The persons who formed this Society were either such as had the care of hospitals, or were otherwise in some degree of repute in their profession; and consequently had frequent opportunities of making observations themselves, and of verifying, in the course of their practice, the discoveries of others.
One of the cases included in the first installment of the Medical Observations and Inquiries was this strange tale:
Elizabeth Orvin, born at St Gilain, of a healthy robust constitution, served the curate of that place for many years very faithfully, till the beginning of 1738, that she became very sullen, uneasy, and so surly, that the neighbours said she was losing her senses. Towards the month of August, she fell into an extraordinary sleep, which lasted four days; during which time, she took no manner of nourishment, neither was it possible to rouse her.
Mme. Orvin did eventually wake up, but for the next ten years, she routinely slept for seventeen hours a day, from 3 A.M. till 8 P.M., and was usually awake only at night. Dr. Brady visited her in February 1756, and found her fast asleep at five o’clock in the afternoon. She was as stiff as a board and could not be roused:
I put my mouth to her ear, and called as loud as I could, but could not wake her; and to be sure that there was no cheat in the matter, I thrust a pin through her skin and flesh to the bone.
Well, that escalated quickly.
I kept the flame of burning paper to her cheek till I burned the scarff skin,* and put volatile spirits and salts into her nose, and lastly, thrust a little linen dipped in rectified spirit of wine in her nostril, and kindled it for a moment: all this was done without my being able to observe the least change in her countenance, or signs of feeling.
Methods not—as far as I know—currently used by any reputable sleep clinic. Three hours later the woman awoke:
About eight, she turned in her bed, got up abruptly, and came to the fire. I asked her several questions, to which she gave surly answers. She was gloomy and sad, and repeated often, that she would rather be out of the world, than in such a state. I could get no satisfactory account from her, about her sickness; all that I could learn from her was, that she felt a heaviness in her head, which she knew to be the forerunner of her disorder, and which determined her to go to bed, where she lay without once turning, from the time she lay down till her sleep was over, and had, during that time, no sort of evacuation except by perspiration.
On occasions she slept for so long that she had to be fed (while still asleep) through a funnel. The local doctor told Dr. Brady about some of the enterprising, but barbaric, methods they had adopted in attempts to wake her up. These entailed her . . .
. . . being whipped till the blood ran down her shoulders, of her having her back rubbed with honey, and her being exposed in a hot day before a hive of bees, where she was stung to such a degree that her back and shoulders were full of little lumps or tumours. At other times, they thrust pins under her nails, together with some other odd experiments that I must pass over in silence, on account of their indecency.
The mind boggles. Even the mildest of these techniques arguably crosses the line separating therapy from abuse. Nevertheless, she remained, to all appearances, beyond the help of medicine.
This poor woman is now fifty-five years of age, of a pale colour, and not very lean. She never sees daylight, but sleeps out the longest day in summer; and, in winter, begins to sleep several hours before day, and does not awake till two or three hours after sunset.
This seems to have been an isolated case; but what’s interesting about the report is that the woman’s symptoms very much resemble those of Encephalitis lethargica, a mysterious illness that began to sweep across much of the globe at around the time of the First World War. Patients often fell into a deep sleep from which they could not be roused. When epidemiologists looked back through historical records, they found that several similar outbreaks had occurred in earlier centuries. Unexplained bouts of somnolence plagued the residents of Copenhagen in 1657, London in 1673, Germany in 1712 and France in 1776. What caused the illness is unknown, although it often seemed to accompany epidemics of influenza. We’ll never know what was wrong with the Sleepy Woman of Mons. But it’s just possible that she had an unusual variety of flu.
THE DREADFUL MORTIFICATION
A case published in the Philosophical Transactions in 1762 is a reminder of a world we have thankfully left behind: one in which disease could rapidly maim or kill entire families, while doctors looked on helplessly. Life was often, in the philosopher Thomas Hobbes’s phrase, “solitary, poor, nasty, brutish and short.” Hobbes was writing about war, but disease was as formidable an enemy as the eighteenth century could muster.
