Category Archives: Surgery

John Arderne, Butt Of No Jokes

Written in Medicine and Science, Surgery, W&M Contributors
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By Marri Lynn (W&M Regular Contributor)

You don't want to know where these are going to go. - Sp Coll MS Hunter 251 (U.4.9), 15th century.

 

When one thinks of the gruesome injuries that could befall a knight in service, one usually thinks of crushed skulls, arrows through the ribs, and unfortunate liaisons between necks and the pointy ends of spears.

John Arderne, a fourteenth-century English surgeon, acquired plenty of experience dealing with these textbook wounds during his service in the Hundred Years War. But he also acquired a particular expertise in treating another knightly occupational hazard which was as uncomfortable for one’s pride as it was for one’s backside. If the infection down south went south metaphorically, the condition could also prove fatal.

John was the first practitioner specializing in the treatment of fistula in ano, which is, unfortunately, precisely what you’d imagine. John’s skills provided many patients from all walks of life, not just knights, with long-term relief. Like modern blue-collar workers stuck behind desks all day while habitually consuming high-fat, low-fiber diets, medieval business folk, scholars, and priests suffered too, and comprised a great portion of John’s patient list. Through prolific operations, many of which were pro bono, John earned himself a reputation in addition to a considerable salary, one gained chiefly through the bills he presented the wealthier patients who paid more dearly on John’s sliding scale.

In modern parlance, fistula in ano is an ischio-rectal abscess in the anal glands, produced by a handful of factors compounded by long hours in a saddle or a chair. It can lead to perforation of the connective tissue between the anal canal and the body’s exterior. When this happens, a passageway is formed which opens up through the perianal skin, suppurating and inviting infection. The social and medical complications caused by a fistula’s tunnel-like annexation of the human sewer system are fairly apparent, but despite this, the condition was under-treated in John’s time.

Surgeons since at least Albucasis in the eleventh century were equipped with the necessary medical and surgical theory required to treat fistulae, but they were understandably loathe to handle the long line of unfortunates seeking relief. The job was frankly inglorious, messy, and it was usually futile as well. Despite the best professionally-advised caustic ointments and prayers in addition to the use of the blade, fistulae and attendant infections had a tendency to return with a vengeance after being improperly excised. In the context of a battle for professional legitimacy, fourteenth-century English surgeons facing little promise of adequate remuneration from their clientele alongside further risk of losing good standing in the community for appearing incompetent typically chose to avoid these cases whenever possible.

John Arderne’s unusual success in treating fistulae became a selling point for his services, and a catapult for his career. By avoiding the use of caustics in his surgical aftercare and by carefully attending and learning from his successive operational experiences, John obtained – and liberally advertised – a high surgical success rate. His skill, and his Latin, enabled him to join a select group of surgeons in England who could call themselves Magister, obtaining within the Guild of Surgeons a professional and social rank which was still below the physician, but adequately above that of the mere barber-surgeon.

In his writings, John leaves the sense of a man who is far from the character one might expect necessary to hedge one’s reputation on backsides and their ills. Well-traveled, shrewd, and educated through his experiences more than through dusty halls, John’s style was emulated and his name repeated by subsequent writers like the Cambridge physician Johannis Argentin. Hardly a one-trick pony, when he wasn’t building on surgical techniques and improving the quality of life for fistulae sufferers, John practiced pharmacy, and has left behind evidence of a considerable knowledge of herbs and their applications. Indeed, following his death in the late fourteenth century, his name carried on more commonly in connection with this less pun-worthy pursuit.

Fortunately for his patients suffering from fistulae and the surgical correction thereof, John also devised and employed an analgesic ointment consisting of no less powerful stuff than hemlock, opium, and henbane.

If one so desires a more detailed account of the surgical treatment of fistula in ano (and who could resist), there is an English translation and reprint of John’s Treatises of Fistula In Ano: Haemorrhoids, and Clysters produced by Elibron Classics.

