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UNFORTUNATE PREDICAMENTS

A REGULAR FEATURE OF any hospital emergency department is the patient who turns up with an embarrassing and entirely self-inflicted complaint. When questioned about the nature of their ailment and how it came about, they may fall silent or offer a less than plausible explanation. In 1953, a man was admitted to a hospital in Barnsley with severe abdominal pain that he said had been plaguing him for almost a fortnight. Surgeons discovered severe tearing in the wall of his rectum, evidently inflicted just a few hours earlier, which they were able to repair. Asked how he had sustained this injury, the patient claimed that he was standing too near a firework “while in a stooping position,” and it had gone off unexpectedly. Pressed for the truth, he admitted that he had become frustrated in his personal life and had “decided to explode a firework up his seat.” That’s one way of dealing with it, I suppose.

The medical literature is brimming with misguided individuals, the forebears of this proctological pyrotechnician, who inserted strange objects in places where they weren’t meant to go. One of the earliest stories concerns a monk who tried to ease his colic by coaxing a bottle of perfume inside his gut; another relates how a surgeon rescued the dignity of a farmer who had somehow ended up with a goblet wedged inside his rectum. But these are prosaic achievements compared with some of the bravura feats recorded in the following pages. What is so impressive about many of these tales of mishap is the sheer ingenuity that had gone into creating a highly regrettable situation—often matched by the imaginative manner in which a physician or surgeon went about treating the unfortunate patient.

Medicine has improved almost beyond recognition in the past few centuries, but some things never change. The human capacity for mischief, misadventure and downright idiocy is apparently a trait that progress cannot eradicate.

A FORK UP THE ANUS

Modern medical journals aren’t exactly famous for their snappy headlines. The professional terminology doesn’t help: It’s not easy to write a zinger of a heading if the subject of your article has a name like bestrophinopathy, idiopathic thrombocytopenic purpura or necrotizing fasciitis.

But recent years have seen a fightback against such sterile jargon, with a few researchers trying to grab their readers’ attention by means of literary allusions, pop culture references and bad puns. One recent article in The New England Journal of Medicine made a desperate pitch to George R. R. Martin fans with the headline “Game of TOR: The Target of Rapamycin Rules Four Kingdoms.” Another, about foreign bodies in the bladder, was headed “From Urethra with Shove.”* And for sheer chutzpah, it’s difficult to beat “Super-mesenteric-vein-expia-thrombosis, the Clinical Sequelae Can Be Quite Atrocious”—the improbable title of an article about a serious complication of appendicitis.

But my favorite medical headline of all was written almost three hundred years ago. In 1724, the Philosophical Transactions, the journal of the Royal Society, published a letter from Mr. Robert Payne, a surgeon from Lowestoft in Suffolk. The title is unimprovable:

James Bishop, an apprentice to a ship-carpenter in Great Yarmouth, about nineteen years of age, had violent pains in the lower part of the abdomen for six or seven months. It did not appear to be any species of the colic; he sometimes made bloody urine, which induced Mr P. to believe it might be a stone in the bladder. He was very little relieved by physic; at length a hard tumour appeared in the left buttock, on or near the glutaeus maximus, two or three inches from the verge of the anus, a little sloping upwards. A short time after, he voided purulent matter by the anus, every day for some time.

This is the old sense of the word tumor: not necessarily indicating abnormal tissue growth, but a swelling of any description. This example was, as it turned out, some sort of cyst, and eventually its surface broke. The surgeon suspected it was an anal fistula—an anomalous channel between the end of the bowel and the skin. But events soon proved him wrong:

Shortly after the prongs of a fork appeared through the orifice of the sore, above half an inch beyond the skin. As soon as the prongs appeared, his violent pains ceased; I divided the flesh between the prongs, according to the best of my judgment; and after that made a circular incision about the prongs and so with a strong pair of pincers extracted it, not without great difficulty, handle and all entire. The end of the handle was besmeared with the excrement, when drawn out.

Naturally. This was a surprisingly large item of cutlery:

It is six inches and a half long, a large pocket-fork; the handle is ivory, but is dyed of a very dark brown colour; the iron part is very black and smooth, but not rusty.

The young man was reluctant to explain how he had managed to get himself in this predicament; at least, not until he was threatened with the withdrawal of his allowance.

A relation of his, a Gentleman in this neighbourhood, who sent him to be under my care, the Reverend Mr Gregory Clark, Rector of Blundeston, on whom, in a great measure, his dependence is, threatened never to look upon him more, unless he would give him an account how it came; and he told him, that, being costive,* he put the fork up his fundament, thinking by that means to help himself, but unfortunately it slipped up so far, that he could not recover it again.

Mr. Payne adds a postscript:

PS: He says he had no trouble or pain till a month, or more, after it was put up.

A fact that does not alter the moral of this cautionary tale: If you’re constipated, it’s better not to stick a fork up your fundament.

SWALLOWING KNIVES IS BAD FOR YOU

Compulsive swallowers have always featured heavily in medical literature. There are numerous cases in nineteenth-century journals—but most of the individuals concerned were obviously suffering from some kind of mental illness. This, from the Medico-Chirurgical Transactions for 1823, is the first I’ve come across in which the patient was swallowing knives for a laugh.

