The clergyman’s symptoms improved dramatically, and a few weeks later, he was able to walk eight or ten miles “with ease.” But my favorite case is that of “Miss E.,” described as a “public vocalist,” which contains this magnificent paragraph:
This case is interesting, from the fact that I gave her the excreta of every serpent I have yet examined, and they all, without exception, after a few days’ use, occasioned headache or sickness, with diarrhoea to such an extent that I was obliged to relinquish their use. From the excreta of the lizards she experienced no inconvenience. She is now taking the excreta of the chameleo vulgaris (common chameleon) with great advantage, and is better than she has been at any one period during the last three years.
It’s all pretty ridiculous—a fact that the medical journals of the day did not fail to point out. A review in The British Medical Journal makes an excellent point about the nature of scientific evidence, suggesting that the “positive” results he recorded were nothing of the sort:
This doctor, unfortunately, gives his cases—his exempla to prove his thesis; and we must, indeed, announce them as such to be lamentable failures as supporters of his proposition. We verily believe, and we say it most conscientiously, that if Dr Hastings had rubbed in one-two-hundredth of a grain of cheese-parings, and had administered one-two-hundredth of a grain of chaff, and had treated his patients in other respects the same as he doubtless treated them, he would have obtained equally satisfactory results.
If The British Medical Journal was uncomplimentary, The Lancet was positively scathing. Its reviewer points out that twenty years earlier, Dr. John Hastings had published another book in which he claimed to be able to cure consumption—using naphtha.* And twelve years after that, he had decided that the cure for consumption was “oxalic* and fluoric* acids”; oh yes, and “the bisulphuret of carbon.”* Dr. Hastings had, in fact, discovered not one but five cures. The reviewer adds, with considerable sarcasm:
As regards that—to ordinary men—unmanageable malady, consumption, all our difficulties are now at an end. The public may fly to Dr Hastings this time with the fullest confidence that the great specific is in his grasp at last.
But he saves the best till last:
What can the public be thinking about, we would ask, when it supports and patronizes such absurd doings? Will there still continue to be found persons ready to allow their sick friends to be washed with a lotion of serpents’ dung?
Dr. Hastings was so offended by this article that he attempted to sue the publisher of The Lancet for libel. The matter was heard before the Lord Chief Justice, Sir Alexander Cockburn, who dismissed the case, ruling:
It might be that he had discovered a remedy, and, if so, truth would prevail in the end; but it was not to be wondered at that the matter was treated rather sarcastically when the public were told that phthisis could be cured by the dung of snakes.
Well said!
4
HORRIFYING OPERATIONS
THE EIGHTEENTH-CENTURY NOVELIST Tobias Smollett was originally destined for a medical career. At the age of fifteen he was apprenticed to two Glasgow surgeons, and three years later volunteered for service in the Royal Navy. Before he could take up his position as second mate to a ship’s surgeon, he first needed to pass an exam at the headquarters of the Company of Barber-Surgeons in London, where his inquisitors included William Cheselden, one of the great surgical innovators of the era. Smollett later satirized this occasion to comic effect in his novel The Adventures of Roderick Random (1748), in which one of the examiners asks the young Roderick what he would do if “during an engagement at sea, a man should be brought to you with his head shot off?” Random proves equal to this facetious challenge:
After some hesitation, I owned such a case had never come under my observation, neither did I remember to have seen any method of care proposed for such an accident, in any of the systems of surgery I had perused.
In 1742, Smollett spent a year treating casualties onboard HMS Chichester during the war against Spain, and the squalor and suffering he witnessed onboard the man-of-war provided him with abundant raw material for Roderick Random. His descriptions of “pitiless surgery and amputation” (as Leigh Hunt described them to Shelley) are among the most vivid ever committed to paper.
The operations Smollett and his fictional alter ego performed in the heat of battle were primitive and mostly concerned with the treatment of wounds. Until the second half of the nineteenth century, when the advent of anesthetics and antisepsis vastly increased the scope of surgical intervention, the repertoire of procedures was small. The removal of cataracts was sometimes attempted in the eighteenth century, but major operations were largely limited to amputations and lithotomy, the removal of bladder stones.
But that’s not the whole story. The early medical literature also contains numerous examples of surgeons attempting procedures that went far beyond the boundaries of what was considered orthodox or even possible. In 1817, thirty years before the discovery of anesthesia, the London surgeon Astley Cooper nearly succeeded in treating a large aneurysm by tying a ligature around the patient’s abdominal aorta—an undertaking of such gravity that it was not attempted again for another century. In Cooper’s age of so-called heroic surgery, many operations of comparable daring took place in front of a large audience, with patients who were horrifically conscious of all that was going on.
Some of these were misguided to the point of rashness, but others display a sophistication and skill not often associated with this early period in medical history. Desperation sometimes prompted surgeons to improvise a solution to a problem that had hitherto been thought insoluble. Necessity is famously the mother of invention, and in some of these cases, operations were performed by those who had never previously wielded a scalpel—and, on occasion, even by the patient on their own body.