Marri Lynn holds an MA in the History of Medicine at McGill University, Montreal (2011). She is currently studying French, while freelancing as a writer and copy editor. You can find out more at her About.me page.

 

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Even Royal Molars Decay

Written in Medicine, Health and Society (Vanderbilt), Queens and Kings, Surgery
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By Lauren Renaud (Vanderbilt University)

A gleaming white smile represents youth and beauty. Today, pearly whites are achievable for many through regular visits to the dentist. However, in eighteenth century France, the dental field was just seceding from quackery. A new professional, the dentiste, was replacing local blacksmiths who remedied toothaches through extraction with bulky metal tools. Without dental hygienists and the knowledge that sugar leads to cavities, even French royalty couldn’t escape the blight of tooth decay.

The most visible of royal dental disasters afflicted French King Louis XIV. Ironically, the Sun King, known for visual extravagance, was toothless by age forty. Throughout the 1680’s Louis XIV experienced tooth decay probably catalyzed by his taste for candied fruits and sweetmeats. Although the decay necessitated numerous extractions, the royal surgeon refused to remove the king’s rotten molars because dentistry was considered a “mechanical” field. Instead, he summoned arracheurs de dents (itinerant tooth pullers) to perform the tasks.

The procedures progressed regularly until 1685, when one extraction merited mention in the Journal de santé [The Health Journal]. In this case, the extractor accidentally removed a large portion of the king’s jaw and palate in addition to the rotten tooth. The Sun King was left with a large hole in his mouth. After this incident, whenever the King took a drink, the beverage spouted out his nose in a fountain-like manner. A surgeon later cauterized the hole ending the embarrassment and the festering infection.

After experiencing the woes of tooth decay, Louis XIV appointed a specialist dental surgeon in 1712. Years later, Louis XV also grew concerned about tooth loss. He assigned an even greater importance to the dentistry by granting his personal dentiste, Jean-Francois Capperon, letters of ennoblement. This meant that, by royal decree, the dentiste was now a member of the nobility.

Tooth decay not only afflicted French commoners but also members of high society. For French royalty, who assigned utmost importance to their appearances, the services of the dentiste became necessary for preserving their smiles and the marriage potential of their children.

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Manly Menstruation?

Written in Lisa Smith, Medicine and Science, Medicine, Health and Society, Surgery
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By Lisa Smith (W&M Regular Contributor)

In 1780, physician M. Carrere wrote a letter to the French Royal Society of Medicine describing the unusual case of a twenty-five year old miller, Jacques Sola, who bled monthly from his right little finger. Sola became ill with dysentery and peripneumonia in 1764. The cause? Sola’s blood flow had been blocked when he stayed too long in the shadow of a windmill. Carrere cured Sola by bleeding him to re-start his ‘evacuation’.

Credit: Wellcome Library Images

Two years later Carrere treated Sola for a bloody cough, again caused by the suppression of Sola’s ordinary bleeding. Carrere had since moved away, but now wondered if Sola still had regular flows, or if there was ‘a fixed time for their cessation’ as in women.

Menstruation wasn’t understood as specifically connected to reproduction until the nineteenth century. It was one of many indications of female fertility, but all were tied to a woman’s overall health. In the Middle Ages, menstruation was seen as poisonous, but eighteenth-century physicians saw it as nature’s way of purging women’s surplus blood (plethora) that developed throughout the month. When normal menstruation stopped, whether by pregnancy, fright or emotional imbalance, the blood might force atypical routes out of the body. Unrelieved plethora clogged up the body, causing disease.

Since men sweat, they didn’t ordinarily develop plethora, although men who were sedentary or ate too much might – like scholars and clergymen. Some plethoric men bled periodically and regularly: by the nose (adolescence), lungs (young men), haemorrhoids (middle-age) and urine (old age). Men and women whose bodies didn’t self-regulate needed surgical bleeding to prevent or cure illness.

