk and plunged into blood tests and multi-million dollar scanners at every uncertainty. But at Halley I’d have to get along with a military X-ray box, a canvas bag of dental tools, and an Edwardian-era microscope for counting blood cells. On arrival I even found an anaesthetic machine, intended to be filled with ether, gathering dust in one of the cupboards. The base had been running for fifty years, and the surgery equipment had evolved to manage all medical emergencies that had occurred over that time. I had glass cabinets full of pills, an ECG machine in case of a heart attack, and several bottles of laughing gas. A bewildering variety of stretchers and splints were piled in the cupboards, some which looked as if they’d been stowed since the base’s inception. There was a kit for trephining holes in the skull, to be used as last resort in coma after a head injury. The earliest Antarctic doctors took straitjackets; I had a stack of ‘chemical cosh’ antipsychotics instead. There were tracheostomy sets, appendicectomy kits, and under the sink I found five vinyl-black body bags. There were only fourteen of us on base: we were equipped for a fatality rate of 35%.
At the beginning I was kept busy several hours a day checking, replacing and packing medical kit boxes. These boxes were to be taken from the base out on ‘deep field’ research projects, by exploration parties probing Antarctica’s heart. They might end up in core-drilling camps, clumped round a tunnel that was being cut kilometre-deep into the ice. Or with small mobile geology groups, buzzing through nameless mountains on snowmobiles, gathering rocks that showed Antarctica once had forests and swamps. Whatever they were doing, what these groups had in common was remoteness, and the lack of anyone medically trained on site. In an emergency they were supposed to get out their medical kit, give a bit of first aid, call me up on the radio and wait for instructions.
Back in England I had been involved in decisions about what would go into these boxes – what was really necessary to provide basic medical care at the end of the earth. Each was designed to fit on For the first few weeks, surrounded by such luminance, thoughts, memories, ambitions and emotions washed through me unsnagged; I had the sense of a deep reordering within. a sledge. Pulled by skidoos now rather than dogs or men, these sledges were the same ash-framed models that Scott and Shackleton had hauled over a century ago. Space on each was limited, and weight was to be kept down to twenty kilogrammes. I stocked the boxes to deal with tonsillitis and tooth-rot, piles and the consequences of unprotected sex (the days of all-male Antarctica are over, thank goodness). I packed laxatives and local anaesthetics, elastoplasts and eye drops. A bottle of vitamin pills to prevent scurvy. Scalpels, catheters and a collar should anyone break his or her neck. Some of the most useful items, considering the risk of falling into a crevasse, were the few rolls of Plaster of Paris. Each box was like the distillation of all that we have learned as a species about our bodies and their infirmities, a time capsule of medicine at the start of the twenty-first century. They spoke of our communications (with question grids for use over radio static), our sexual mores (condoms, the Pill, and the morning-after pill), and even the ozone hole (tubes of factor thirty sun block).
Ours is a nervous age, we’re often told, and the heroes of exploration are all gone. What, I had wondered, did our predecessors like Scott or Shackleton take when they set out into the blank spaces on the map?
In the well-stocked polar section of the little base library I unearthed the packing list for Shackleton’s medical kit – the drugs and dressings he took on the sledge trips of his Nimrod Expedition of 1907, the one that turned back only ninety-seven miles from the South Pole. It added up to a weight of about three kilos, less than a sixth of the modern kit, and to my technomedical mind read more like a witch’s grimoire than the best medical advice of just a century ago.
Shackleton had isinglass, prepared from the swim bladders of Russian sturgeons. Coated with silk, it was used on open wounds. He had ‘gold-beater’s skin’, a parchment-like dressing only fractions of a millimetre thick. Prepared from the intestines of Each box was like the distillation of all that we have learned as a species about our bodies and their infirmities, a time capsule of medicine at the start of the twenty-first century. oxen or of sand sharks, it was used in the manufacturing of hammered gold foil but also to promote the healing of open sores. He had tonics of iron and strychnine and tonics of iron and arsenic; the wrong doses of either would cause a lingering death. The kit carried a preparation to treat colic that combined tincture of cannabis with tincture of chilli pepper. Ginger was used as a carminative, a sonorous word that I had to look up (it stops farting). Cocaine was dripped in the eye to cure snowblindness, and chalk ground up with opium was used for diarrhoea. No antibiotics in 1907 of course. Perhaps the only medications that Shackleton carried that we would still use today were aspirin and morphine.
Only fifty years ago it was still mandatory for doctors to study botany and chemistry. Fifty years before that, most drugs and dressings were prepared directly from raw materials, often by the prescribers themselves. The contrast with the material I had to work with was extraordinary; all of mine came pre-packaged, shrink-wrapped and sterilized, each with a barcode and a use-by date.
As I cleared away the mountain of packaging left over after refilling each medical box, I envied those doctors of a century ago. I wondered if I had been born a hundred years too late. Their drugs and equipment might have been primitive, but they betrayed an intimacy with the natural world that I felt I had lost. It takes special knowledge to prepare and store arsenic and shark-gut, coca leaves and opium. That knowledge, gained through the practice of medicine, was useful in other sciences. Medical practitioners of that age often made ground-breaking contributions to widely divergent disciplines.