But be in no doubt: Even when such procedures were successful, it was not a pleasant business. As the German Lorenz Heister, author of the most widely read surgical textbook of the eighteenth century, wrote:
Students in surgery should not only be furnished with strength of body, but constancy of mind also, that they may remain unmolested and unmoved by the stench, blood, pus, and nastiness that will naturally occur to them in their practice.
And if that didn’t put them off, nothing would.
THE CASE OF THE DRUNKEN DUTCHMAN’S GUTS
On August 28, 1641, the twenty-year-old English diarist John Evelyn visited the great university of Leiden in the Netherlands. He was unimpressed, declaring it “nothing extraordinary,” but one building took his fancy:
Amongst all the rarities of this place, I was much pleased with a sight of their anatomy school, theatre, and repository adjoining, which is well furnished with natural curiosities. Amongst a great variety of other things, I was shown the knife newly taken out of a drunken Dutchman’s guts, by an incision in his side, after it had slipped from his fingers into his stomach.
This object evidently made quite an impression. More than twenty years later, Evelyn recorded the following exchange with the future King James II (James VII, if you’re Scottish):
I had much discourse with the Duke of York, concerning strange cures he affirmed of a woman who swallowed a whole ear of barley, which worked out at her side. I told him of the KNIFE SWALLOWED and the pins.
No wonder he remembered it: The case of the “drunken Dutchman’s guts” was one of the most extraordinary medical events of the seventeenth century—an operation so daring that two hundred years later, in the era of anesthetics and aseptic surgery, it would still be regarded as a heroic achievement. In 1738, the professor of medicine at the University of Königsberg, Daniel Beckher, wrote a book about this case (in Latin) that became a bestseller across much of Europe. De cultrivoro Prussiaco observatio (“On the Knife-Eating Prussian”) was translated into English as A Miraculous Cure of the Prusian Swallow-Knife, a copy of which eve
ntually found its way into John Evelyn’s library. Beckher’s account goes into exhaustive detail, so here I’m relying on a more digestible (as it were) summary by Thomas Barnes written for The Edinburgh Philosophical Journal in 1824:
On the morning of the 29th of May 1635, Andrew Grünbeide, a young peasant, feeling sick at stomach from having committed some irregularity in his mode of living, endeavoured to excite vomiting by irritating the fauces with the handle of a knife . . .
The fauces is the back of the throat. The original text makes clear that Herr Grünbeide had had far too much to drink the previous night, and no doubt many students, past and present, will be familiar with this method of provoking vomiting. It is not recommended, particularly if you are stupid enough to use a knife.
. . . but the desired effect not being immediately produced, he thrust it further down, in consequence of which it escaped his hold, and gradually descended into the stomach. The knife-eater was terribly frightened at the time, and continued afterwards much depressed, yet was able to follow his accustomed employment without much inconvenience.
It’s difficult to imagine anybody in his position being anything other than “terribly frightened.”
The wretched condition of this afflicted peasant excited much pity, and many physicians and surgeons of great learning and celebrity were consulted respecting him. At a meeting of the Faculty, held on the 25th of June, it was decided that the abdomen should be opened, an incision made into the stomach, and the knife extracted. Previous to the operation, the patient was to make use of a balsamic oil, called Spanish Balsam, which they supposed would alleviate the pains of the stomach, and facilitate the healing of the wound.
It was decided that the dreaded operation should take place on July 9. The original account (in its 1642 translation by Daniel Lakin) is vivid:
There met therefore with the Dean of the faculty of physic, the most excellent physicians, honourable members of the same college, as also the students, masters of our Art, together with the most experienced surgeon and cutter of the stone, Mr Dan. Schwabius my gossip* and venerable friend now in Heaven.
It was quite a crowd of eminent medical men in the operating theater. When they were satisfied that everything was ready, they bowed their heads in prayer to invoke “divine assistance and benediction,” and the operation could begin.
The rustic who with an undaunted courage waited the section* was bound to a wooden table, and the place being marked out with a coal, the incision was made towards the left side of the hypochondrium some two fingers’ breadth under the short ribs.
In other words, the incision was made on the upper part of the abdomen, on the patient’s left side.
First the skin and that fleshy pannicle (there was no fat seen) and then the subjected muscles, as also the peritoneum was cut and opened.
Pannicle is an archaic anatomical term meaning a layer of tissue. The peritoneum is the membrane lining the abdominal cavity. Thomas Barnes describes the climactic moment of this great endeavor:
The stomach subsided and slipped from the fingers, which prevented it from being immediately seized; but it was at length caught hold of with a curved needle, and drawn out of the wound. A small incision was then made into it upon the knife, which was then easily extracted . . .
In case you’re wondering, yes, the patient was still awake. In 1635, he had little alternative, except perhaps passing out with the pain. But far from being in agonies, he was apparently the most enthusiastic spectator:
. . . which was viewed by all that were standing by, and greatly applauded both by them and the patient himself, who professed that this was the very knife he some few days before had swallowed, but the wound itself when the knife was drawn forth was quickly allayed.*
The English translation includes a frontispiece that shows the remarkable size of the knife and the incision from which it was removed.