Physicians and surgeons in seventeenth- and eighteenth-century Europe widely discussed similar cases of ‘menstruating men’. The sexed bodies that we see today as being self-evident were ambiguously understood in the past when knowledge was observational: why wouldn’t men and women have similar flows?

But throughout the eighteenth century such tales were increasingly rare as medical men began to see male and female bodies as distinct rather than parallel.

Lisa Smith is an Associate Professor of History at the University of Saskatchewan. She writes on gender, family, and health care in England and France (ca. 1600-1800).

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Drinking Blood and Eating Flesh: Corpse Medicine in Early Modern England

Written in Lindsey Fitzharris, Medicine and Science, Medicine, Health and Society, Surgery
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By Lindsey Fitzharris (W&M Contributor)


In order to restore youth to an aging body, the fifteenth-century practitioner, Marsilio Ficino, advised:

There is a common and ancient opinion that certain prophetic women who are popularly called ‘screech-owls’ suck the blood of infants as a means, insofar as they can, of growing young again. Why shouldn’t our old people, namely those who have no [other] recourse, likewise suck the blood of a youth? — a youth, I say who is willing, healthy, happy and temperate, whose blood is of the best but perhaps too abundant. They will suck, therefore, like leeches, an ounce or two from a scarcely- opened vein of the left arm; they will immediately take an equal amount of sugar and wine; they will do this when hungry and thirsty and when the moon is waxing. If they have difficulty digesting raw blood, let it first be cooked together with sugar; or let it be mixed with sugar and moderately distilled over hot water and then drunk. [1]

At first glance, cannibalistic medical practices such as this seem far removed from our own culture. However, the utilization of body parts for medicinal purposes still persists today, albeit in different forms. Although blood transfusions or organ transplantation may seem dramatically different than drinking the blood or eating the flesh of another human being, these medical practices do share a common belief in the body as an instrument of healing.

Blood, in particular, featured prominently in the treatment of the sick during the early modern period as it was central to the Galenic model of health which was dependent on a balance of the body’s four humors (blood, phlegm, black bile and yellow bile). The image of a patient being bled—his sleeve rolled up, blood pouring from an opened vein into a bowl placed below his elbow—is one which is familiar to us. Less familiar, however, is the image of epileptic patients crowded around the scaffold, cups in hand, waiting to “quaff the red blood as it flows from the still quavering body” of a freshly executed criminal. [2] Thus, blood could be both contaminating in its excess and restorative in its replenishment.

The surgeon’s association with blood contributed to the duality of his image during the early modern period. Like blood, he had both the power to heal and the power to harm. [3] Not only would the surgeon come into contact with blood through surgical procedures, but he might also taste a person’s blood in order to test its consistency when attempting to diagnosis his patient.

Medicinal cannibalism existed in other forms as well. One of the most common human substances used by apothecaries during the early modern period was mummy, a “medicinal preparation of the remains of an embalmed, dried, or otherwise ‘prepared’ body that had ideally met with sudden, preferably violent death.”  [4] Sometimes referred to as “the menstruation of the dead,” this remedy was recommended to patients as late as 1747. In The Marrow of Physick (1669), Thomas Brugis wrote:

A Mans Skull that hath been dead but one yeare, bury it in the Ashes behinde the fire, and let it burne untill it be very white, and easie to be broken with your finger; then take off all the uppermost part of the Head to the top of the Crowne, and beat it as small as is possible; then grate a Nutmeg, and put to it, and the blood of a Dog dryed, and powdered; mingle them all together, and give the sick to drinke, first and last, both when he is sick, and also when he is well, the quantity of halfe a Dram at a time in white Wine. [5]

Although the sixteenth-century surgeon, Ambrose Paré, noted that mummy (or mumia as it was sometimes known) was “the very first and last medicine of almost all our practitioners” against bruising, the substance did not come cheap. In 1678, a pound of mummy could cost as much as 5s 4d. [6] Thus, many apothecaries substituted mummy with cheap imitations that typically came from the corpses of beggars, lepers and plague victims.