This report was written by Charlton Wollaston, a twenty-nine-year-old who had just been appointed physician to the queen’s household. His promising career was cut tragically short two years later when he died from a fever. His daughter Mary later attributed his death to blood poisoning contracted when “opening a mummy, he having previously by accident cut a finger.”
John Downing, a poor labouring man who lives at Wattisham, a small village about sixteen miles from Bury, in January last had a wife and six children; the eldest a girl of fifteen years of age, the youngest about four months. They were also at that time very healthy, as the man himself, and his neighbours, assured me. On Sunday 10th January, the eldest girl complained in the morning of a pain in her left leg; particularly in the calf of the leg. Towards evening the pain grew exceedingly violent. The same evening another girl, about ten years old, complained of the same violent pain in the leg. On the Monday the mother and another child, and on the Tuesday all the rest of the family, except the father, were affected in the same manner. The pain was exceedingly violent; insomuch, that the whole neighbourhood was alarmed with the loudness of their shrieks.
Chilling. This was a rapid, insidious and deeply unpleasant complaint. Dr. Wollaston visited the family and questioned them in detail about the progress of the disease.
In about four, five, or six days, the diseased leg began to grow less painful, and to turn black gradually; appearing at first covered with spots, as if it had been bruised. The other leg began to be affected, at that time, with the same excruciating pain, and in a few days that also began to mortify.
To “mortify” means to become gangrenous: The leg discolored and then went black as the tissue died.
The mortified parts separated, without assistance, from the sound parts, and the surgeon had in most of the cases no other trouble than to cut through the bone, with little or no pain to the patient.
The summary that follows is simply written, but brutal in its impact.
Mary, the mother, aged forty. The right foot off at the ankle; the left leg mortified, a mere bone; but not off.
Mary, aged fifteen. One leg off below the knee: the other perfectly sphacelated,* but not yet off.
Elizabeth, aged thirteen, both legs off below the knees.
Sarah, aged ten, one foot off at the ankle.
Robert, aged eight, both legs off below the knees.
Edward, aged four, both feet off at the ankles.
An infant four months old, dead.
Only the father escaped relatively unscathed: A couple of fingers became stiff and useless, but his lower extremities were not affected.
It is remarkable, that during all the time of this calamity, the whole family are said to have appeared in other respects well. They ate heartily, and slept well when the pain began to abate. When I saw them, they all seemed free from fever, except the girl, who has an abscess in her thigh. The mother looks emaciated, and has very little use of her hands. The rest of the family seemed well. One poor boy, in particular, looked as healthy and florid as possible, and was sitting on the bed, quite jolly, drumming with his stumps.
A poignant image that wouldn’t be out of place in a Dickens novel. Dr. Wollaston did his best to est
ablish the cause of this unusual complaint, but eventually had to admit defeat. A local clergyman with a bleakly appropriate name, the Reverend Mr. Bones, offered to make further inquiries. He questioned the family minutely about where they bought their food and drink, and even examined their cooking implements. But he, too, drew a blank:
I have taken all the pains I can to inform myself of every circumstance which may be deemed a probable cause of the disease, by which the poor family in my parish has been afflicted. But I fear I have discovered nothing that will be satisfactory to you.
John Downing himself attributed his family’s misfortune to witchcraft, a suggestion that the priest naturally discounted. Dr. Wollaston came closest to solving the problem when he made this observation:
The corn with which they made their bread was certainly very bad: it was wheat, that had been cut in a rainy season, and had lain on the ground till many of the grains were black and totally decayed; but many other poor families in the same village made use of the same corn without receiving any injury from it.
An editor at the Philosophical Transactions then made a connection that Dr. Wollaston had missed: Half a century earlier, a French surgeon had noticed something strikingly similar. In an article published in 1719, Monsieur Noël, a surgeon from Orléans, wrote that he . . .
