The port-wine enema

Alcoholic drinks were an important part of the physician’s armoury until surprisingly recently.  In the early years of the twentieth century, brandy (or whiskey, in the US) was still being administered to patients as a stimulant after they had undergone major surgery.  Every tipple you can think of – from weak ale to strong spirits – has been prescribed at some time or other.  I recently wrote about a case of tetanus treated with 24 pints of madeira.

But doctors didn’t just get their patients to drink booze; indeed, they were remarkably imaginative in the strange things they did with it – for instance, injecting claret into the abdomen.  But this case, published in the British Medical Journal in 1858, trumps even that for sheer wrongheadedness.

No, you didn’t misread the headline: this article seriously suggests a port wine enema  as a substitute for a blood transfusion.  The author is Dr Llewellyn Williams from St Leonard’s-on-Sea in Sussex:

On September 22nd, 1866, I was called into the country, a distance of four miles, to attend Mrs. C., aged 42, then about to be confined of her tenth child. All her previous accouchements had been favourable. When about six months advanced in pregnancy, she received a violent shock by the sudden death of her youngest child, since which time her general health had become much impaired. She had a peculiar pasty anaemic appearance, and complained much of general weakness.

Shortly after the doctor’s arrival a ‘fine female child’ was born without much difficulty. But then:

My patient exclaimed, “I am flooding away,” and fainted. I immediately had recourse to such restoratives as were at hand, and presently she began to revive.

Any improvement was short-lived.  The patient was bleeding heavily, and Dr Llewellyn Williams became seriously concerned.

My efforts still being foiled, and the haemorrhage continuing, the powers of life manifesting evident symptoms of flagging, I introduced my left hand into the uterus, after the manner recommended by Gooch, endeavouring to compress the bleeding vessels with the knuckles of this hand, whilst with the other I pressed upon the uterine tumour from without. This combination of external and internal pressure was equally as unavailing as any of the other plans already tried. At last, by compressing the abdominal aorta, as recommended by Baudelocque the younger, I was enabled effectually to restrain any further hemorrhage.

The abdominal aorta – the largest blood vessel in the abdomen – is only a few inches from the spinal column, so compressing it by hand is a procedure as difficult as it is drastic.

The condition of my patient had  now become sufficiently alarming, she having been for upwards of half an hour quite pulseless at the wrist, the extremities cold, continual jactitation being present, the sphincters relaxed, and the whole surface bedewed with cold clammy perspiration.

‘Jactitation’ is pompous medic-speak for ‘tossing and turning’.  It was probably archaic even in the 1850s.

It now became a question what remedy could be had recourse to, which should rescue the patient from this alarming state, it being utterly impossible to administer any stimulant by the mouth. My distance from home, together with considerable objections to the operation itself, which it is not here needful to dwell upon, made me abandon the idea of transfusion of blood.

The first successful human blood transfusion was conducted by James Blundell in 1818, also for postpartum haemorrhage.  But it was hideously risky: blood types were not discovered until 1901, so it was not possible to match donor to recipient, with often catastrophic results.

But Dr Llewellyn Williams had another idea.  A really, really bad one.

As a means which I believe will prove equally as powerful as transfusion in arresting the vital spirit, I had recourse to enemata of port wine, believing that this remedy possesses a threefold advantage. The stimulating and life-sustaining effects of the wine are made manifest in the system generally; the application of cold to the rectum excites the reflex action of the nerves supplying the uterus; and the astringent property of port wine may act beneficially by causing the open extremities of the vessels themselves to contract.

I wonder what the London consultants reading this article made of the country doctor’s reasoning.

I commenced by administering about four ounces of port wine, together with twenty drops of tincture of opium. It was interesting to note the rapidity with which the stimulating effects of the wine became manifest on the system. Two minutes after the administration of the first enema, there was a slight pulsation distinguishable in the radial artery, which perceptibly increased in strength for the space of five minutes, after which the pulse again began to flag, and I had recourse to the administration of a second enema twenty minutes after the first. A more marked improvement was now manifest in the patient. She regained her consciousness; the pulse continued feebly perceptible at the wrist. In half an hour, I had again recourse to the enema, with the most gratifying result; and, after ten hours most anxious watching, I had the happiness of leaving my patient out of danger.

Whether Dr Llewellyn Davies was in any way responsible for her improvement remains a moot point.

The quantity of wine consumed was rather more than an ordinary bottle.

Not the most pleasurable way of consuming a bottle of port, by any means.

A postscript: six months after this article appeared, the British Medical Journal announced that Dr Llewellyn Davies’s wife had given birth to a son. For her sake, let’s hope he left the delivery of his own child to one of his colleagues.