If you can’t find a surgeon…

…employ a butcher. That, at least, is the advice implied by this unusual eighteenth-century case:Two letters from Dean CoppingThe hamlet of Clogher in Co Tyrone, Northern Ireland, is a bit of an oddity. Although it has barely 500 residents, it also possesses a cathedral – one of the smallest settlements in the British Isles to do so.  Between 1737 and 1743 the Dean of Clogher was one John Copping, a keen amateur scientist who had been elected a Fellow of the Royal Society. In 1739 the society’s Philosophical Transactions published a letter from the reverend gentleman – or, rather, two. The first contains a story he had heard from a young clergyman in the same diocese, who had briefly studied medicine and knew a little about it:

Sarah McKinna, who now lives at Brentram, two miles from the city of Clogher, in the county of Tyrone, was married at the age of sixteen years. Before her marriage she never had the appearance peculiar to women; but, in a month after her marriage, those appearances shewed themselves properly.

A delicate way of saying that she had gone through puberty unusually late.

Ten months after her marriage, she found the symptoms of pregnancy, and bore a child at the expiration of the usual time. Ten months after, she was delivered of another; and each time had a speedy and easy delivery. Two months after her second lying-in, symptoms of pregnancy appeared again, and increased in proportion to the time; but at the end of nine months those symptoms began to dwindle, and in a little time she had no other reason for thinking she was with child, but an absolute stoppage of her catamenia.

She had stopped menstruating – and this symptom persisted for another six years, together with mysterious abdominal pains. And then a ‘swelling in her belly’ led her to believe that she might once again be pregnant:

About seven months after this uncertain account, a boil, as she thought, appeared about an inch and an half higher than her navel. It was attended with very great pain. She sent for one Turlogh [Terence] O’Neill, a butcher, who then did, and does now live with Capt. George George Gledhames, about a mile from Clogher.

Why she sent for a butcher rather than a doctor is not explained. He arrived a few days later and found her ‘in an expiring condition’:

By this time the impostumation [abscess] had broken, and an elbow of the child had forced itself through it, and appeared in view. At the request of herself and friends, he undertook to administer relief to her, and made so large an incision above and below the navel, as enabled him, by fixing his fingers under the jaw of the foetus, to extract it; in which operation he met not with the least impediment.

That’s bad enough; but worse was to come.

He afterwards looked into her belly, and seeing something black, he put in his hand, and extracted, by pieces, a perfect skeleton of a child, and several pieces of black putrefied flesh. After the operation, he swathed her up; and in six weeks she pursued her domestic business.

She has been in good health ever since this wonderful accident happened; only she has a navel rupture, owing to the ignorance of the man in not applying a proper bandage.

A strange tale, and one leaving many questions unanswered. Dean Copping was a man of science, and at the first opportunity he went to visit the woman and her husband to hear their own version of events. But his interview with the couple did not provide complete enlightenment.

They are so ignorant, that, with their bad language, I could not make myself quite master of what they said; but, if they speak true, there is something more surprising than the former account mentioned: for the several parts of the latter, or rather the former, foetus were extracted by degrees, from July to Christmas

A ghastly predicament. The woman told Copping that she had been married for around a decade before she first fell pregnant . Labour had begun at the normal time, around nine months after conception. But the contractions ceased, the abdominal swelling went away and the midwife concluded that there had never been a child: it had been a phantom pregnancy. Seven years later she conceived for the second time.  But this time, after nine months a new symptom appeared:

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.

It doesn’t get any more pleasant, does it?

When O’Neile 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. British Poets Laureate have traditionally been paid (partly) in sack: one almanac for 1730 records that

Mr Colley Cibber, the player, made poet laureat [sic]. The salary is £100 a year, and a but [barrel] of sack, or £50 in lieu of it.

This custom persists: the ‘butt of sack’ is today paid as 600 bottles of sherry.

Anyway, back to the story: a ‘large draught of sack’ was the closest available thing to an anaesthetic, and therefore probably not a bad idea. 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, as I said, were extracted at different times, it seems too in different ways; for some came by the navel, others from the womb the natural way.

It’s like something from a horror film.

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 suggests she was in a very bad way. The good dean was determined 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 prevailed upon.

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.

Dean Copping ends by expressing one minor regret:

I am sorry the several bones extracted were carried away by different physicians, that I cannot procure one to be sent to you; which, with the account, might find a place in your surprising Collection.

Sadly I can find nothing to indicate what happened to the woman after her removal to Dublin; at this date any further surgical intervention might easily have killed her.  I suppose that butchers must on occasion have been pressed into service as stand-in surgeons (their knowledge of animal anatomy might have been quite useful in performing amputations, for instance); but if so they have left mercifully little trace on the literature.

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