The Sloane Correspondence contains several examples of curious medical cases, many of which were intended for publication in the Philosophical Transactions (which Sloane as secretary of the Royal Society edited for many years). One such case is that of Mrs Stevens of Maidenhead, aged 62. Surgeon Ralph Calep recounted her case in a letter to anatomist William Cowper, who in turn forwarded it to Sloane for publication.
Mrs Stevens became ill with a fever in November 1697. Within two weeks, she developed a swelling and numbness in her foot that spread up her leg. For a month, the attending physician treated her with remedies that theoretically should have helped according to early modern medical thought. The first treatment was a warm, moist compress of centaury, wormwood, and St. John’s Wort. According to the Pharmacopoia Londinensis (1702), these ingredients all had hot and dry properties and cleansed and treated wounds. Centaury might be used to treat scurvy (often seen as a skin problem) or gout, while wormwood was thought useful in resisting putrefaction. St. John’s Wort was supposed to dissolve bad blood and cure wounds. The second remedy, an oil of turpentine with galbanum, was to relieve pain, soften the skin, and reduce the tumour.
By the time surgeon Ralph Calep saw Mrs Stevens in early 1698, her foot and leg were in a bad way: brown and withered with black spots and no feeling in the leg. She was in great pain and occasionally delirium, begging Calep for help. But the only solution Calep could think of was to remove the leg, which Mrs Stevens refused. Calep thought this was best since he “did not expect any Success in the performing of it”, given her age and weakness, and left “supposing I shou’d never see her more”. He advised her friends to continue the compresses.
Amputation scene, “De gangraena et sphacelo”
Credit: Wellcome Library, London. Wellcome Images
A month later, Calep returned and was surprised to discover Mrs Stevens still alive, though with a hole in her leg that discharged black matter. Calep enlarged the opening to aid the flow. He also cut into a tumour on her knee, but was surprised to find nothing but air. He again left the patient, advising her to continue the compresses. When he returned another month later, he was not only surprised to find her still alive, but “to my admiration saw that, which thro’ the whole course of my Life I may never see again”: Nature had made a perfect separation of the mortified flesh, with the skin above looking healthy. At this point, he decided to remove the leg. Now, over ten years later, the woman was still alive! For Phil. Trans. readers, this would have indeed been a fascinating case—a peculiar physical problem, with a remedy that demonstrated the power of nature’s healing.
For the historian, the tale is intriguing for a couple other reasons. First: the surgeons’ claims to authority. Calep had one complaint after the amputation. He had hoped to take the leg for dissection, but “the Friends of the Woman deceived me”. They had promised to keep the leg for him, but then buried it in a secret location. Calep’s authority rested in his careful observation over time, as well as the verification of the story by Cowper. Cowper included a note to Sloane stating that he had also been to visit Mrs Stevens, though he had been unable to look at the thigh. Mrs Stevens was “decrepid” and the weather was too cold for her to show him. He did, however, feel the stump through her clothing and Cowper diagnosed her problem as one of petrification in the arteries. This problem, he had previously seen in “aged Persons” or cases of gangrene, and had published on it. Cowper’s authority rested in his reputation and previous scholarship.
William Cowper. Credit: National Library of Medicine and Wikimedia Commons.
But what is striking is the absence of real evidence: the amputated leg had disappeared and Cowper had not actually examined Mrs Stevens’ stump in detail. In the late seventeenth century, natural philosophers were establishing what counted as good evidence. Close observation and reputation were two of the crucial elements, but both surgeons recognised that their accounts would have been even more compelling if they had been able to examine the leg and stump. Each explained in detail why they had not done so.
The case is also interesting for what it tells us about the relationships among surgeon, patient, and patient’s friends. The “friends” (which would have included family) were important throughout, ensuring that Mrs Stevens received good care during her illness. Mrs Stevens also continued to have full control over her medical care, despite her occasional delirium. She refused the only treatment Calep could offer, amputation, until her leg started the process of separation itself. She was typical of many patients in this regard, who generally avoided surgery until it became the only option–unsurprising in an age without anaesthesia. Later, she also refused to show Cowper her stump in its entirety.
The patient’s control over the disposal of the body part appears to have been more contentious. Calep certainly wanted the leg for scientific purposes—at the very least for dissection, but possibly even intending to preserve it as a sample. He even seemed to expect that he should have it, suggesting that he’d been tricked out of having it when he called the friends deceitful. For Mrs Stevens, by contrast, there may have been some anxiety surrounding the leg’s dissection: what might happen to her body at the Resurrection? Was it shameful? By burying the leg, Mrs Stevens’ friends would have been acting on her wishes, or seeking to protect her.
A curious case, indeed, for contemporaries and historians alike!