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1838 — Tetanic Therapies

by Susan Marie Brown, © 2014

Canterbury, England

How wonderful it felt to fulfill the dreams of youth and join the ranks of demigods as a physician. Robert Chisholm worked day and night while training in Edinburgh. He memorized the details of anatomy and physiology, the nature of poison and disease, the benefits of potions, pills, leeches, electricity and — most important — the philosophy of modern science. He graduated in 1808, blessed with the power to cure maladies, transform near-tragedies to joyful days, and make life bearable for the chronically afflicted. He carried his diploma away to begin his career, determined never to simply trot along the path of tradition. No.

He was a modern man — a scientist — compelled to carry medicine into the future. He would not simply give all patients the same old treatment. He would always seek better new therapies, better new comprehension of the old troubles.

He was very well equipped with good tools, good health, and the educated mind of a scientist. He loved experimenting, innovating, using new cures, and publishing results. Yes, he was very appreciated: brilliantly spending his days squashing fevers, placing leeches, making blisters, cutting veins, inoculating tots, and prescribing precisely the right amounts of arsenic, mercury, opium, turpentine, quinine, and all the other pills and potions sold by chemists to relieve his patients’ pain and improve their health.

How many lives did he save? Oh, so very many. Who could count them all? God, perhaps. Dr. Chisholm lost track. Distractions, like marriage, never made him falter. No. A Sirenic lass once broke his heart in Dorset, in his youth. Angelic singing, glossy silk, rosy scents, and, oh my — the glimpse of feminine ankles hidden under skirts — turned him to a fool, a dog, a speechless idiot.

Adorable damsels attract many men: men with wisdom and kindness, men with swords and guns. Did Robert Chisholm duel for her love? No. No. He said farewell! And dedicated himself to the people, to the art of science, to the Hospital of Kent and Canterbury, where he served with Dr. Carter.

Residing beside the Hospital, always eager to thwart the threat of death, Dr. Chisholm often ran to drain poisons from the blood and bowels, diagnose disorders, and halt the demise of endangered souls, whether crisis called in day or night. The wonders of medicine helped him vanquish and manage most common troubles and many unusual ones.

Tetanic paralysis was one of the worst: all too common, a mystery, often a consequence of accidents, cuts by rusty metal, or other injuries. The medical journals presented an endless series of case reports, experiments, theoretical discussions of pathology, innovative schemes for treatment. Tetanus was usually tragic, always memorable.

Forty-year old William Bryne lived in a wretched state, devoted to gin and self-neglect. He stumbled to the hospital, where Dr. Chisholm treated him for dropsy. He was cured, advised to stay sober, and sent home. After a week in his filthy hovel, his neighbors hauled the drunkard back to the hospital. He was paralyzed. His mouth would not open, his head was drawn back, his back was arched, a puncture wound on his foot was half-healed. His limbs were hard as wood and completely immobile. Dr. Chisholm applied a hundred leeches to suck the excess blood from Mr. Bryne’s spine. He prescribed frequent doses of opium and mercury, plus daily enemas meant to rid him of intestinal worms. The patient died on the fourth day.

A shoeless milkmaid, Anna Parks, age eighteen, was brought to the hospital for treatment of a bloody foot injury: three toes crushed by a stomping cow. She was always cheerful and seemed to be healing well, but on the seventh day she was stricken by tremors, pain in the jaws and chest, an achy back, and widespread muscular slowness. The next morning her jaws were locked. She was going stiff. Dr. Chisholm and Dr. Carter discussed this emergency. Dr. Carter removed a pint of blood from her arm. Chisholm prescribed opium, six daily enemas of castor oil and turpentine, frequent rubbings with mercury and drenchings in alternating hot and cold waters. The next morning, tetanic paralysis had fully taken hold. Eighty leeches were applied to her spine. Opium and mercury were given hourly. When the bloated leeches were removed, the enema and bath schedules were renewed. The next morning, she was dead.

Then a dubious report announced that great success in curing paralytic disorders could be achieved by injecting a boiling slurry of tobacco soup into the bowels. Dr. Carter declared himself eager to see how much good such steamy enemas could do. Dr. Chisholm said none, never try thatboiling water will kill anyone.

Carter grumbled. Chisholm went about his work. Three months later he returned to the hospital after making his outpatient rounds, and found Dr. Carter in the library, bashing himself on the head with a heavy copy of Gray’s Anatomy. Chisholm wrestled the book away, but couldn’t get Carter to speak. He kept trying to coax an explanation out, till their assistant, Mr. Spratt, came to the door, made a gesture for Chisholm to follow, showed him a child’s body, and described the fiasco. This severely tetanic little boy’s parents carried their suffocating toddler in, frantically begged Dr. Carter to quickly treat him with the new cure they recently heard about: boiling tobacco. Which he did: with this terrible, fatal, result. Spratt was ready to clean up the mess, but he thought a doctor should to walk down the stairs to give those parents the news.

The ensuing conversation was one of Dr. Chisholm’s worst hours.

On Christmas Day stomach pains struck thirty-year old Frederick Moss. The next day he was stiff as a board, struggling to breathe. Dr. Chisholm took blood from his arm. Mr. Moss fainted, but soon awoke and drank his prescribed water with laudanum. More waves of tetanic spasms and pain struck him. He started repetitive whispering. At first his speech seemed like babble, then Dr. Chisholm realized the patient was begging for rum. Not a good sign, he thought, not a good sign at all. Could a physician ever indulge such an untherapeutic request? He thought not.

But the dying man kept mumbling rum, rum, rum. Should a doctor ever refuse his patient’s last simple wish? Chisholm thought not. He told Spratt to get him a pint. Moss drank that, and asked for more. And more. And more. On the third day he sat up and smiled. On the fifth day, he stood up and walked home.

Dr. Chisholm watched the man go. He felt very puzzled. Why did Moss survive tetanus? Was rum truly a cure? Or was his recovery just luck? Dr. Chisholm gave liquor to six more paralyzed patients, but none of them survived.

It was late in July, 1838, when Dr. Chisholm’s horse lost a shoe. The blacksmith took too long to replace it. The doctor decided to carry his bag of instruments and medicines through the rain, across the countryside on a footpath. He knew a shortcut to the cottage of two patients.

The path followed the river, then wound between pastures, then crossed hedge after hedge via wooden stiles. The steps were all drenched, slick from the rain. They were slippery, slippery, ladders. Dr. Chisholm carefully climbed up and down the first two stiles, lost his balance on the third. He reached to catch himself, dropped the bag, slashed his arm on the tip of a nail, and tumbled onto the grass, bleeding.

He crawled to the bag, wrapped a bandage round the bloody arm, sat by the hedge, and closed his eyes. Yes, this slashing hurt. It was not deep enough to stop him, but he knew such cuts could be precursors to tetanic paralysis. What if he was going to die in a week or two? What should he do?

Dr. Chisholm sat beside the hedge thinking of places he always meant to go but hadn’t been, of deeds he always meant to do, but hadn’t done, of joys and sorrows he always meant to feel, but hadn’t yet felt, of the good work he always meant to carry on till he was very, very, old.

This might be the wound that killed him with tetanus. With a future so short, what could he still do? What did he want most?

He sat in the grass till the rain stopped and the clouds showed him a patch of blue. Then he stood up, found his hat, picked up his bag, and went on walking toward that cottage, to see those patients. They needed help.