Thursday, 4 November 2010

Toilet troubles in 1840s Perth

I thought I might lower the tone for a bit...

Some people complain of a fear of visiting the doctor. The following is an account of some of the many bizarre things my five times great uncle Dr William Henderson (1784-1870) used to get up to in the royal burgh of Perth in the mid 19th century, as sourced from editions of the Lancet from 1841 and 1845. The first involves a tin terror device, leeches, and the rectum, and is not for the squeamish - I had tears coming out of my eyes when I first read it...!


By W. Henderson, M.D., Perth

On the 1st of June, 1840, a gentleman consulted me under the following circumstances. About four years ago, he first felt a more frequent desire than usual to void urine, accompanied with more or less pain, and followed with frequent slight mucus discharge from the urethra. He was then in London, and the medical gentleman whom he consulted treated the complaint as gonorrhoeal. He shortly after that left London, but, impressed with the idea of the alleged nature of his disease, he continued to take all sorts of medicines, known and secret, without any abatement of his sufferings.

When I first saw him, he felt an almost constant desire to empty the bladder, often passing only a few drops of urine at a time, accompanied with much pain and pressure; occasional severe lancinating pains at the neck of the bladder, which extended throughout the urethra, and were most distressing at the point of the penis; priapisms and emissions during sleep, followed with extreme heat and pain; constant mucus discharge from the urethra; bowels confined; much uneasiness in passing the faeces; a sensation as if some hard substance were pressing from within against the verge of the anus, which no effort to empty the bowel could remove. Sitting for any length of time on a hard seat causes a deep-seated, heavy pain at the neck of the bladder; heat and excoflation at the verge of the anus on taking even moderate exercise on foot, and he cannot ride on horseback at all from the pain it occasions.

On introducing a catheter, to ascertain whether stricture existed, the instrument passed freely until it reached the prostate gland, where there was obstruction and much pain in passing it into the bladder. I then examined the gland with the finger through the rectum; it was much enlarged, and painful on pressure.

The ordinary means, viz. aperients, iodine, leeches, and counter-irritants on the perineum, were persevered with for four weeks, with scarcely any alleviation of the patient's sufferings, and no progress whatever made in reducing the size of the gland.

While pondering on this most distressing case, it occurred to me , that if I could manage to apply leeches upon the gland, through the rectum, they might have a good effect. Accordingly, I had a tube made of tin, a quarter of an inch wide at one end, and half an inch wide at the other end, bent into the form here represented (see diagram, right). I then cut down the wide end of the tube about a third part of an inch, two-thirds of its diameter, in front, corresponding with the bend, leaving the projection behind as a handle to enable me to guide the other end accurately, and keep it steady after it had been properly applied. Having just had the bowel freely emptied, I cautiously introduced the tube, so directed, that by pushing it up in a straight line, its mouth must pass over the centre of the right lobe (the tenderest part) of the gland. As the tube advanced, I made gentle lateral pressure with its projecting point, at the distance of about every line, until the patient experienced a sensation somewhat similar to that felt when the point of the finger was pressed against the most sensible part of the gland. I then secured the tube gently, but steadily, with the left hand, and with the right hand introduced a leech into it, which, I was not a little pleased to find, took readily. When this leech dropped off, I changed the position of the tube, so as to place the mouth of it over the left lobe of the gland, and then introduced another leech, which also took readily.

When the tube was withdrawn the blood accumulated in the rectum, and brought on a desire to evacuate the bowel; this was frequently the case, but, from the feculent matter with which it was mixed, the exact quantity could not be ascertained, but it was considerable. This application of the leeches was followed with great relief to the patient; the priapisms and emissions by which he had been so long harassed and weakened entirely ceased, and all his other symptoms were much mitigated. The aperients and iodine were continued. A week after the leeches were again applied, and acted equally well. After this, the pressure on the sphincter ani, and desire to empty the bowel, were scarcely at all experienced; and the mucus discharge from the urethra altogether disappeared. The only uneasiness which he now felt was the heat and lancinating pains in the gland and urethra, particularly at the point of the penis, wheich were occasionally a little troublesome. Two days after the last application of the leeches, I examined the gland with the finger, through the rectum; it was now greatly reduced in size, and pressure upon it gave very little uneasiness. Six days afterwards, the heat and pains in the gland and urethra being still occasionally felt, and attempt was again made to apply the leeches as formerly, which failed. When the tube was withdrawn the cause of the failure was manifest, the introduced end of it being quite filled up with feculent matter. Something had occurred to prevent the patient from taking his aperient at the usual time, and his bowels had not been properly relieved. A similar occurrence was guarded against on the following day, when the leeches acted well. The relief which the patient experienced was now so complete , that, except continuing the aperients and iodine, nothing more was done for two weeks, when I again examined the gland. It had now decreased to about the natural size, but pressure on the right lobe still gave a little uneasiness. On this part one leech was again applied, which acted well.

