Admiral Lord Nelson's death: known and unknown - A historical review of the anatomy

Study design: Reviewing documents about Lord Admiral Nelson's wound inflicted at the Battle of Trafalgar and studying the collected data in connection with ballistics and human anatomy. Objectives: Attempting to find out the actual cause of death of Lord Nelson as soon as 4 h postinjury by a musket ball. Setting: United Kingdom. Methods: ( 1) Review of the original report of Mr W Beatty, Lord Nelson's surgeon, on his examination of His Lordship's wound. ( 2) Investigating the course of the musket ball in connection with an atlas of human anatomy. ( 3) Investigating the course of the musket ball on a cadaver by RP ( one of the authors). ( 4) Reviewing modern medical literature. Results: The report of Mr Beatty suggested that division of a large branch of the pulmonary artery was the cause of Lord Nelson's early death. Assuming the left pulmonary artery was injured, anatomical studies based on atlases and dissection on a cadaver failed to support a simple straight-line course of the musket ball that could have divided the artery and damage the spinal cord on its pathforward. Conclusion: The question remains open as to how the musket ball following a relatively straight-line trajectory by entering the body at the acromion, could have divided the left pulmonary artery and damaged the spinal cord later in its course. The mechanism needs further investigation.