Abstract
We thank Firth and Kinane for their interest in our essay. We are particularly glad to hear from Firth, who wrote a fascinating account of the medical issues affecting Shackleton’s men on Elephant Island.1,2
They suggest that cardiac damage caused by scurvy provides a more likely explanation of Shackleton’s breakdowns than our ASD and paroxysmal dysrhythmia theory. Shackleton clearly had scurvy when he suffered his first breakdown in 1903, but his companions seem to have felt that something else (‘a sort of asthma’) was wrong, and we struggle to imagine what structural cardiac damage could have resulted, that produced a pulmonary systolic murmur and four more breakdowns (that we know of) during the following 20 years, but allowed extraordinary feats of physical endurance, such as crossing South Georgia in 1916, or marching 60 miles in 48 hours a few weeks after his second breakdown in 1908. Firth and Kinane quote three authorities in support of their contention, whose publications we enjoyed reading, but do they really provide a logical explanation of Shackleton’s problems? Darling (their Ref. 3) did not mention long-term sequelae but described right ventricular hypertrophy and ‘vagal nerve degeneration’ in ‘several’, possibly four, post-mortems. Hess (their Ref. 4), in his monograph mentions that ‘Adults complain not infrequently of palpitation and pain over the pericardium, or rather of a tightness or oppression in the chest’, but did not describe long-term sequelae. Taylor (their Ref. 5) reported his experimental study on 17 guinea pigs. The longest survival was 7.5 weeks, and he noted heart enlargement in three with mitral valve thickening in 11 at post-mortem.
Firth and Kinane’s point about Shackleton’s father being unlikely to allow his son to become a seaman if he suspected a congenital heart defect, is well taken. Nevertheless, we wonder whether he might have followed the same course as Dr Marshall did in 1908, when faced with an uncertain diagnosis, no obvious treatment option, and an apparently healthy and determined Ernest Shackleton, who was not later called ‘The Boss’ for nothing!
We definitely want Sir Ernest to rest in peace, and hope that he would be glad to know that he is still discussed and admired a century after one of his finest exploits.