A thorn in the flesh
A Victorian doctor's own mysterious symptoms puzzled his eminent friends
While leaping a hedge in Yorkshire in 1845, Dr John Richard Wardell’s horse fell on it and Wardell’s thigh got bashed just above the right knee. Although the doctor stayed on board and the horse soon righted himself, all was not well. By the time they had hacked the few miles home, Wardell was in so much pain that he had trouble dismounting.
A general practitioner friend, William Cole, believed he had torn a muscle, so Wardell used leeches and hot compresses to reduce the swelling and ease the pain. He was soon back on his feet and back in the saddle, only feeling the odd twinge after severe exertion. He did not know that the incident would return to haunt him five years later.
Wardell (1820-1885) had only graduated from Edinburgh University the year before the accident, but by 1850 he was practising in St John’s Wood, London, where most of his house calls could be done on foot. In May that year, when his services were in particularly high demand, all the walking made his old injury ache. Too busy to pay much attention to it, he started doing his calls on horseback and resting in between – this helped, although there was now an area of swelling and redness above his knee. A London surgeon friend suggested putting iodine on it, but this had little effect.
Wardell called upon the famous Sir Benjamin Collins Brodie (1783-1862), who advised bandaging the limb with vulcanised strapping. This, however, made the pain and swelling worse, so Sir Benjamin removed the bandage and applied a dozen leeches, advising Wardell to use hot poultices followed by cold lotions. Wardell rested for two weeks then went back to visiting his own patients, but his symptoms flared up again, leaving him in pain from the ankle to the groin. Sir Benjamin believed the great saphenous vein was inflamed along its whole course. The remedy – more leeches.
In his history of his own case for The Lancet, Wardell makes a subtle but illuminating comment about the medical profession of his time, realising that patienthood meant navigating a maelstrom of conflicting advice:
Several of my medical friends kindly called to see me, but unfortunately for the cure, all their opinions varied. Not being fully convinced—so far as medical consultations are concerned—that in a multitude of counsellors there is wisdom, I resolved to place myself under the care of one gentleman, to rigidly obey his injunctions, and abide by the result.1
The favoured practitioner was Benjamin Travers FRS (1783-1858), Surgeon Extraordinary to Queen Victoria. He advised a mercurial plaster and a firm bandage. The pain rumbled on, but Wardell improved enough to go and visit his widowed mother in Pickering, Yorkshire, and the air of his homeland restored his spirits. Back in London, he carried on visiting patients and hoping his leg would eventually improve of its own accord.
But after having rushed to an emergency in October 1850, Dr Wardell became agonisingly lame. Travers now recommended blistering, which involved applying an irritant substance (usually cantharides a.k.a. Spanish fly) to the skin with the aim of drawing out the impurities causing the inflammation. Dr Wardell couldn’t help but become disheartened:
All the remedies which now, during four months, had been tried, had, it was too evident, been tried in vain; and on the 10th of November I found myself again in bed, not one whit better than I had been in July.
Travers suggested that the only option left was to cut deep into the muscle and have a look, to which Wardell ‘cheerfully agreed’ – probably relieved at the prospect of some sort of outcome after months of suffering. Travers, along with his surgeon son, also called Benjamin Travers, and Dr Samuel Edwards made up the surgical team.
Dr Wardell relates the procedure from a clinical standpoint and doesn’t go into the pain he must have experienced. The operator carefully dissected the muscle, then:
‘On scratching open with the point of the scalpel an evidently distended bursa, a couple of drachms of slate-pencil-coloured fluid welled from below.’ The muscle tissue around it ‘looked dark and congested, of a dirtyish-red colour.’ The wound was intentionally kept open to allow the fluid to drain, but Dr Wardell’s condition deteriorated; Travers applied a caustic and prescribed ‘quinine, a generous diet, and two or three glasses of port wine daily’.
Wardell’s thigh swelled up and he developed a cough, night sweats and a pulse rate of 120. The surgical wound drained copious amounts of fluid, and any exertion made him feel faint. He decided to relinquish his medical practice and go to Brighton for the sea air.
At this point, a new but sadly unnamed hero enters the tale – Dr Wardell’s servant, who was changing the bandages when he spotted a tiny sharp black point emerging from the doctor’s skin.
‘I desired him to reach a pair of forceps,’ Wardell relates, ‘and to my utter consternation I drew out a huge piece of hard black-thorn, measuring exactly an inch and a half long.’ He realised it must have been there since his hedge-hopping scrape of 1845.
Although it took several weeks for Wardell to recover from his long illness, the removal of the thorn marked a turning point. From Brighton, he went up to Yorkshire and soon felt healthier than he had done for years.
Although Dr Wardell refrained from criticising his eminent friends, his case does imply that the medical and surgical professions of this era were largely working in the dark. Each practitioner made his best guess at a diagnosis and recommended such treatments as were available – but it ultimately took an eagle-eyed servant to save the day.
All quotations from: John Richard Wardell, MD, ‘A Thorn in the Flesh’, The Lancet, 18 October 1851.
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