A Century of Service - Eoin O'Brien

The Voluntary Hospital Movement and the Dublin School
another fee for I know not what service, unless he may have thought the last fee too
small.” 25 Though his publications are fewer than those of his later contemporaries,
the quality and content are exceptional. “Colles’s fracture” was described in 1814,
and in his work on Venereal Disease he challenged the well-established Hunterian
view that secondary syphilis was not contagious, by stating what was once known
as Colles’s law – “One fact well-deserving our attention is this; that a child born of
a mother without any obvious venereal symptoms, and which without being exposed
to any infection subsequent to its birth, shows the disease within a few weeks old;
this child will infect the most healthy nurse whether she suckle it or merely handle
it; and yet this child is never known to infect its own mother, even though she suckle
it while it has venereal ulcers of the lips and tongue.” 26 What Colles did not realise
was that the mother had previously been infected, but nonetheless his deductions
were for the time prescient. Dr Steevens’ hospital then as now had a reputation for
the treatment of venereal disease. In the “fluxing” or “salivating” wards patients were
given under special nursing care courses of mercury, which is highly poisonous if
given in excess. It was administered either as a medicine by mouth, or was applied
to the skin as an ointment. To improve absorption of mercury by the skin the patient
was placed in front of a good fire and the area for application was rubbed with a dry
hand until red; then the ointment, often containing turpentine and fresh hog’s lard
in addition to mercury, was applied. An alternative treatment was the inhalation of
mercury vapour by stoving or fumigation, a technique regarded as quite hazardous.
Patients were prepared for mercury treatment by bleeding, purging and the
administration of emetics to induce vomiting. One of the effects of mercury is to
stimulate the production of saliva, and the efficacy of treatment was judged by the
quantity of saliva produced each day; each patient had a pewter mug in which the
saliva could be collected and measured. A satisfactory response or “ptyalism”, as it
was known, was three to six pints of saliva in the twenty-four hours and a course of
salivation generally lasted about one month. 27
Colles was a skilled surgeon but surgery in these early days before anaesthesia and
antisepsis was to say the least, primitive and often terrifying. In one of his papers
there is a vivid description of an operation in which he attempts to tie off one of the
main arteries in the chest to cure an aneurysm or swelling of the artery: “And now
it was found that the aneurismal tumour had extended so close to the trunk of the
carotid as to leave it uncertain whether any portion of subclavian artery was free
from the disease … the majority (of assistants) appeared disposed to abandon the
operation altogether. Prior to tightening the noose (around the artery) the breathing
11