Shackleton's heart.

Abstract

One hundred years ago, from October 1915 to April 1916, Sir Ernest Shackleton and his men were forced to camp on ice floes in the Weddell Sea after the Endurance was crushed and sank. After escaping from the ice in three small open boats, the crew of the Endurance spent six months living under two of the boats on Elephant Island, while Sir Ernest with five companions sailed 800 miles in the third, and made the first crossing of the mountains and glaciers of South Georgia. The Endurance expedition was the third of four expeditions towards Antarctica undertaken by Sir Ernest between 1901 and 1922 and was the only one during which he did not suffer a physical breakdown. We believe that his breakdowns were the result of a congenital cardiac defect. The evidence rests mainly on diary entries made by Dr Eric Marshall, the medical officer on Shackleton’s second expedition to the Antarctic (1907–1909) in the Nimrod. On 20 January 1908, Dr Marshall wrote in his diary ‘Heard S was very unwell after pulling on a rope. Will not hold myself responsible until he allows me to examine him. Something wrong?’. As medical officer, Dr Marshall was able to insist on an examination and on two occasions found a ‘pulmonary systolic murmur’. Shackleton, Marshall, Wild and Adams sledged south, discovered the Beardmore Glacier and the Polar plateau, but realising they would perish from starvation if they carried on, turned back when about 100 miles from the Pole. Back on the Beardmore, some 380 miles from base, Dr Marshall wrote ‘Shacks collapsed after dinner tonight’, and the next day ‘Sh very unwell, walked by the sledge all day – Midday-Pulse on march thin & thready, irregular about 120’. However, Shackleton recovered within a few days, and was one of the strongest of the party by the end of the journey, performing a forced march of thirty miles with Frank Wild to prevent the Nimrod leaving without them. As well as the two episodes recorded by Dr Marshall, Sir Ernest suffered a breakdown in 1903, during his first Antarctic expedition in the Discovery. He was unable to pull the sledge, due to breathlessness and weakness, towards the end of a sledge journey southwards with Robert Scott and Edward Wilson. Shackleton’s collapse was attributed to scurvy and ‘a sort of asthma’, and he was invalided home against his will. Dr James McIlroy, medical officer on Shackleton’s third and fourth expeditions, told of two other incidents, one in 1919, during an expedition to Spitzbergen ‘ – when he [Shackleton] changed colour very badly – he had a very bad bout that time but he wouldn’t undress and let me listen to his heart’, and a similar episode in 1922 on Shackleton’s last expedition. Figure 1. Frank Hurley (L) and Sir Ernest Shackleton on an ice-floe in the Weddell Sea. Image provided by the Scott Polar Research Institute, University of Cambridge.