An enormous concretion

At a meeting of the Pathological Society of London in 1855, members were shown a specimen that might have been better suited to a geological society rather than one devoted to the study of disease. The object in question, which looked like a lump of brick, had been supplied by Edward Lacy, a surgeon from Poole.  Mr Lacy was unable to attend, so the talk was given instead by Jonathan Hutchinson, a young surgeon who would later achieve great eminence in several fields. This case was not exactly of historical importance, but it was at least a curiosity:

an enormous concretion of iron and magnesia

A lady past middle age consulted Mr. Lacy in May, 1853, with the account that she had, for more than twelve years, suffered extremely from constipation, and most painful sensations in the lower bowel. Her appearance being thin and haggard, and the statement of her symptoms involving much that was unusual, an examination of the rectum was deemed necessary. On passing the finger into the bowel, a hard uneven substance was encountered, having somewhat the shape of a vase, and being at least fifteen inches in circumference.

Patients have an uncanny habit of sticking the most unsuitable objects inside themselves, so the doctor no doubt suspected that this foreign body actually was a vase.

Its exterior did not in the least resemble that of indurated [hardened] faeces, feeling, indeed, as hard as stone, and being rough, like an oyster shell. Very fortunately its interior was not so hard as the outside, otherwise its removal might have been impracticable. By the use of a pair of long polypus forceps, a hole was gradually made into its centre, and working outwards from this by degrees, the mass was broken down, and extracted piecemeal by means of a scoop.

If you’re thinking that this sounds a laborious process, you’re right.

Many sittings were, however, required before this result was obtained.

‘Sittings’ sounds like a rather more civilised process, like having one’s portrait painted. Which is no doubt what the patient told her friends about her regular appointments in town.

The patient ultimately recovered well, and remained afterwards quite free from her former symptoms.

But what was the strange object that had caused constipation for over a decade? The pathologists leapt into action.

The outer part of the concretion consisted of concentric layers of what looked like a red stone, and which proved, on examination, to be a compound of iron and magnesia. The interior was a softer mixture of the earthy and ferruginous matters with many thousands of strawberry and other seeds.

‘Ferruginous’ means ‘rust-coloured’, or in a more technical sense, ‘containing iron’.

The discovery explained some otherwise baffling symptoms. For many years the patient had been in great pain when standing, stopping or sitting, and was comfortable only when lying on her back. This was because the lower surface of the massive foreign object was lumpy, and its bumps and points dug into the inside surface of the anal sphincter if she was upright.

As to the cause of the concretion, it had, no doubt, resulted from the immoderate employment of medicines. Nearly thirty years ago the patient had been in the habit of taking carbonate of magnesia very frequently, and in large doses, for the relief of stomach irritation; and had also, about the same time, used the sesqui-oxide of iron very freely during attacks of tic doloureux. For twelve years past she had never taken either of the drugs named.

Tic douloureux – also known as trigeminal neuralgia – is a notoriously painful condition which can affect any part of the face between the jaw and the forehead. It’s generally believed to be caused by compression of the trigeminal nerve, causing stabbing, shooting pains which arise spontaneously and disappear as suddenly.

The medicine she was taking for this condition was ferric oxide, otherwise known as rust.  Carbonate of magnesia – magnesium carbonate – is a fairly innocuous white solid often used as an antacid, or added to table salt to prevent the granules from sticking together.

After spending some time puzzling over what might have happened to this unfortunate woman, I eventually came up with what seems (to me, at least) a half-plausible theory.

The human stomach contains hydrochloric acid, which reacts with magnesium carbonate to produce magnesium chloride. Both magnesium carbonate and magnesium chloride are used to make several types of cement, some of which are among the strongest available to the modern construction worker.

But that’s not all. Antacids such as magnesium carbonate also reduce the body’s ability to absorb iron. So large amounts of ferric oxide powder were passing straight through her gut unaltered.  It surely isn’t too much of a stretch to hypothesise that the magnesium and iron salts formed a sort of ‘cement’ inside her intestines, causing the large, hard object which had to be broken up two decades later.

As ever, if your knowledge of inorganic chemistry is superior to mine, please feel free to leave a comment below.

One thought on “An enormous concretion”

  1. A “bezoar” is a hardened concretion in the bowels that can occur over time with overconsumption of large amounts of plants like fibrous leaf vegetables and unripe fruits. Seems like a similar situation. The magnesia may have cemented the process (pun intended).

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