Sometimes a headline says it all. In June 1842 the London Medical Gazette printed a letter under this memorable title:
The case report that followed was submitted by a retired naval surgeon called Archibald Blacklock (previously featured on this blog, and best known as the man who crept into Robert Burns’s tomb one night in 1834 and took a plaster cast of the poet’s skull).
Blacklock explained that an article in the previous week’s edition had reminded him of a case that had taken place at the infirmary of the Royal Greenwich Hospital almost thirty years earlier.
The Greenwich Hospital was a home for retired seaman rather than a hospital in the modern sense – but, confusingly, it had an infirmary which offered medical treatment and surgery to sailors old and young. In 1814 the surgeon in charge of this institution was Bryant McLaughlan, the narrator of this immortal tale:
Philip Nelson, aged 49, a native of Brabant, who has lost one leg, and is employed in Deptford dockyard, came to the infirmary on the 20th of Oct., 1814, about noon.
Brabant is a region of the Netherlands, so Mr Nelson was some way from home. After arriving at the hospital, he revealed that…
…an immense plug of wood, which he had fitted and introduced into the anus for the purpose of stopping a looseness under which he then laboured, had been, by his accidentally and suddenly falling on the end of a stool, forced into the rectum eight days previous to his applying for relief, where it still remained.
By ‘looseness’ Mr Nelson meant, of course, diarrhoea. Inserting a plug of wood to treat the condition is somewhat unorthodox.
Incredible as this strange story appeared to us, it was found, on examination, to be literally true. I could barely reach it with the end of my forefinger, owing to the highly inflamed and tumefied state of the intestine, in which suppuration to a considerable extent had already taken place.
Inflammation, swelling and pus formation would certainly seem to indicate infection.
He said that a sense of shame prevented his earlier making known his wretched condition, although his sufferings were excessive.
The patient told his doctors that he felt a constant urge to defecate, although it was impossible to do so.
The whole abdomen was considerably enlarged, and felt knotty, evidently from the long-retained and indurated faeces, none of which, as may readily be inferred from the size of the plug, could have been passed per anum.
By ‘indurated’ the doctor means that the faeces had become hard and impacted – and therefore much more difficult to expel. Naturally, the medics’ first priority was to remove the obstruction.
After repeated and persevering trials for several hours with every variety of instrument which we could procure either in this neighbourhood or in London, I found our attempts worse than unavailing, inasmuch as they could not fail to aggravate the already highly irritable and painful state of the parts.
Frustrated to exasperation, the doctors decided eventually to use an instrument specially fabricated for this operation and never previously used at the hospital – a hefty pair of forceps. To ensure that it kept a firm grip on the wooden plug, the jaws could be secured by a powerful screw. Armed with this formidable item, the surgeons went to work the following morning, when…
…we happily succeeded therewith in extracting this tremendous remedy for diarrhoea, and in relieving the poor man from the most terrible sufferings.
This was by no means a straightforward undertaking.
The operation was painful, and required all the force I was capable of exerting with both hands, assisted by the counter-exertion of two of the medical gentlemen, for upwards of twenty minutes after the instrument was properly fixed upon the plug through the powerful agency of the screw. The man bore it, as well as our former unavailing and harassing attempts for his relief, with surprising fortitude.
A horrible experience for him, of course, but also a scene of high farce. One doctor was heaving with all his might on a massive pair of pliers stuck up the patient’s bottom, while two others pulled on his shoulders. Mr McLaughlan does not describe the moment when the plug finally emerged, but I like to imagine that it made a sound like a champagne cork.
The man was perfectly recovered on the 7th November, and discharged on that day to resume his usual employment in the dockyard.
The grateful patient thanked the doctors for relieving his distress. Mr McLaughlan was curious to know why on earth he had chosen to treat diarrhoea by this strange method. He was told…
…that it is quite a common practice in his native country, and the domestic remedy in similar complaints, to use a cork on the first attack; and that, for the most part, it proves an infallible cure.
The patient explained that he had not had a cork to hand on this occasion, so had been forced to improvise:
Falling in with the end of a spar in crossing the dock-yard, which he thought well suited to his purpose, he fitted it with a lanyard, which broke in his endeavour to pull it out after the accident.
The original report was accompanied by an engraving of the ‘immense plug’ and the special instrument used to extract it. Alas, the London Medical Gazette omitted it, and one must assume that this important illustration is tragically lost to posterity.