At the end of other two weeks, I again examined the gland, through the rectum, and a perceptible degree of tenderness still remaining when pressure was made upon the right lobe, one leech was once more applied upon it, which after a little manoeuvring, acted well.

From that time the patient has continued well, and was some time ago married to a lady to whom he had long been attached.

So far as I know, this is the first time that leeches have been used in the manner above pointed out for disease of the prostate gland; and if, in the hands of other gentlemen, this mode of applying them shall prove as beneficial as it has been in mine, it will, in an practical point of view, be an improvement of no small value; for it is well known to the profession, that there are few structures in the human body which occasion more trouble and anxiety to the medical attendant, or which are more painfully harassing to the patient, than the prostate gland when in a diseased state.

In thus applying leeches, the most essential requisite is to have the rectum well emptied of all feculent matter immediately prior to their application; for if this should be neglected, the operator will be foiled in his endeavours to make them take.

Another point which requires attention is, the close application of the mouth of the tube to the parietes of the rectum over the diseased portion of the gland; because if this be not acrefully attended to, the leech may pass through the tube into the bowel. This actually happened in the above case, and occasioned some anxiety to myself, and much alarm to the patient; but, fortunately, no unpleasant consequences followed, for in about eight minutes after its passage through the tube, the leech made its escape through the sphincter ani.

The tube should be cautiously introduced with its mouth directed over that portion of the gland on which the leech is wished to be put, when lateral pressure should be made with the end of the tube against the gland, to ascertain the most sensitive point. This can be easily found by pushing the tube either a little higher up, or drawing it a little lower down in the rectum, and making lateral pressure at the distance of every line, until the patient experience a sensation somewhat similar to that produced when pressure made with the point of the finger is made upon the gland. Having found this spot, the tube is then to be held steadily with the left hand, and a leech introduced into it with the right hand, when, if the rectum have been properly emptied beforehand, it will be found to take readily. When the first leech drops off, if another be wished to be applied, the mouth of the tube should then be moved a little round either to the right or left, as the case may require, so as to make a fresh wound, and another applied in the same manner. If the heat of the tube cause the leech to become refractory, by pushing the corner of a towel into the tube so as to force the leech up to its duty, I invariably succeeded in making it take.

This practice is rational, free from danger, and, with a little address, easily executed, and, in this case, has been eminently beneficial.

Should any of my professional brethren do me the honour to repeat this experiment, I should esteem it a special favour if they would take the trouble to communicate the degree of success which may attend it, either through the pages of THE LANCET, or to me personally by letter.

Perth, Dec. 2, 1840.

"This practice is rational" - haha, love it! William's inventiveness with metal devices for solving medical problems in the areas where angels feared to tread continued in 1845, when he once again wrote about an invention designed to help a male patient clear out his blocked bowels! The Lancet article that he penned shortly after, "Intus-Susceptio Succesfully Treated by the Injection of Tepid Water Through the Rectum", published on August 19th 1845, is far too long to reproduce here completely, but the following paragraph gives an idea of the problem he was faced with, and how he overcame it:

(August) 5th.- Was called early in the morning; (patient) had passed a very restless night; the pains in side and back, and hiccough, which came on during the night are very distressing; has vomited two or three times. Repeat enema. Twelve o'clock, noon: enema was simply returned; stercoraceous vomiting. The symptoms were now so urgent, and the duffering and prostration so great, that I made him aware of the danger he was in, and the necessity of having recourse to more powerful means for relief. The patient eagerly declared his willingness to submit to anything,a nd begged of me to proceed. I then had a tin tube, thirty-four inches long and three-sixteenths wide, fitted into the nozle of a large enema syringe, and a short piece of wider tube soldered on the other end, and fitted to receive the pipe of a small funnel. Through this I injected tepid water into the bowels through the rectum. The tube with the funnel was thirty-seven inches and a half in length, and when raised upright, produced a pressure upon the bowels of a column of water that height. When a little more than the second quart of water had passed, and the patient was calling out to stop, or he should burst, I observed a shock in the tube, accompanied with a gurgling noise, and a quicker descent of the water through the funnel. I now withdrew the tube, and at the patient's earnest desire had him lifted to the night-stool, when the water was speedily ejected mixed with liquid feculent matter, with complete remission of the pain. In about twenty minutes afterwards he had to be again lifted to the night-stool, whent he remainder of the water was thrown off, mixed with feculent matter as formerly.

Once more, William's radical treatment greatly eased the suffering of the male patient, but on the following day, it had to be applied again. This time, William poured in two quarts of water, and when the last of the water was finished, he took the rubber tube and blew into it with all the force he could exert, until the patient again complained that he felt a "boiling in his stomach" and that once more he felt he was going to burst! But, miracle upon miracles, it worked, and the patient was cured of his painful blockage!!

Never argue with your physician...


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