As popular as “corpse medicine” was during the early modern period, this does not mean it was not without its critics, many of whom described these remedies as cannibalistic and unnatural. By the late eighteenth century, practitioners had stopped prescribing “three drams of [crushed] human skull” for epilepsy, or “two ounces of mummy in a plaster against ruptures.”  [7] However, the concept of the body as an instrument of healing continued to persist, and indeed, still exists today albeit in a much more dehumanised (mechanised) form.

1. Marsilio Ficino, De Vita II (1489), 11: 196-199. Translated by Sergius Kodera.

2. Mabel Peacock, ‘Executed Criminals and Folk Medicine’, Folklore 7 (1896), p. 274.

3. P. Kenneth Himmelmann, ‘The Medicinal Body: An Analysis of Medicinal Cannibalism in Europe, 1300-1700’, Anthropology 22 (1997), pp. 192.

4. Karen Gordon-Grube, ‘Anthropophagy in Post-Renaissance Europe: The Tradition of Medicinal Cannibalism’, American Anthropologist, 90 (1988), p. 406.

5. Thomas Brugis, The Marrow of Physick (London, 1669), p. 65.

6. Richard Sugg, ‘“Good Physic but Bad Food”: Early Modern Attitudes to Medicinal Cannibalism and its Suppliers’, Social History of Medicine, 19:2 (2006), p. 227.

7. J. Quincy (ed.), The Dispensatory of the Royal College of Physicians (London, 1721), pp. 86, 221.

*This article originally appeared on The Chirurgeon’s Apprentice. 

About the author: Lindsey Fitzharris received her PhD in the History of Science, Medicine and Technology from the University of Oxford in 2009. She is currently a Wellcome Trust Research Fellow at Queen Mary, University of London. Her project focuses on aspects of 17th-century surgery. Read more gory stories on her website: http://thechirurgeonsapprentice.com. 

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Cutting for the Stone: the Case of Stephen Pollard

Written in Lindsey Fitzharris, Medicine and Science, Medicine, Health and Society, Surgery
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By Lindsey Fitzharris  (W&M Contributor)

If you visit the Gordon Museum at Guy’s Hospital in London, you will see a small bladder stone—no bigger than 3 centimetres across.  Besides the fact that it has been sliced open to reveal concentric circles within, it is entirely unremarkable in appearance. Yet, this tiny stone was the source of enormous pain for 53-year-old Stephen Pollard, who agreed to undergo surgery to remove it in 1828.

Many people suffered from bladder stones during the early modern period. Depending on their size, these stones could block the flow of urine into the bladder from the kidneys; or, they could prevent the flow of urine out of the bladder through the urethra. Either situation was potentially lethal. In the first instance, the kidney is slowly destroyed by pressure from the urine; in the second instance, the bladder swells and eventually bursts, leading to infection and finally death.

Bladder stones were unimaginably painful for those who suffered from them during this period. Many acted in desperation, going to great lengths to rid themselves of the agony. In the early 18th century, one man reportedly drove a nail through his penis and then used a blacksmith’s hammer to break the stone apart until the pieces were small enough to pass through his urethra. [1]

It is not a surprise, then, that many sufferers chose to undergo surgery. Although the operation itself lasted only a matter of minutes, lithotomic procedures were painful, dangerous and humiliating. The patient—naked from the waist down—was bound in such a way as to ensure an unobstructed view of his genitals and anus [see illustration].  Afterwards, the surgeon passed a curved, metal tube up the patient’s penis and into the bladder. He then slid a finger into the man’s rectum, feeling for the stone. Once he had located it, his assistant removed the metal tube and replaced it with a wooden staff. This staff acted as a guide so that the surgeon did not fatally rupture the patient’s rectum or intestines as he began cutting deeper into the bladder.  Once the staff was in place, the surgeon cut diagonally through the fibrous muscle of the scrotum until he reached the wooden staff. Next, he used a probe to widen the hole, ripping open the prostrate gland in the process. At this point, the wooden staff was removed and the surgeon used forceps to extract the stone from the bladder.

