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 path forward. 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.