. . . had received into the hospital more than fifty patients afflicted with a dry, black and livid gangrene which began at the toes, and advanced more or less, being sometimes continued even to the thigh.
This aroused great interest when M. Nöel presented his findings to the members of the French Royal Academy of Sciences.
The gentlemen of the academy were of opinion, that the disease was produced by bad nourishment, particularly by bread, in which there was a great quantity of ergot.
Hitting the nail right on the head. Ergot is grain that has been infected by a parasitic fungus, Claviceps purpurea. The tainted grain takes on a dark blue-black hue and contains toxic chemicals that are unaffected by heat, so baked foodstuffs such as bread are still dangerous to eat. The toxins can even be passed from mother to child via breast milk, which explains the death of John Downing’s infant son. Dr. Wollaston’s article is a classic description of the symptoms of gangrenous ergot poisoning.
In October 1762, six months after his first visit, Dr. Wollaston returned to John Downing’s house. He was pleased to find that John’s wife, Mary, was still alive:
In my former account . . . I mentioned that one of her feet had separated at the ankle, and that the other leg was perfectly sphacelated to within a few inches of the knee, but not then taken off. Some little time afterwards the husband broke off the tibia, which was quite decayed, about three inches below the knee: the fibula was not decayed, so the surgeon sawed it off.
Cases of ergotism are still encountered from time to time, but, thankfully, such scenes of horror are long gone.
THE HUMAN PINCUSHION
In 1825, a doctor from Copenhagen published a case so incredible that he felt it necessary to point out that thirty of his colleagues could corroborate the story. Dr. Otto’s article appeared originally in a German journal, but the editors of the Medico-Chirurgical Review then translated it for the benefit of an English-speaking audience:
Rachel Hertz had lived in the enjoyment of good health up to her fourteenth year; she was then of a fair complexion, and rather of the sanguineous temperament.
At this period many physicians still believed in four “temperaments,” or personality types. This was a relic of the ancient idea of the four humors, which had dominated medicine at least since the era of Hippocrates in the fourth century BC. According to humoral theory, disease was caused by imbalance among four bodily fluids, or humors (blood, phlegm, yellow bile and black bile). The “sanguineous” temperament was associated with an abundance of blood; one early-nineteenth-century doctor wrote that “people of this temperament are usually very strong, and all their functions are extremely active.”
In August 1807, she was seized with a violent attack of colic, which induced her to apply to Professor Hecholdt, and this was the first acquaintance which the Professor had with the case. From that time to March 1808 she experienced frequent attacks of erysipelas* and fever, which left her in a very debilitated state. Many symptoms of an hysterical character showed themselves, but which the ordinary remedies failed to remove. From March to May 1809, a period of fourteen months, she suffered in this way from repeated and violent hysteric attacks, accompanied with, or rather followed by, fainting, which sometimes continued so long that people considered her dead. Occasionally she was attacked with epileptic fits, at other times with drowsiness and hiccough, and sometimes with delirium.
The next development says a lot about the leisure habits of educated Danish teenagers in the early nineteenth century. I don’t suppose many modern patients are troubled by this symptom:
During the paroxysms of her madness, she delivered, with a loud voice and correct enunciation, long passages from the works of Goethe, Schiller, Shakespeare, and Oehlenschläger, just as accurately as any sane person could do, and although she kept her eyes closed, she accompanied the declamation with suitable gesticulations.
Another journal, in its report of this case, included “long fits of theatrical recitations from tragic poets” in its description. The association between Romantic literature and mental illness was quite genuine: After the publication of The Sorrows of Young Werther in 1774, young men started to dress like Goethe’s tragic hero and even emulate his melancholic behavior, causing such alarm at the possibility of copycat suicides that several countries banned the book. There is no suggestion, however, that this was what ailed poor Rachel Hertz:
The delirium continued to increase until it assumed a very alarming height; she gnashed her teeth, kicked about, and fought with whatever came in her reach, and disturbed with her ravings, not only her own household, but the whole neighbourhood.
