In September 1991, a 29-year-old man who cleaned chickens for a living pricked his finger on a bone. A fact that really should not go beyond a little blood and that with a good cleaning and disinfection should end up curing in days.
However, things got worse: first it turned reddish, which presaged an infection, and then it began to give off a bad smell . Surely he was worried that his finger would have to be amputated – and if he delayed any longer he could end up without a hand – so he decided to go to the Royal Gwent Hospital in Newport, Wales. There he was treated by doctors who administered an antibiotic, flucoxacilin.
Days passed and the smell did not go away. Back at the hospital, the doctors tried another antibiotic, ciprofloxacin. Any. The thing was already getting complicated and the poor man was having a really bad time. The rotten smell could be clearly felt in the room he was in.
A team of four doctors, Caroline Mills, Meirion Llewelyn, David Kelly, and Peter Holt, focused their work on two things: first, understanding why it was happening; and second and more important, to solve the smelly problem, which already affected the social and family life of the poor man.
They kept giving him antibiotics in the hope that one would work : they started with erythromycin, an antibiotic used to treat certain bacterial infections, assuming, with good reason, that that smell was indicative of something to blame (in fact, the smell Sweat is produced by the bacteria that live on our skin). Since it didn’t seem to improve, they switched to metronidazole , which is used to treat dermatological conditions, such as acne rosacea. More of the same.
What if he had something lodged inside his hand and they hadn’t seen it? They decided to do a little surgical exploration: they found no foreign body , no pus, no tissue damage. It was a completely normal hand. That didn’t make sense.
They took a sample of the skin for a biopsy, and its culture revealed the existence of a microorganism similar to Clostridium novyi type B , a large bacterium that is present in the soil and in the intestine of all pigs. It is well known in veterinary medicine and has been known to enter the body of animals through breaks in the skin. It produces a series of toxins that produce a gas that quickly kills the host . In fact, the course of the disease is so short in animals that often the only outward symptom is death. Why it was affecting a human being in this way was beyond them.
They took samples from several places along his arm and even his chest, which gave the same result, in addition to discovering two other species of clostridia: C. cochlearium (the closest relative to C. tetani , responsible for tetanus) and C. malenominatum . Doctors gave him long courses of antibiotic therapy and also treated him with hyperbaric oxygen at the British Air Force hospital in Wroughton for two months. This therapy consists of making the patient breathe pure oxygen through a pressurized tube. It is commonly used to treat decompression problems in divers, but is also used for serious infections. An extensive blood test revealed something surprising: he was not immunosuppressed , that is, the patient was healthy, although he did have antibodies against C. novyi type B . On the other hand, studies of his feces did not reveal the presence of any clostridia in his digestive system.
The doctors tried everything to see if they could improve his quality of life, because the smell was really disgusting: more antibiotics, isotretinoin (used for acne), ultraviolet light treatment with psoralen (used for psoriasis), colpermine, probantene, chlorophyll… From time to time they gave him a respite from the antibiotics so that the patient’s own bacterial flora would return to normal levels. Nothing worked. After five years of treatment, this poor man’s finger still smelled rotten . Desperate, Welsh doctors published an article in the medical journal The Lancet in 1996 asking for help: “Although the clinical appearance improved, the most disabling consequence of the infection was a putrid odor emanating from the affected arm, which could be detected through a large room and when confined to a smaller examination room it became almost intolerable.”
This article earned him the 1998 Ig Nobel Prize in Medicine (a prize that recognizes research that “first makes people laugh and then makes them think”). During the award ceremony we were able to find out how it all ended: “Although we received a huge number of letters, nobody had ever seen anything like it, so no suggestion had any effect. However, our story has a happy ending. Our patient no longer smells rotten.”
