How did the stoma come to be? Vera SA, leading supplier of ostomy underwear and proud partner of CANSA and The South African Society of Ostomates, takes a look…

Photo from **The South African Society of Ostomates**

The first colostomy

While stoma procedures date back to as early as 350 BC, official reports state a colostomy was said to be the first-ever recorded surgery in early literature in 1750. There was no distinction at the time between a colostomy and an ileostomy.

The first patient to undergo the procedure – and survive – was a lady named Margaret White of London who ruptured her abdominal wall following severe vomiting. She was 73 years old and suffered a number of health problems as a result of tears in her intestines.

After consulting with a surgeon known as William Cheselden, it was discovered that 55 centimetres of Margaret’s intestine were dead.

Cheselden removed the gangrenous portion of the prolapsed gut and left the sound portion, thought to be the small intestine, hanging through her umbilicus.

Despite the hospitals’ poor hygiene and surroundings, Margaret survived the treatment and walked around for many years, likely managing the output with rags and towels because there was no stoma care or wound management at the time.

It wasn’t until the early 1950s that ostomy appliances came onto the medical market and literally changed the lives of ostomates at the time. At this time there were bulky rubber products that were combined with plastic materials that were aesthetically pleasing. But we’ll get to that in just a minute.

Back to Margaret…

Surgeons during the seventeen hundreds were hesitant to conduct procedures in the abdomen area for fear of controversy and scrutiny, as the death of the patient was usually the end result.

Jean Amussat, a surgeon, collated and published a list of all previously done stoma procedures from 1716 to 1839. In total, 27 operations were performed, but only six were successful.

The invention of the stoma was not well received by surgeons and did not gain traction until the First World War; this operation was not only detrimental to a surgeon’s career, but it also resulted in odd experimentation.

The following were the results of these strange experiments (hold on to your shorts guys, these are a little brutal):

Excessive laxative usage
Stool removal by hand through the anus
Placing a kitten on the tummy to allow the heat to warm the abdomen and aid with the passage of faeces
A kilo of mercury was ingested to assist in the passage of a blockage.

As you guessed, many of these therapies were ineffective, and this was exacerbated by the fact that the majority of patients died as a result of mercury poisoning.

Advancing Slowly But Surely

According to historical sources, only a few surgeons prior to and following Mary’s surgery were daring enough to even attempt to make an artificial anus when other therapies failed.

In 1776, a surgeon named M Pillore performed the first successful colostomy on a woman named Mrs M Morel, who had a malignant growth in the rectum and as a result, had a total gut closure. Previously, the stoma was opened in the appendix. With the regular use of clysters, a sponge held in place with an elastic band captured the faeces that came out of the stoma (enema). These occasionally contained mercury as well as other strange compounds.

Unfortunately, this lady died 18 days after her surgery as a result of peritonitis. The autopsy indicated that the cause of death was not the procedure, but a bowel constriction and 1 kg of recoverable mercury that had been injected preoperatively.

Littre’s procedure was used on a newborn baby by a surgeon named Dubois in 1783, but the baby died a week later.

In 1793, the French surgeon Duret performed a successful operation on a newborn who was only a few days old and was born without an anus. He recovered quickly and lived with the stoma for 43 years.

Hendrick Callisen, a Danish surgeon published a surgical handbook in which he outlined the surgical procedure for constructing a colostomy.

In 1815, the first British surgeon, George Freer, had little success. Both of his patients died within a few weeks after the surgery. The cause of this was the excessive use of laxatives and enemas through the stoma. Both patients died as a result of a ruptured appendix.

Finally, A Stoma Success Story

The second British surgeon (after William Cheselden) to perform a colostomy was Daniel Pring who in 1820 performed a sigmoid colostomy on a woman also by the name of White.

This surgical procedure was the first to describe dermal complications in the stoma and the first to report how the faecal matter is kept inside the stoma.

This was the first time that reports of problems including skin ulcers and prolapse were discussed. Stoma devices were deemed to be in need of development. White is supposed to have utilised a pillow, rags, towels, or a bucket to manage her stoma at the time.

The Origins Of The Urostomy

Surgery involving the intestines was risky in the late nineteenth and early twentieth centuries due to a lack of antibiotics and the linkages with peritonitis.

The first reported urostomy operation was performed on a youngster with a congenital defect in 1851; regrettably, the infant died.

Verhoogen and De Grawe created an appendicectomy, which is akin to the urine stoma of the 1980s, in 1909.

Robert Coffee was an American surgeon who pioneered the placement of the urethras in the rectum. Both urine and faeces exited through the same hole using this manner. The biggest disadvantage was that it caused diarrhoea in the patient.

In the 1950s, an American Urologist devised a new urinary stoma in the ileus of the small intestine, with the urethras placed in the reservoir and subsequently placed outside of the body like an ileostomy or colostomy. This was referred to as the Bricker technique.

Since the 1950s, this has been the most often utilised procedure due to the discovery that Coffee’s method resulted in 80 percent of patients suffering from acid poisoning as a result of urine flowing back into the body.

The Ileostomy’s History

The history of ileostomies was a little harder to find while doing research for these topics.

Baum, a German surgeon from Danzig, performed the first experimental ileostomies on a patient with a malignant tumour in 1879. Unfortunately, the patient died 9 weeks later as a result of a leaky gut and post-op complications.

The ileostomy, as explained further down, is a newer technology that was proven to be more useful in individuals with IBD who needed a total colectomy. This was more commonly used after 1950 due to advances in anaesthesia and general anaesthetic being utilised for those that did not require the old chloroform.

Prior to 1950, the ileostomy was a headache to handle because it would close up on itself. In 1883, one surgeon devised a procedure that involved inserting a rod slightly beneath the skin and through the ileostomy, and then cutting the ileostomy in a subsequent operation to construct a double-barrelled stoma.

They would later try skin grafts, but the stoma would either stricture or close up again.

Brooke Bryan demonstrated in 1952 that skin grafts were not viable and discovered that if the end of the small intestine was turned back in itself and linked to the skin, it was prevented from shutting up again. This was such a straightforward and reasonable technique, and it is still utilized today.

“Most plain persons, as well as many physicians and surgeons, have the terror picture of the constantly discharging intestinal stoma and commonly believe, out of ignorance, that death is preferable to an ileostomy,” Dr Albery Lyons noted in 1952.

Medical science has gone a long way in the last 68 years. Stoma surgery is a generally low-risk procedure that enhances our quality of life for many of us.

So that’s a quick rundown of how the stoma came to be. For many of us, the long history and medical discoveries of the last century are either lifesaving or improve the quality of life. I know I wouldn’t be here if it weren’t for medical advances.

CURIOUS TO KNOW THE HISTORY BEHIND THE STOMA?