A fishy business

Three extraordinary cases in surgeryIn 1739 a surgeon from the village of Kelvedon in Essex wrote to the Philosophical Transactions of the Royal Society to communicate ‘three extraordinary cases’ from his practice. The first and last are separated by over thirty years, which makes me suspect – perhaps unkindly – that not much of medical interest took place in Kelvedon in the first half of the eighteenth century.

Be that as it may, the last of the three cases is a corker:

John Spilman, bricklayer, of Maldon, came to me the 3rd of October 1734, having a sinuous ulcer in his rectum, about two inches from the anus.

A ‘sinuous’ ulcer is one that creates a sinus, a long narrow opening.  This can in turn produce a fistula – an anomalous channel – between two nearby cavities, for instance between the rectum and vagina. In an age before antibiotics sinuous ulcers were therefore potentially dangerous.

This had remained a twelvemonth, and was taken for the piles, and treated as such, both internally and externally. I soon perceived a tumour in his buttock, two or three inches from the anus, which coming to suppuration, I opened it by incision.

Having a suppurating cyst on my buttocks opened by an eighteenth-century surgeon isn’t high on my bucket list, I have to say.

After dressing it several weeks with little prospect of success, I discovered at the bottom of the ulcer something that looked like a bone, which when extracted, proved to be the lower jaw of a fish, as a whiting, or young cod, &c. And unquestionably this was swallowed at least a year before it came away, because the pricking pain he felt when the sharp end of the bone stuck in the rectum, was the symptom mistaken for the piles; and when this had made its way through the rectum, and got into the fleshy part, the aposthume followed in course…

‘Aposthume’, more usually spelled apostume or aposteme, is an archaic word for an abscess or a swelling filled with pus.

…and the bone being extracted, the ulcer was soon cicatrized [healed] by the common methods of cure in such cases.

The doctor seems to have taken it for granted that the fish-head was swallowed. There is, of course, another possible explanation for its location, and I’ve read enough journal articles to know that I’m not being unreasonably cynical to raise the idea. But let’s give Mr Spilman the benefit of the doubt.

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