In June 1828 the Lancet published a pair of short case histories that contemporary readers must have found rather confusing. Printed on the same page, they both dealt with cases in which a strangulated hernia had been treated with a tobacco enema (yes, really: an infusion of tobacco administered via the anus). In the first case the treatment was a complete success; in the second it was a total failure. So as to the efficacy of the intervention: no idea. Flip a coin.
The second case was submitted by a rural surgeon, a Mr J. Trought. The editor omitted to include any further identifying information about him; all it is possible to say with any certainty is that he was a country practitioner. This is apparently the only reference to such a person in the medical literature – though a much better known Samuel Trought was a surgeon, magistrate and sometime mayor of Louth in Lincolnshire.
The subjoined case affords a remarkable instance of constitutional vigour in a rustic, who had exceeded the “natural” age of man. It presents a striking contrast to the enfeebled and shattered constitutions which the surgeon in London has to deal with.
An interesting observation. There was no shortage of grinding poverty in rural England in the early nineteenth century, of course, but the conditions of the inner-city slums were on an entirely different scale of misery. Doctors in the poorer areas of London would have been accustomed to treating men and women whose health had been prematurely ruined by malnutrition and disease.
Case. —John Knox, a nail-maker, 72 years of age, had been subject to inguinal rupture of the left side four years, when, on the 3rd of May, the hernia suddenly came down, and became strangulated.
An inguinal hernia is one in the groin. A loop of intestine had protruded through the left inguinal canal, a natural passage between the abdominal cavity and the scrotum, cutting off its blood supply. A strangulated hernia is a medical emergency, since the section of bowel deprived of blood can soon die, eventually resulting in gangrene.
Bloodletting, and the subsequent use of the taxis, were had recourse to without effect…
‘Taxis’ is the simple measure of attempting to push the displaced bowel back through the inguinal canal.
…and on the following morning a tobacco enema was administered, with a like want of success.
The tobacco enema enjoyed a considerable vogue in the 18th and early 19th centuries. The original form of the treatment used smoke – typically as a resuscitation measure – but doctors also used to inject a fluid prepared by steeping tobacco leaves in hot water or other liquid. It was thought to be of particular utility in the treatment of hernias. One authority, writing in 1811, observed that
In the practice of modern surgery the value of the Tobacco Enema is folly appreciated. In every species and degree of hernia, where medicine is required, it may be serviceable; but especially in that alarming and dangerous state when the protruded parts become inflamed and painful, and cannot be returned.
But back to the 72-year-old nail-maker. The tobacco enema having failed, there remained no option except surgery.
Mr. Trought then proceeded to the operation, and, upon laying open the hernial sac, found a knuckle of intestine, which was returned without difficulty.
A straightforward operation, though performed without anaesthetic or antiseptic measures. The surgeon had to make one simple incision and then push the loop of intestine back through the inguinal canal, before repairing his incision.
When Mr. Trought visited the patient on the following day, to his great surprise he found the man sitting by the side of the fire, dressed, and apparently ailing nothing. It is important to mention, that an old nurse had administered a large quantity of yeast prior to the operation, and after its performance, when an injection was used, free evacuations from the bowels were speedily obtained.
Yeast – which was thought outdated even in 1828 – was used as a stimulant, though in this case it appears to have functioned as a laxative.
Four days after the operation, Mr. Trought found the man at work in his shop, and, to use his own expression, “as well as ever he was in his life.” He had been an extremely free liver, and, in fact, subject to great excesses.
A great result for Mr Trought – even if his tobacco enema failed him.