A case in point was Shackleton’s doctor, Eric Marshall, who was cartographer and surveyor as well as chief surgeon. Another was the doctor on Scott’s Discovery expedition, Edward Wilson, who doubled up as a marine biologist and ornithologist. In 1910, when Wilson returned to the Antarctic on the Terra Nova, he not only selected the medical inventory, he oversaw the colossus of Scott’s scientific programme as well as gathered data for a monograph on the lives of emperor penguins.
I asked around Halley, trying to understand how scientists there were unravelling the mysteries of Antarctica. I wanted to find a way to contribute the way my predecessors did. Halley concentrates on atmospheric science, with big-budget projects examining the solar wind, clean air chemistry, the ozone hole, the earth’s magnetic field. But my medical training towards the end of the twentieth century had been so narrow there was little that I could add. It is not only medicine that has become super-specialised over the last hundred years; the sciences have done the same.
I got used to dealing with medical queries over the radio. The calls were few and far between: upset stomachs, scalding burns, constipation and the odd toothache. Someone had a rash and someone else an itchy scalp. On one occasion I even managed to make a ‘home visit’, being flown four hundred miles to give a ten-minute consultation. On base I did my first dental filling and picked steel fragments from an eye.
My list of consultations could have been taken from the medical records of the Nimrod or the Terra Nova. Human beings, regardless of the age they live in, seem to rot their teeth, obsess over their guts, or injure themselves with fires and falls. I may not have been able to contribute to the scientific programme the way Wilson did, but he would have nodded with recognition at the problems I was called on to manage. Hubris aside, I wondered if the kit he carried meant that he could have managed them as well as I could.
I looked up the contents of Wilson’s sledging medical kit, the one that he dragged to the South Pole, that was buried with him when he As I cleared away the mountain of packaging left over after refilling each medical box, I envied those doctors of a century ago. died on the Ross Ice Barrier. The whole case weighed less than two kilograms, and, prepared only three years after the Nimrod sailed, showed an unsurprising degree of overlap with Shackleton’s kit. The list of contents read like an incantation to me: Aromatic chalk, kola, borate, digitalis tincture, chlorodyne, borofax, hazeline and camel hair. But isn’t all medicine a form of enchantment?
In early 1912, on the return journey from the Pole, shattered by defeat and weakened by inadequate stores, the four men with Scott began to succumb to injury. Despite Wilson’s best management, the party was slowed down. Edgar Evans, the strongest in the party, cut his hand and the wound turned septic. Wilson no doubt dressed it with isinglass, and administered iron tonic with caffeine, but Evans still died at the foot of the Beardmore Glacier.
When Titus Oates unwrapped his frost-bitten foot in the tent each evening, Scott wrote that Wilson showed ‘self-sacrificing devotion in doctoring Oates’s feet.’ He spent hours lancing Oates’ blisters, lathering his sores in antiseptic, debriding dead tissue and carefully wrapping each foot in gauze. But Oates still died, wandering out into a blizzard, just days after Wilson handed out the opium ‘tabloids’ that would enable each man to choose a painless death.
I pictured their tent as they set up each night. The silence around them unassailable, Oates and Evans dissolving by turn into the vastness of Antarctica the way that breath dissipates into the sky. Each day the surviving men edged closer to their hut and their salvation, but the day’s marches grew shorter. The temperatures plummeted as the summer’s radiance dimmed. The sun became murderous, reddening as winter approached. Their injuries had slowed them too much, they had left too late, and by mid-March, close to the autumnal equinox, they knew they would never get through. We know the rest.
Wilson was a renaissance man; a scientist, healer and polymath. Though trained as a doctor he made advances across the natural sciences that would be inconceivable today. He took the best medical kit of his day, but he and his men died all the same.
Would I have done any better? I’d found I couldn’t contribute to modern Antarctic The sun became murderous, reddening as winter approached. science, but my antibiotics and non-adherent dressings might have cured Evans’s wound. My Inadine gauze and hydrocolloid plasters might have saved Oates’s foot. If they had been able to march a little faster, with a little less pain, then they just might have made it home.
When I looked out over the plains of ice beyond my office window they seemed endless, stretching sequinned towards the Pole, sublime in their indifference. I felt relief that I’d never have to walk into that unknown the way that Shackleton or Scott did.
But if I did, and injured myself on the ice, satellite-tracking would pinpoint my location. Friendly voices would reassure me over the radio, and an aeroplane of deliverance would swoop down from the sky. There are advantages to living in an era of specialization. Perhaps I was born to the right age after all. ?
Gavin Francis is the author of Empire Antarctica – Ice, Silence & Emperor Penguins, published November 1st 2012, Chatto & Windus
You can also read Gavin Francis on Sven Lindqvist’s The Myth of Wu Tao-Tzu,