Nicolás Roberto Robles 
Badajoz, Spain

 

Figure 1. Samuel Taylor Coleridge. Contemporary portrait. Public Domain. Via Wikimedia

Samuel Taylor Coleridge, the tenth and last child of the vicar of Ottery Saint Mary near Devonshire, England, was born on October 21, 1772. In vivid letters recounting his early years he describes himself as “a genuine Sans culotte, my veins uncontaminated with one drop of Gentility.” He had an amazing memory and an eagerness to learn. In 1782, after the death of his father, Coleridge was sent to Christ’s Hospital, a London grammar school where he trained in Hebrew, Latin, Greek (at which he excelled), and English composition. Financial problems, however, drove him from Cambridge, and in his third year he traveled to London to enlist in the 15th Dragoons under the pseudonym Silas Tomkyn Comberbache. His friends, recognizing how ill-suited he was for military life, were able to buy him out of this improbable destiny. He returned to Cambridge in April 1794, but left in December without completing a degree.

Coleridge left Cambridge because of his developing friendship with Robert Southey. Both young men were interested in poetry and shared the same dislike for the neoclassical style. In their emotional and idealistic conversations, they developed a plan for a “pantisocracy,” a vision of an ideal community to be founded in America. In 1795, under pressure from Southey, Coleridge hesitantly married Sara Fricker, the sister of Southey’s wife, Edith; their first son, Hartley, was born the following year. Shortly afterward, his friendship with Southey ended. That same year, Coleridge met William Wordsworth, who moved to Alfoxden in 1797 to be near the Coleridges at Nether Stowey. The two poets planned Lyrical Ballads, which appeared in 1798. Coleridge’s most important contribution was “The Rime of the Ancient Mariner.”

It is an ancient Mariner,
And he stoppeth one of three.
‘By thy long grey beard and glittering eye,
Now wherefore stopp’st thou me?

In September 1798, he joined the Wordsworths for a long tour of Germany. There, he became quickly fluent in the language and acquainted himself with German philosophy and scholarship. When he returned to England in July of 1799, Coleridge fell in love with Sara Hutchinson, the sister of Wordsworth’s future wife. The domestic trouble this occasioned is evident in the despondent tone of “Dejection: An Ode” (1802):

Figure 2. Engraving by Gustave Doré for an 1876 edition of the Rime of the Ancient Mariner. From Wikimedia Commons.

A grief without a pang, void, dark, and drear,
A stifled, drowsy, unimpassioned grief,
Which finds no natural outlet, no relief,
In word, or sigh, or tear—

Perhaps because he conceived such grand projects, he had difficulty carrying them through to completion and berated himself for his “indolence.” It is unclear whether his growing use of opium was a symptom or a cause of his growing depression. In 1804 he traveled to Sicily and Malta, working for a time as Acting Public Secretary of Malta under Commissioner Alexander Ball. He gave this up and returned to England in 1806. His opium addiction (he was using as much as two quarts of laudanum a week) now began to take over his life. He separated from his wife in 1808, quarreled with Wordsworth in 1810, lost part of his annuity in 1811, put himself under the care of Dr. Daniel in 1814, and finally moved in with Dr. Gilman in Highgate, London, where the doctor and his family managed for the next eighteen years to keep his demon under control. He died on July 25, 1834.

In “The Rime of the Ancient Mariner,” an old sailor tells the harrowing story of a ship lost at sea. Everything starts off well as the ship and crew leave England. The mariner recalls that the voyage quickly darkened, as a giant storm rose up from the sea and chased the ship southward. Quickly, the ship came to a frigid land, where the ice came floating by; the ship was hemmed inside this maze of ice. But then the sailors encountered an albatross, a great sea bird and a symbol of good luck. As it flew around the ship, the ice cracked and split, and a wind from the south propelled the ship out of the frigid regions. The albatross followed behind and the mariner shot and killed it with his crossbow. The wind pushed the ship into a silent sea where the winds died down and the ship was quiet. The sailors blamed the mariner for their plight and hung the corpse of the albatross around his neck like a cross. A weary time passed; but one day, a ship moved toward them. The sailors believed they were saved but as the ship neared, they saw that it was a ghostly, skeletal hull of a ship crewed by Death and the Night-mare Life-in-Death. The sailors dropped dead, one by one—all except the mariner, whom each sailor cursed “with his eye” before dying. Alone on the ship, surrounded by the corpses, the mariner tried to pray but was deterred by a “wicked whisper” that made his heart “as dry as dust.” For seven days and seven nights he endured the sight, and yet was unable to die. At last the moon rose and the great colorful water snakes moved through the silvery moonlight and became beautiful in the mariner’s eyes. He blessed the beautiful creatures in his heart; at that moment, he found himself able to pray, and the corpse of the albatross fell from his neck, sinking “like lead into the sea.”

Figure 3. Christian Albert Theodor Billroth. Photograph by F. Luckhardt. Credit: Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

This poem would make its way into surgical history. On January 29, 1881, Professor Theodor Billroth at his clinic in Vienna completed the first successful partial gastrectomy on Therese Heller, a forty-four-year-old woman who had developed a pyloric carcinoma. The following month Woelfler, when operating on a thirty-eight-year-old man with a pyloric carcinoma, found that the growth had infiltrated the pancreas, making the case unsuitable for a gastrectomy. He therefore performed the first successful gastrojejunostomy, and in 1883 performed the first anastomosis-en-y in order to prevent kinking, an operation later popularized by Roux of Lausanne. Lacking effective drug treatment, gastrectomy was increasingly used for gastroduodenal hemorrhage secondary to peptic ulcer until in 1946 Gordon Taylor recommended “selective surgical interference” for this problem.¹

Many patients were treated with partial or total gastrectomy before the first anti-H2 receptor drug, cimetidine, was introduced in the 1980s. Gastrectomy had many complications, including recurrent ulcers, pernicious anemia, dumping syndrome, and esophageal stricture. This led Johnstone et al² from Vancouver to describe “Albatross Syndrome” in 1967: “Though operation may cure the ulcer, the patient is worse off because the resulting physiologic derangements cannot be accepted or handled by him. These patients continue to haunt the surgeon . . . In Coleridge’s poem the ancient mariner shot the albatross, and when calamity followed, his shipmates hung the dead bird around his neck. The surgeon who operates upon these patients is likely to have them, with their dissatisfaction and multiple complaints, if not about his neck, at least haunting his office or his colleagues, demanding that something be done.”

Alone, alone, all, all alone,
Alone on a wide wide sea!
And never a saint took pity
on My soul in agony.

“The Rime of the Ancient Mariner,” Part 4.

 

End Notes

1. Robinson JO. The History of Gastric Surgery. Postgrad. Med. J. 1960; 36: 706-713.
2. Johnstone FRC, Holubitsky IB, Debas HT. Post-Gastrectomy Problems in Patients with Personality Defects: The “Albatross” Syndrome. Canad. Med. Assoc. J. 1967; 96: 1559-1564.

 

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NICOLÁS ROBERTO ROBLES is a professor of Nephrology at the University of Extremadura.

 

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