Unfortunately for Stephen Pollard, what should have lasted 5 minutes ended up lasting 55 minutes under the gaze of 200 spectators. The surgeon, Bransby Cooper fumbled and panicked, cursing the patient loudly for having “a very deep perineum,” while the patient, in turn, cried: “Oh! let it go; —pray, let it keep in!’”

When Thomas Wakley heard of this medical disaster, he railed against Cooper in The Lancet, accusing him of incompetence and implying he had only been appointed surgeon to Guy’s Hospital because he was the nephew of the well-known surgeon, Sir Astley Cooper. Later, Cooper sued Wakley for libel. The judge reluctantly awarded him £100 in damages. [2]

But Cooper’s reputation, like his patient, never recovered. Sadly, Pollard survived the surgery only to die the next day. His autopsy revealed that it was indeed the skill of his surgeon, and not his alleged “abnormal anatomy,” which was the cause of his death.

1. Druin Burch, Digging up the Dead: Uncovering the Life and Times of an Extraordinary Surgeon (2007), p. 26.
2. Thomas Wakley, A Report of the Trial of Cooper v. Wakley (1829), pp. 4-5.

About the author: Lindsey Fitzharris received her PhD in the History of Science, Medicine and Technology from the University of Oxford in 2009. She is currently a Wellcome Trust Research Fellow at Queen Mary, University of London. Her project focuses on aspects of 17th-century surgery. Read more gory stories on her website: http://thechirurgeonsapprentice.com. 

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Lobotomies and Stomach Surgery

Written in Surgery
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By Randi Hutter Epstein

The LobotomistRecently, I came across a few newspaper articles about the stomach-constricting band to cure obesity. At the same time, I was immersed in a book about lobotomies to cure insanity. Sure, one is news and the other is history, but I couldn’t help but see the parallels. Not about being obese and insane, but about cowboy medicine and about lowering the threshold for treatment.

First the history: Jack El-Hai’s The Lobotomist (Wiley: 2007) is a titillating tale of Dr. William Freeman, the neurologist who promoted lobotomies in the middle years of the 20th century. Simply put, he and his colleagues scooped out bits of brain with something that seems to resemble a metal straw. The idea was to cut off dysfunctional brain connections.

The book is not simply one man’s crusade but a wonderful read about the growth of neurology and psychiatry. Freeman was a persevering, clever doctor who truly believed that he would revamp the treatment of the mentally ill, who all too often languished in mental hospitals. (He also wanted to make a name for himself.) His most outrageous procedure (I don’t want to give all the crazy experiments away) was outpatient brain surgery – he would knock patients out with electroshock therapy and then, as Freeman put it, cure them by “thrusting an icepick between the eyeball and eyelid through the roof of the orbit.”

The guy wanted to surgically fix personality defects, anxiety, and schizophrenia kind of like the way we are trying to fix obesity (caused by faulty genes, or overeating, or whatever) by a surgically implanted corset. According to the New York Times, the FDA panel voted to “expanded” use of a stomach-restricting device. (pun intended, presumably.) Allergen’s Lap-band used to be limited to the morbidly obese but now it’s going to be for fat people, too. This could double the number of folks who opt of surgery and spend the rest of their lives vomiting when they over-eat. (And truly expand Allergen’s revenue.)

Finding more people who need treatment – or widening the scope of illness – is always a good way to broaden the patient population, whether it be labeling more anxious folks as insane or the overweight as obese.

I couldn’t help think while I was reading about both stories that it’s easy to poke fun of strange quick-fixes of yesteryear, but we just can’t see the absurdity about 21st century remedies. Perhaps today’s young medical historians should be saving these stomach-band stories for a book they’ll write in their retirement about the silly things we did in the early years of the 2000s.

About the author: Randi Hutter Epstein, MD is a medical writer and adjunct professor at The Graduate School of Journalism, Columbia University. She is also the managing editor of the Yale Journal for Humanities in Medicine. Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank is her first book.

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