These communication problems are immediately apparent in Copping’s narrative, since its chronology is wildly at odds with the original version. The woman now told him that she had been married not for ten months, but for ten years, before first falling pregnant. She had gone into labor at the expected time, but the contractions ceased, the abdominal swelling disappeared and the midwife concluded that it was a “phantom” pregnancy—there had never been a fetus. Seven years later, Sarah McKinna conceived again, and prayed that this time she would deliver a healthy child without any alarms. But then, as she explained to Dean Copping, things went terribly wrong:
There was a swelling in her navel about the bigness of a goose-egg, which broke in a small orifice, of itself, and discharged a watery humour. She had a midwife, and three or four physicians, who gave her over, and left her as a dying woman. From this orifice started the elbow of a child, which hung some days by the skin, visible to abundance: at length she cut it off for her own relief.
Imagine the sort of state you’d have to be in to do such a thing.
When O’Neill came she begged him to help her. The man was frightened, and went to sleep; but, when he got up, gave her a large draught of sack, and, I suppose, took one himself . . .
Sack is a fortified white wine from Spain.* In the rural Ireland of the 1730s, a “large draught of sack” was the closest available thing to an anesthetic and therefore the only viable way of mitigating the pain. Having administered this dose, the butcher
. . . opened the place, and made such a hole as the man describes to be as large as his hat.
A vivid comparison, but not one you’d expect to read in a medical paper.
He put in his hand, took hold of the second bone of the child, and, pulling it backward and forward to loosen it, in a little time extracted the child. After this, looking into the hole, and seeing something black, he put in his hand, and extracted other bones. Some bones still remained, which were extracted at different times, it seems too in different ways; for some came by the navel, others from the womb the natural way.
Dean Copping explains that these body parts continued to emerge from the poor woman’s body over a period of six months, from July to Christmas.
She had great pain at each time. The former account says, she pursued her domestic business: she might be about the house, but she was fifteen months confined to the house. I have examined the rupture, and can put a finger a pretty way up into the body. Mr Dobbs, I hear, an eminent surgeon at Dublin, thinks there may be relief, and that the rupture may be much helped, and the guts reduced. I question whether he will think so, when he sees her.
A laconic remark that implies she was in a very bad way. Dean Copping was a kindly man and was determined to do something to help.
I have collected about four pounds for her among the Gentlemen that visit my Lord Bishop, shall buy her some clothes, and send her to Dublin about ten days hence, to the infirmary. She was fond of going, but her ignorant priest, and some other ignorant neighbours, told her they would keep her till she dies.
Nothing like a bit of moral support, eh? Eventually, the woman and her husband were persuaded otherwise.
But, upon my answering those difficulties, she consents to go; her husband will carry her, and they are so thankful to me for entering so much into their condition that they now say she shall go to London, or wherever I please.
Sadly, there is no word as to what happened to the woman after her removal to Dublin; at this date, any further surgical intervention might easily have killed her. In rural areas, where surgeons were scarce and few could afford them, butchers must on occasion have been pressed into service instead—and being able to dismember a cow or pig would be a useful skill if you were suddenly asked to turn your hand to an amputation. But examples of butchers pursuing such extracurricular activities are thankfully rare in the medical literature.
THE SELF-INFLICTED LITHOTRIPSY
In 1961, a Russian scientist working at a remote base in the Antarctic fell seriously ill with an infected appendix. The weather was treacherous and there was no possibility of evacuation, so Leonid Rogozov knew that the only option was for the team’s medical officer to perform an appendectomy. Unfortunately, he was the medical officer, the one person within a thousand miles capable of doing such a thing. So, aided by his colleagues and a little local anesthetic, Rogozov became the first surgeon to take out his own appendix.
Rogozov’s auto-appendectomy is the best-known case of self-surgery on record, but it’s far from unique. A less bloody, but far more prolonged, example took place in India in the eighteenth century. The patient (and surgeon) was Claude Martin, a French-born colonel in the service of the British East India Company. As well as enjoying a successful military career, he also worked as a cartographer, architect and administrator, becoming the richest European in India. He also constructed—and flew—the first hot-air balloon in India. A polymath and voracious reader, Martin bequeathed much of his fortune to good causes, including the foundation of three schools that still exist today.
In 1782, Martin developed the symptoms of a bladder stone, and realized that unless he did something about it, he would have to undergo surgery. This operation, known as lithotomy, is one of the oldest in all the surgical canon. It would entail making an incision into the bladder and extracting the stone, a concretion of minerals from the urine. Ancient Indian and Greek doctors described the procedure in some detail, and until 150 years ago, it was of course conducted without anesthetic. It was dangerous and notoriously painful, and Colonel Martin was understandably reluctant to put himself through the experience—so he decided to deal with the problem himself. In 1799, he wrote a letter, subsequently published in a medical journal, explaining how he had taken matters into his own hands:
I have been so fortunate as to cure myself of the stone; which cure was, and must certainly appear very extraordinary to those who do not know how I accomplished it.
