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Spinal Hematoma



Gender Roles

Much of the conflict in The Colonel and The Enchantress centers around a spinal injury the hero sustains. While there are several chapters that deal with the physical effects and rehabilitation, a hefty portion of the internal conflict deals with the hero's perception of his role in society as a man and as a lover. The conflict is not overt, but as we reach closer to the final climax, we see it more acutely.


For this research section, I'd like to touch on three areas--the nature of the spinal injury and what I've fictionalized to make the story possible, the man's place in society, and the limitations such an injury would have on his place in society, specifically the lack of wheelchairs and mobility aids. This is a lot to cover, so hang on to your seat! Let's begin with the fun part--the man's place in society.


The gender roles in society found the greatest divide in the upper classes. The lower classes still held to a woman's place in the home, but women knew their fair share of hard labor. In the upper classes, the belief that men were stronger, more logical, and more intelligent was the greatest. This article talks a bit about where this belief stemmed from. Regardless of profession, the man was the provider and protector. As such, the man was responsible for staying current and involved in politics, seeing to the finances, ensuring the social sphere was well connected, displaying sexual prowess, overseeing the teachings and values and beliefs of the children, and more. The man's contributions to society and to the family were a heavy burden, for if he could not fulfill these roles, how could he be a provider and protector?

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Mr. Knightly from Emma 1996

Fulfilling the man's expected roles was as much about how others viewed him as it was about how he viewed himself. When a man's success in society is determined by his ability to fulfill the roles, his self-perception would hinge on that fulfillment, as well. We're all familiar (I assume) with a woman's need to wed during the 18th century and much of the 19th, but a man's need was no less. The man had far different reasons for marrying, but the expectation and need to wed was just as great as a woman's.


To wed meant the man could provide and protect by fulfilling all of those lovely roles. If a man did not wed or if a man wed but could not fulfill the roles, he was a failure. Throughout 18th century literature and art, there's evidence of how society saw men who could not fulfill the roles, especially aging bachelors. This article talks about this at some length. I'll include this article for those who want to explore a fantastically thoughtful article on masculinity in the 18th century, but I do warn that this one needs a subscription to JSTOR to read it (and you all know how much I love JSTOR!).


What does all of this mean for our hero? It means that when he sustains an injury that affects his mobility, he cannot fulfill his role as a man in society, neither from the viewpoint of those in society nor his own.

The injury is a spinal epidural hematoma, though the phrase is never used in the story since it wasn't coined until 1826. At the time of this story, physicians would have known nothing more than the patient had partial paralysis. That said, there was already some groundbreaking research being conducted on spinal injuries, the purpose of the spine, the structure of the spine, etc. Domenico Cortugo spearheaded a great deal of this research. In the story, I've fictionalized an apprentice of Cortugo who would be familiar with some of the spinal research, thus able to help our hero.


Domenico Cotugno

A spinal epidural hematoma is a blood clot in the spine that causes compression on the nerves. This means a loss of both feeling and use of the lower extremities. If caught at early onset, it's a quick surgery of draining the clot, and the patient could walk out (potentially the next day). The longer a person goes without diagnosis, the less likely the person will recover. With too much time passing between symptoms and surgery, it means the patient is more likely to remain paralyzed and/or without feeling.

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Spinal Epidural Hematoma (severe)

I chose this injury, which for our hero is a post-surgery injury from a war wound, because I met a young fellow who had suffered from a spinal epidural hematoma. The symptoms, rehabilitation, and recovery of our hero are all based on what this young man experienced. Since each case is a wee bit different, I read countless case studies to better understand what others experience and how they recover. The man I met was my primary resource and inspiration, however. Here are a few cases you might find interesting: Case Study and 4 Cases in 1 


One key point in the story is heavily fictionalized because I knew no other way to help the physician discover the root of the problem. In the story, the physician can see the clot as a bruise at the base of the hero's spine. This would be accurate if the clot were close to the skin's surface. The trouble is, it's in the spine, not next to the skin, and thus in a real case, there would be no outward indication of this condition, no swelling or bruising that one might experience with a traditional blood clot, such as a deep vein thrombosis.


Something else that is fictionalized is that the physician in the story is able to drain the clot. While that's the case in modern medicine, I highly doubt a physician at that time would have had the tools, knowledge, or gumption to perform such a surgery. But this is the joy of creative fiction, right?


Our hero uses hippotherapy (which I talk about in another research section) as his primary method for rehabilitation. This article offers a discussion of horseback riding after a spinal injury. This is accurate for the time period, although the hero would have had no way to know he was participating in hippotherapy. He just wanted to ride and refused to allow his injury to stop him! However stubborn his decision, the riding aids his recovery.

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Hero on Horseback

So where does all this fit into the gender role dilemma? For a man who cannot walk, mobility is not only limited but impossible. It wasn't as if his family could pop down to the apothecary and pick up a wheelchair or have ramps fitted on the stairs. Without the ability get around, he could not prove his ability to provide for and protect a future or existing family. He could not labor. He could not socialize. He could not meet with the steward or tenants. He could not ride about the home farm. He could not exude masculinity and sexual prowess. He could not bed his bride or produce children. He could not do a great many things. Our hero has to contend with these could nots and find a way to fulfill his role regardless.

The wheelchairs of the time were for outdoor use. Aside from some rudimentary designs made for personal use, there wasn't anything like what we know of today as a wheelchair until Dawson's Bath Chair in the late 18th century (pictures included in that link). It was a mammoth wheeled vehicle that could be pulled by a horse or pushed by a man. The rider could not wheel about in it by self-propulsion, and it could not be used indoors, not to mention it would cost a small fortune.


Bath Chair

In Europe, there were indoor versions that were little more than a wicker chair with wheels and handles in the back for pushing. An enterprising person in England could very well pay the good money it would take to have someone craft such a chair for indoor purposes. It would still be limiting. Someone would have to push it. Someone would have to carry it and the person down and up the stairs. It would not be suitable for outdoor use, just as the Bath Chair would not be suitable for indoor use.



Indoor Wicker Wheelchair

Even with this added mobility, which no one but the wealthy could afford, the role of the man could not be met to society's or self's expectation. Hence the primary conflict of our hero, whether or not he recognizes that as his conflict. A little determination, ingenuity, and humbleness go a long way for our hero.      

Note: All research sections are here for entertainment purposes to offer insights into the research and plotting of novels. Information does not represent historically accurate scholarship, only research findings that aided in crafting fictional novels.

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