The girl’s obvious mental distress was now compounded by physical ailments: Constipation and difficulty in urinating necessitated the daily use of a catheter. Most seriously, she began to vomit blood. The fits of mania began to retreat, and she sank into a stupor from which, apparently, nothing would rouse her.
In May 1809, Professor Collisen was consulted, who during the lethargic state of the patient recommended snuff to be pushed up her nostrils, the effect of which was so favourable that, without sneezing, she soon came to her senses. She complained of nothing during that day, and the snuff frequently produced equally good effects, for a time only. The delirium continued from May 1809 to December 1810, with little variation of importance, and then gradually subsided.
She remained in much better health for the next few years, apart from one brief relapse. Until January 1819, when
severe colic pains made their appearance, with fever, vomiting of blood, and purging of black faecal matter, from which it was considered impossible that she could recover—but recover she did. On examination of the abdomen, a large tumour was found, having three distinct elevations just below the umbilicus.
Soothing dressings were placed on this swelling, but to no avail. In desperation, Professor Hecholdt decided to open the tumor with the scalpel. And this is where things started to get really interesting.
It was expected that a copious discharge of pus would follow, but no pus came, and the bleeding was very slight. When the wound was examined with a probe, a curious sensation was communicated to the hand, just as if a metallic body had been thrust against the probe; this was repeated, a forceps was introduced, the substance was laid hold of, and, to his great astonishment, out came a needle. The extraction of this needle produced some alleviation of the sufferings of the patient, but it was of very short duration; great pain with vomiting of blood returned, another tumour appeared in the left lumbar region, the touching of which caused great uneasiness. On the 15th of February, an incision was made into it, and ano
ther black oxidised needle drawn out.
Similar lumps started to emerge all over the young woman’s body. Each time one appeared, the doctors cut it open, always with the same result:
From the 12th of February 1819, to the 10th of August 1820, a period of eighteen months, severe pains, followed by tumours, were felt in various parts of the body, from which two hundred and ninety-five needles were extracted, viz.—
From the left breast, 22; from the right breast, 14; from the epigastric region, 41; from the left hypochondriac region, 19; from the right hypochondriac region, 20; from the umbilicus, 31; from the left lumbar region, 39; from the right lumbar region, 17; from the hypogastric region, 14; from the right iliac region, 23; from the left iliac region, 27; from the left thigh, 3; from the right shoulder, 23; between the shoulders, 1; from under the left shoulder, 1.
Total—295.
Between August 1820 and March 1821, no further needles appeared; assuming his patient was cured, Professor Hecholdt wrote a pamphlet (in Latin, naturally) documenting the strange facts of the case. But this turned out to be premature:
A large tumour formed in the right axilla,* from which, between the 26th of May and the 10th of July, 1822, no less than one hundred needles were taken out! From the 1st of July, 1822, to the 10th of December, 1823, five needles were at different times extracted, making the total number of FOUR HUNDRED!!
The emphasis is in the original; the author could barely contain his excitement.
The patient has amused herself during her convalescence by learning Latin, and writing a journal of her own case. She is at present living at Frederick’s hospital, at Copenhagen, and enjoys good health.
Oddly, the article in the Medico-Chirurgical Review does not attempt to explain the emergence of several hundred needles from different parts of the patient’s body. Incredible as it may seem, the most likely explanation is that she had swallowed them. She probably had an eating disorder called pica, in which the patient compulsively ingests inedible objects such as soil or paper. Once inside the body, needles have a nasty habit of piercing the walls of the digestive tract and then migrating all over the body. This would explain the girl’s stomachaches, her vomiting of blood, and finally the dramatic appearance of rusty needles everywhere from her armpits to her thighs. Not until the era of punk would so many dodgy piercings again be seen on a single human body.
The Mystery of the Exploding Teeth and Other Curiosities From the History of Medicine Page 6