Colonel Martin’s method involved inserting an instrument into his penis and up the urethra until it reached his bladder, and then filing the stone away, bit by bit. The file he used was one of his own making, consisting of a knitting needle set in a whalebone handle.
I began to file the stone in the bladder in April 1782, and as appears by a note I received from Doctor Rennet Murchison who was at this place as surgeon to the Resident, it soon made an impression upon the stone, and brought away many small pieces which are in my possession.
The plucky colonel sent one of these fragments to Dr. Murchison for his inspection. The doctor replied:
“Dear Martin, I have examined the stone with a good microscope; it seems to have a solid shell on the external part, but is internally of a loose texture. From this appearance I fancy your mechanical plan has had some effect; but, my dear friend, do not suffer yourself to be so sanguine in your hopes, as to use your file too often, for an inflammation in the bladder might now prove fatal; however, as the internal texture of the stone is loose, and as you have broken the hard surface on the outside, I have no doubt but you may get a great deal of it away, by the cautious use of your instrument.”
What had he started? Dr. Murchison strongly disapproved of Colonel Martin’s plan; but the intrepid Frenchman was not to be deterred.
This good man, Doctor Murchison, endeavoured to dissuade me from going on, but as I found daily the good effect of my filing, and never suffered particular pain in doing it, I persevered till the middle of October of the same year, and I think I filed, on an average, at the rate of at least three times in the twenty-four hours.
Yes, that’s right: Three times a day he voluntarily inserted a knitting needle up his own urethra and had a good scrape. If that doesn’t make you wince, I don’t know what would.
I was at first puzzled how to bring the stone to the neck of the bladder, but I contrived to inject warm water into the bladder, which, endeavouring to discharge, it protruded the stone to its n
eck; I then introduced my file between the flesh and the stone, keeping my body inclined against a wall all the time, till by a bad stroke I pushed the stone from the neck of the bladder.
Was this really better than undergoing a painful ten-minute operation?
Fear of inflammation I had none; for it once happened that a spasm of the whole urethra fixed my file so firmly that I could not move it. This spasm lasted about ten minutes, and, when relaxed, a great deal of blood came away, and also many small pieces of the stone. In a couple of days, I could renew my filing without any pain, which convinced me that there was no fear of inflammation, and such spasms happened often without any bad consequence.
So that’s all right, then.
I am convinced that all persons may cure themselves, as it requires very little address. I do not think it possible for another to operate, as none but the patient can know where it pains him, and he will naturally know, when and how he can introduce the file, as he cannot do it to any purpose, but when the stone is at or near the neck of the bladder. The file being so very small (not thicker than a straw), is easily introduced between the fleshy part and the stone, and the motion in filing does not extend beyond the length of about half an inch.
Colonel Martin evidently had great confidence in the procedure he had invented, but I must say I’m a long way from being convinced. He then explains that he had previously been given conventional treatments (mainly emetics and laxatives) by Dr. Murchison, which had only made him sicker. The complaint was so painful that the colonel had had to give up eating anything containing salt or spices.
My food was nothing else but boiled or roasted meat, and water for my drink, taking care to keep my body open by gentle laxatives. But, as soon as the urine became clear, my stomach began to be better, and I grew more easy, and more regular in filing the stone, which I did very often in the day and night, sometimes ten or twelve times in the day, and passed almost every day small pieces, till the whole came away: and, as I said above, I have been very well since; never had any pain, or return of stone or gravel till very lately.
The article concludes with a letter from Warren Hastings, a friend of Martin’s and the most senior British administrator in India during this period (he was famously accused of corruption, put on trial and acquitted by Parliament). Hastings writes:
I return you many thanks for the perusal of Colonel Martin’s curious letter; for curious and interesting it is, even to me, who well remember all the particulars of his case, as he has detailed it to you, and even the language in which he has delivered them. I mentioned the fact once to Mr Pott, who evidently shewed, by his looks and silence, that he did not believe it.
Percivall Pott was one of the leading surgeons of the day, best known for noticing that chimney sweeps were particularly prone to scrotal carcinoma—the first occupational cancer ever identified. His disbelief is understandable, since Colonel Martin was breaking new surgical ground. Until the 1820s, the only effective treatment for a patient with bladder stones was lithotomy, which involved extracting the object through an incision, with all the concomitant risks. But in the first half of the nineteenth century, several experts developed methods of drilling, grinding or crushing stones using instruments inserted through the urethra, avoiding open surgery entirely. The first such operation, which became known as lithotripsy, was performed in 1824 by the French surgeon Jean Civiale. Colonel Martin anticipated this breakthrough by forty years—and, not content with being the pioneering surgeon, he also volunteered to be his own first patient. And why not?