It would be reasonable to expect some pretty major complications to follow an operation of such gravity, performed two hundred years before the mechanisms of infection were understood. But this patient enjoyed a near-miraculous recovery. The surgeon cleaned the external wound and then stitched it with five sutures; “tepid balsam” was poured on it before a dressing of clay, egg white and alum was applied.
The following day, he was well enough to eat chicken broth, “boiled with bitter and astringent herbs,” which doesn’t sound like the sort of thing I’d want to eat straight after a stomach operation. After a week, his doctors declared him out of danger, and he was given rhubarb to aid his digestion.
The same treatment and dressing were continued until the 23rd of July, which was the 14th day after the operation, when the wound had healed, and nothing occurred afterwards worthy of notice. He was restored to the best of health, gradually returned to his ordinary diet and employment, and never afterwards complained of pains in his stomach.
And the knife? It was a fearsome object, described in a later article in the Philosophical Transactions as being six and a half inches long. The author of that article, Dr. Oliver, met a Scottish merchant living in Königsberg, who told him
that Andrew Grünbeide was his particular friend and acquaintance; that he saw his wound several times when his surgeons dressed him, and was godfather to one or two of his children after his recovery.
It’s an amazing story, and a historic operation: Gastric surgery would remain a rare and risky undertaking until the twentieth century. For many years, the knife removed from the “drunken Dutchman’s guts” was kept in a velvet bag in the king of Prussia’s library—but the current whereabouts of this prize exhibit are, alas, unknown.
IF YOU CAN’T FIND A SURGEON . . .
. . . employ a butcher. That, at least, is the advice implied by this unusual eighteenth-century case from rural Ireland.
The village of Clogher in County Tyrone, Northern Ireland, is a bit of an oddity. Although it has never been much more than a hamlet, with barely five hundred residents even today, it also possesses a cathedral—one of the smallest settlements in the British Isles to do so. Between 1737 and 1743, the Dean of Clogher was John Copping, a keen amateur scientist who had been elected a Fellow of the Royal Society. In 1739, the society’s journal, the Philosophical Transactions, published a pair of letters from the reverend gentleman. The first contains a story he’d been told by a young clergyman in the same diocese, who had briefly studied medicine and knew a little about it:
Sarah McKinna, who now lives at Brentram, two miles from the city of Clogher, in the county of Tyrone, was married at the age of sixteen years. Before her marriage she never had the appearance peculiar to women; but, in a month after her marriage, those appearances showed themselves properly.
A delicate way of saying that she had gone through puberty unusually late.
Ten months after her marriage, she found the symptoms of pregnancy, and bore a child at the expiration of the usual time. Ten months after, she was delivered of another; and each time had a speedy and easy delivery. Two months after her second lying-in, symptoms of pregnancy appeared again, and increased in proportion to the time; but at the end of nine months those symptoms began to dwindle, and in a little time she had no other reason for thinking she was with child, but an absolute stoppage of her catamenia.
She had stopped menstruating—and this symptom persisted for another six years, together with mysterious abdominal pains. And then a “swelling in her belly” led her to believe that she might once again be pregnant:
About seven months after this uncertain account, a boil, as she thought, appeared about an inch and a half higher than her navel. It was attended with very great pain. She sent for one Turlogh O’Neill, a butcher, who then did, and does now live with Capt. George Gledhames, about a mile from Clogher.
Why she sent for a butcher rather than a doctor is not explained. However, Mr. O’Neill duly arrived a few days later and found her “in an expir
ing condition”:
By this time the impostumation* had broken, and an elbow of the child had forced itself through it, and appeared in view. At the request of herself and friends, he undertook to administer relief to her, and made so large an incision above and below the navel, as enabled him, by fixing his fingers under the jaw of the foetus, to extract it; in which operation he met not with the least impediment.
Although it isn’t spelled out, the implication here is that the fetus had already died. That was bad enough; but far worse was to come. Brace yourself.
He afterwards looked into her belly, and seeing something black, he put in his hand, and extracted, by pieces, a perfect skeleton of a child, and several pieces of black putrefied flesh. After the operation, he swathed* her up; and in six weeks she pursued her domestic business. She has been in good health ever since this wonderful accident happened; only she has a navel rupture, owing to the ignorance of the man in not applying a proper bandage.
The “navel rupture” was an umbilical hernia: The incision had weakened the muscles of the abdominal wall, allowing a portion of the intestines to bulge through them. It’s a strange tale, and one leaving many questions unanswered. Dean Copping was not one to trust hearsay, and at the first opportunity, he went to visit the woman and her husband to hear their own version of events. But his interview with the couple did not provide complete enlightenment.
They are so ignorant that, with their bad language, I could not make myself quite master of what they said; but, if they speak true, there is something more surprising than the former account mentioned.
The Mystery of the Exploding Teeth and Other Curiosities From the History of Medicine Page 12