Plum stone colick

In 1781 an eminent Scottish doctor, Thomas Simson, reported this unusual case in the pages of the Medical Museum: 

A girl about twelve years of age, who had been long troubled with colick pains, was last year under my management. She complained of pains fixed in one part about two inches below the short ribs of the left side, somewhat nearer to the back-bone than to the navel, where I was informed they had kept for at least three years.

The girl’s parents told the doctor that she had been suffering from colic for a further three years before this specific symptom appeared. He asked them whether any particular foods tended to provoke an attack; they replied

that she never missed them some hours after eating pease, oranges, strawberries, or any other summer fruits, and upon taking any thing that was sour or hard of digestion; all of which for the most part produced a loose belly, which carried the trouble off; but if this did not happen, they were obliged to procure some stools by purges or clysters, which always succeeded till this attack of the disease, when I was consulted.

‘Clysters’ being enemas. Summer fruits were not the culprit this time, it appears:

This fit, which was reckoned to have been occasioned by drinking small ale upon the turn, was accompanied with a violent constipation, and the pain was so violent, that she cried out in a most moving way, holding the affected side as firm as she could with her hand. Her stomach was so squeamish, that she threw up every thing immediately after swallowing it. Her pulse was the mean time of a natural strength and quickness; clysters had little effect on her, and though she got purgatives in different forms, and clysters were repeated some hours after to sollicit them downwards, yet they never were successful.

The doctor tried several other remedies, but all were unsuccessful.

The pain and vomiting seldom left her for three weeks together, in which time, from the fatigue and want of sleep and nourishment, she was brought from a plump well coloured girl, to have much the countenance of a skeleton. After so many disappointments in my attempts to help her, and looking on her case as desperate, I was resolved to give her no more drugs; but early in a morning observing her to vomit a great deal of bile of a deep tincture, I began to suspect that the abounding of such a sharp liquor might be the occasion of her trouble, and, with that view, desired she might drink down an English pint, or a pint and a half of tepid water, to provoke her to vomit, and to repeat this six or seven times.

Simson was rather a modern doctor for his era, in some ways, but his diagnosis (an overabundance of bile) is an interesting throwback to the age of humoral medicine.

She immediately fell about the work, and, with some small intervals, went through her task, which proved a remedy to her, but in a different manner from what I expected; for after she had vomited five or six times with the water, she had a demand to stool, which was copious; and in passing the fæces, she was sensible of something bulky and hard among them. Upon a search the ball herewith sent was found.

See right for image.

This ball is, you see, of an irregular cubical shape, with a deep depression A, fig. 3, in two of its sides that are opposite to each other; it was four inches in circumference, and weighed five drachms at first, though now it is much lighter. It seems to be compounded of threads matted together, and disposed into layers. In the middle of it there is a plum-stone, the flat sides of which answer to the depressions in its external surface.

 I imagined the plum-stone had been six years in my patient’s body gathering the crust round it, and had occasioned the colicks so long. In the persuasion of her disease depending on this preternatural ball, I made no scruple, when asked by her friends whether I thought she would be any more troubled with these colicks, to give it as my opinion, that perhaps she might have some small relapses, till once the parts so long distended and compressed by the ball had recovered their natural state again, but that in a short time she would be quite free of them, since what I was consident was the cause was now removed, which has fallen out accordingly, she having had no fits these eight months except two; one she took pretty severely the tenth day after passing the ball, which was carried off by bathing and bleeding; a second she was seized with half a year after, by some cold, which went off without medicines; and all this while she has eat every thing that comes in her way, particularly pease and oranges, which of all things brought formerly the fit most certainly upon her.

Lest you think this an isolated case, Dr Simson adds that one of his patients actually died after swallowing a plum stone:

The end of last year I opened a brewer, who for many years past had very little respite from severe colick pains, arising from the right side above the haunch bone; under them he would have been some weeks tossed together, sometimes with a perpetual vomiting and great feverishness, and though the open belly often relieved him, yet he had often a looseness with the pain, by which disorders he was much decayed in his strength, though originally a very strong man, and at length, under the severity of a long continuing fit, expired.

Upon opening him, I found the hard tumour, which I easily felt externally, and always had judged in the mesentery, to be in the cæcum, which I slit quite across, and yet had difficulty to extract from it two large tumours, one about the bigness of a goose, and the other of an hen’s egg, of the same substance with that in the preceding history, but more knobby; they lay in particular cells of that intestine, which  with the parts about was very much inflamed.

You have been warned.