A HIGH PAIN THRESHOLD
In the late 1870s, an elderly retired surgeon from Birmingham, Dickinson Webster Crompton, was persuaded to write a short memoir. The friend who suggested it, a lecturer at Guy’s Hospital in London, had been fascinated by his older colleague’s tales about the operating theater of half a century earlier and thought they should be preserved for posterity. Crompton studied in London, Bonn and Paris, where his teachers had included Guillaume Dupuytren, the doyen of French surgery. But after completing his training, he returned to Birmingham, the city of his birth, where he pursued a happy and successful career until his retirement. By the age of seventy-three, he was almost completely blind, telling his friend that
I am now getting cataracts in my eyes, and at the present moment do not see what my hand writes, but hope it forms the words my mind would dictate.
In 1878, Crompton’s “Reminiscences of Provincial Surgery” was published in Guy’s Hospital Reports, the institution’s house journal. It provides a vivid account of early-nineteenth-century medical life in the West Midlands.
Crompton was in his forties when chloroform and ether first made their appearance, and he records the novelty of operating on a patient who was unconscious and unable to feel pain. But in the early part of his career, no such luxuries existed, and most of the operations he narrates took place without the benefit of anesthetics. They include this startling case of a double leg amputation:
A man of intemperate habits, living at Tamworth, lay drunk during a frosty night with his feet in a puddle by the railway. His feet were frozen in the morning, and eventually sloughed off, the integument closing in a conical form, leaving the extremities of the tibia and fibula exposed and carious.
Carious means “decaying.” There’s something shockingly casual about the statement that “his feet . . . eventually sloughed off,” as if it were a snake losing its skin.
I heard of the case, and recommended him to be brought to the Birmingham General Hospital. When I saw the case I was astonished at the wonderful effort of nature towards cure. If the bones could have borne ferules like a walking-stick, being placed on them, the man would have been able to walk as well or better than on wooden legs.
Now, that would have been a sight worth seeing.
However, that could not be, so the man and I agreed that I should amputate the legs at the usual place, leaving him good stumps and the knees, whereupon to place the common wooden leg. I removed one first, the man sitting on the table and holding the thigh himself and looking on. Not a sound escaped him, but, when done, he said, “By gam! It is sharp.”
By which, it seems, he was describing the keenness of the saw blade rather than the pain.
After three weeks’ time I removed the other leg in the same manner, except that the man thought the saw did not cut well.
A real connoisseur!
When he was nearly ready to leave his bed he again took me into his consultation as to the inconvenience of the length of the common wooden leg, and asked to have them made only nine inches long, as then, “when he had grog aboard,” he should not have so far to fall!
A very practical sentiment.
He lived years after, and was well known as a tramp, I think.
Dickinson Crompton follows that anecdote with one about a patient who showed even more impressive stoicism:
Some years ago I was called in the night to go to Meriden to an accident, prepared to amputate. I found a poor labourer lying on his cottage bed, his left arm hanging over the edge of the bed, dropping blood into a chamber-pot. A tourniquet was tightly placed just below the shoulder-joint; the arm was black, as if already mortified. I heard that the man’s arm had been caught in the cog-wheel of one of the agricultural machines, and was drawn in up to the shoulder.
In the circumstances, there was no alternative but to amputate the mangled limb, as close to the shoulder joint as possible.
There was no room for a tourniquet; and I requested Mr Clark, the surgeon of the village, to press upon the artery against the head of the bone.
The artery in question is the axillary, a major vessel that supplies the arm. Usual practice during amputation was to use a tourniquet to prevent major bleeding; on this occasion, there was no room for one, so instead, they were forced to compress the artery with a finger. Once the limb had been cut off, it would be permanently tied shut.
There was a boy in the room, an apprentice, I was told, but he declined to come near the patient to hold out the arm. I was therefore obliged to hold the artery against the head of the bone with my left hand, while Mr Clark held the arm out at full length by the hand; but he told me he always “fainted at the sight of blood”, so turning his face and body away as far as possible, he held on till I had made my incision and sawn through the bone as high as I could.
You’d think that fainting at the sight of blood might be a significant handicap to being an early-nineteenth-century surgeon, but apparently not.
There was only a cottage candle in the room, and therefore I asked Mr Clark to hold it, so that I could look for the arteries, but he had had enough. The poor patient was sitting on a chair making no complaint; in fact I think there could not have been much pain felt, from the appearance of the parts, so he himself said, “Sir, if you will give me the candle, I think I can hold it”; this he did, bringing his right hand round with the candle in it, so that I had a good view of the face of the stump.
Holding a candle with one arm, so that a surgeon can see well enough to finish amputating the other, takes some courage.
The man recovered, but I heard he died of phthisis* six months afterwards; indeed, he was phthisical at the time of the operation.
Rotten luck.
A WINDOW IN HIS CHEST
Occasionally, a surgeon performs a feat so impressive that the operation becomes permanently associated with their name. In 1817, the English surgeon Sir Astley Cooper astonished his colleagues by tying a ligature around a patient’s abdominal aorta, the largest blood vessel in the abdomen. His patient (who was being treated for a large aneurysm in his groin) died, but the attempt was so widely admired for its audacity that for many years afterward, it was referred to simply as Sir Astley Cooper’s operation.
The Mystery of the Exploding Teeth and Other Curiosities From the History of Medicine Page 13
