An unfortunate couple

extraordinary cases in surgeryJohann Georg Steigerthal was an eminent German medic of the early seventeenth century. In 1715 he was appointed court physician the Elector of Hanover Georg Ludwig – otherwise known as George I of Great Britain. Steigerthal was also a Fellow of the Royal Society, and in 1720 he contributed this striking case history to the society’s journal, the Philosophical Transactions.

John Henry Oizmann, aged 31 years and born at Barum, was fifteen years of age, when the following misfortune befell him.

Barum is a municipality in Upper Saxony, about sixty miles south of Hamburg.

He felt a spasm or cramp in his left hip, and the inferior part of his leg; as this pain seized him pretty often, he consulted Mr. Raek a surgeon at Ulzen, who applied several plasters to the place where the pain was, but without any relief to the patient.

The ‘plasters’ were probably steeped in a caustic agent to provoke blistering – this method, known as counter-irritation, was believed to reduce deep-seated pain by drawing out toxins from the tissues.

After all those fruitless efforts, the surgeon, to see whether Oizmann had still a feeling in his leg (which to outward appearance was become very brown) made about 37 incisions all over the whole leg, of which the patient was not at all sensible, except at such times when the instrument happened to grate upon the bone, the periosteum being as yet sound and not infected by the disease of the flesh.

The periosteum is the tough connective tissue that surrounds the bones. The treatment sounds extremely unpleasant, and the fact that the patient was almost unaware of it suggests that the tissue was already very badly diseased.

The leg however did daily grow blacker, and the pain continued both in the periosteum and all the bodies of the superior and inferior part of the leg. At last a black circle was seen round about the muscles of the hip, an indication of an approaching putrefaction.

A sight which must have been all too familiar to medics of the period. The black circle was a sign of necrosis – tissue death. I’m not sure what the young man’s disease was, but it sounds like gangrene. It may possibly have been caused by ergotism, a fungal infection caused by eating tainted grain, which was common in the eighteenth century and often provoked the loss of a limb.

This circle appeared so visibly, as if it had been cut off with a knife from the other part. It has ever since spread itself, and come to such a head that without any other help and cure the flesh began gradually to rot away from the bones; and at last quite fall away from the superior part of the leg which has preserved its soundness. After this nothing was seen but the bare tendons or sinews hanging down like so many strings or cords.

Not a pleasant experience – watching one’s own leg rot away.

At last the tendons being grown dry, consumed away, and after all, the leg itself, I mean the os femoris, did wholly drop off in such a manner, that there remained about four inches betwixt the bones and the flesh loosely hanging down from them.

Just imagine that: waking up one morning and realising that part of your femur had fallen off.

The flesh is at last grown up to the bone, and without the help of any man has fastened itself to them. And in this sound part the patient feels a great pain, whenever the weather proves tempestuous.

A rather unpleasant sort of personal barometer.

It is remarkable that at the same time he perceives also a swelling in tarso pedis dextri [the main part of the foot], the matter whereof discharged itself through the toes, and is of so corrosive a nature, that it had consumed all the toes but the little one.

It sounds as if the ‘matter’ discharged was pus, the result of internal infection.

The surgeon has at last healed up this wound; but after all there is as yet but little feeling or warmth in the foot.

Strangely, the young man seems to have retained the use of his leg even after this ghastly disease. But his wasn’t even the oddest injury in his immediate family.

This man after this great accident is married now about seven years to a woman, whose bodily constitution is almost as remarkable. She is now in the 41st year of her age. In her younger years she had the misfortune to be gored by a wild boar under the short ribs of the left side.

The short (sometimes known as ‘false’) ribs are the lower ribs, which are not attached to the breastbone.

Of this wound she then received, she has still a fistula to this day.

A fistula is an anomalous opening; in this case the wound remained open to the skin, so that some part of her digestive tract communicated with the outside world.

What food she eats dischargeth itself half concocted [digested] through this opening, and she is obliged to clean this wound often for that purpose, however she had notwithstanding this, her daily evacuation per anum. It is remarkable, that the victuals thus discharged, by the wound aforesaid, are still distinctly known what kind they have been of.

The fact that it was possible to tell what sort of food she had been eating when it reappeared, half-digested, suggests that the wound was in the upper part of the bowel, the small intestine.

What an unfortunate couple! But Dr Steigerthal’s report suggests that they were both able to live with their respective injuries. Let us hope they enjoyed a long and happy life together.

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