It is appropriate that the word 'stoma' has its origins in the ancient Greek language for they were often at war and appeared to have had considerable experience in perforating injuries of the abdomen. Ancient Greek physicians such as Hippocrates (460 - 377BC) and Celsus (53BC - 7AD) wrote that wounds of the large intestine were not deadly, where as wounds of the small intestine and bladder were (Richardson 1973). Another ancient medical figure was Galen (130 - 200AD), who was surgeon to the Emperor Marcus Aurelius and the Roman gladiators, and one presumes very experienced in traumatic perforations of the abdomen. In his prolific writings he discussed surgical management of the large intestine and abdominal wall following penetrating injuries, however, he believed little could be done to save the person with a rupture of the small intestine (Haeger 1989).
Throughout the ages, military surgeons have been presented with great challenges in caring for traumatic wounds. These challenges were exacerbated from the 14th century onwards, for it was in 1346 at Crecy that artillery was first used in battle (Leavesley 1996). Those that survived traumatic injuries to the abdomen, it seems, did so largely as a result of human endurance rather than on account of surgical skill. Cromar (1968) reported that a soldier, George Deppe, who was wounded at Ramillies in 1706 lived for 14 years with what appeared to be a severely prolapsed double-barreled colostomy. Acute bowel obstructions and perforations occurred not only within the realm of the military but royalty has been sorely effected. King Stephen of England died in 1154 with what was termed "iliac passion", a Saxon term described in 923AD as: "a disorder in which a desire cometh upon a sick man for discharging his bowels, and he is not able, when he is out in the outhouse" (Brooke 1980, p1).
The first recorded royal, though not the last, who had an ostomy was Queen Caroline, wife of George II, who died in 1736 from a strangulated umbilical hernia. She endured 7 days of suffering before her gut ruptured, but alas to no avail, for she died 3 days later (Leavesley 1996).
William Cheselden (1688-1752), a British surgeon, had a 73 year old patient, Margaret White, who ruptured her abdominal wall following severe vomiting. Cheselden removed the gangrenous portion of prolapsed gut and left the sound portion, thought to be small intestine, hanging through her umbilicus (Richardson 1973). Although she lived for some years we are left to ponder how she may have managed her ostomy. Surgeons of that period were reluctant to operate on the bowel for fear of peritonitis and inevitable death to the patient. This was not only harmful to a surgeon's reputation but the major stimulus for what is considered today, some bizarre medical practices. These included purging with laxatives and enemas, attempted dilatation via the anus, blood-letting and the consumption of large amounts of mercury in the hope that the heavy weight of the substance would push through the obstruction. Death due to mercury poisoning was a common side-effect (Leach 1986). Thomas Sydenham, a noted London physician during the mid-1800's, recommended horseback riding as a means to assist the passage of stool through obstructed gut and his treatment for paralytic ileus was to keep a kitten on the distended abdomen, presumably for the warmth (Leavesley 1996). Failed treatments such as these usually resulted in the death of the patient.
PLEASE NOTE: FROM THE EDITOR: A Second part of this article will appear in a future edition of Inside Out.