In the month of June 1799, John Cummings, an American sailor, about twenty-three years of age, being with his ship on the coast of France, and having gone on shore with some of his shipmates about two miles from the town of Havre de Grace, he and his party directed their course towards a tent which they saw in a field, with a crowd of people round it. Being told that a play was acting there, they entered, and found in the tent a mountebank, who was entertaining the audience by pretending to swallow clasp-knives. Having returned on board, and one of the party having related to the ship’s company the story of the knives, Cummings, after drinking freely, boasted that he could swallow knives as well as the Frenchman.

Not a particularly wise boast, and his comrades lost no time in challenging him to prove it. Eager not to disappoint them, he put his penknife in his mouth and swallowed it, washing it down with yet more booze.

The spectators, however, were not satisfied with one experiment, and asked the operator “whether he could swallow more?”; his answer was, “all the knives on board the ship”, upon which three knives were immediately produced, which were swallowed in the same way as the former; and “by this bold attempt of a drunken man”, (to use his own expressions) “the company was well entertained for that night.”

Actions have consequences, as every sailor should know, and when foreign objects are ingested, the “consequences” usually come within twelve hours. And lo, it came to pass.*

The next morning he had a motion, which presented nothing extraordinary; and in the afternoon he had another, with which he passed one knife, which however was not the one that he had swallowed the first. The next day he passed two knives at once, one of which was the first, which he had missed the day before. The fourth never came away, to his knowledge, and he never felt any inconvenience from it.

So no problem, right?

After this great performance, he thought no more of swallowing knives for the space of six years. In the month of March 1805, being then at Boston, in America, he was one day tempted, while drinking with a party of sailors, to boast of his former exploits, adding that he was the same man still, and ready to repeat his performance; upon which a small knife was produced, which he instantly swallowed. In the course of that evening he swallowed five more. The next morning crowds of visitors came to see him; and in the course of that day he was induced to swallow eight knives more, making in all fourteen.

It seems safe to assume at this point that Mr. Cummings was not—ahem—the sharpest knife in the drawer.

This time, however, he paid dearly for his frolic; for he was seized the next morning with constant vomiting and pain at his stomach, which made it necessary to carry him to Charleston hospital, where, as he expresses it, “betwixt that period and the 28th of the following month, he was safely delivered of his cargo.”

No doubt this was a common naval euphemism of the time rather than an original bon mot; but it made me laugh. Having “emptied the hold,” Cummings boarded a vessel traveling to France. But on the return journey, his ship was intercepted by HMS Isis, and he was press-ganged into service with the Royal Navy.

One day while at Spithead, where the ship lay some time, having got drunk and, as usual, renewed the topic of his former follies, he was once more challenged to repeat the experiment, and again complied, “disdaining,” as he says, “to be worse than his word.”

An honorable person may keep their word, but a sensible one does not consume five knives, as the misguided American did that night. And he still wasn’t finished; far from it.

On the next morning the ship’s company having expressed a great desire to see him repeat the performance, he complied with his usual readiness, and “by the encouragement of the people, and the assistance of good grog”, he swallowed that day, as he distinctly recollects, nine clasp-knives, some of which were very large; and he was afterwards assured by the spectators that he had swallowed four more, which, however, he declares he knew nothing about, being, no doubt, at this period of the business, too much intoxicated to have any recollection of what was passing.

Dear oh dear. Will he never learn?

This, however, is the last performance we have to record; it made a total of at least thirty-five knives, swallowed at different times, and we shall see that it was this last attempt which ultimately put an end to his existence.

Feeling like death, and probably more than a little foolish, Cummings applied to the ship’s surgeon for laxatives, but the drugs he was given had no effect.

At last, about three months afterwards, having taken a quantity of oil, he felt the knives (as he expressed it) “dropping down his bowels”, after which, though he does not mention their being actually discharged, he became easier, and continued so till the 4th of June following (1806), when he vomited one side of the handle of a knife, which was recognized by one of the crew to whom it had belonged.

And who presumably was not eager to reclaim it.

In the month of November of the same year, he passed several fragments of knives, and some more in February 1807. In June of the same year, he was discharged from his ship as incurable; immediately after which, he came to London, where he became a patient of Dr Babington, in Guy’s Hospital.

The doctors did not believe his story and discharged him. His health improved, and it was not until September 1808 that he reappeared:

He now became a patient of Dr Curry, under whose care he remained, gradually and miserably sinking under his sufferings, till March 1809, when he died in a state of extreme emaciation.

Even during this final illness, the doctors treating him refused to believe that he had swallowed more than thirty knives, until . . .

Dr Babington having one day examined him, conjointly with Sir Astley Cooper, these gentlemen concluded, from a minute inquiry into all the circumstances of the case, and especially from the deep black colour of his alvine evacuations,* that there really was an accumulation of ferruginous* matter in his organs of digestion. And this was fully confirmed soon afterwards by Mr Lucas, one of the surgeons of the hospital, who, by introducing his finger into the rectum, distinctly felt in it a portion of a knife, which appeared to lie across the intestine, but which he could not extract, on account of the intense pain which the patient expressed on his attempting to grasp it.

The doctors tried to dissolve the knives (or at least blunt their edges) with nitric and sulfuric acids, a measure that must have done more harm than good. Powerless to help their patient, they had to watch as he wasted away and finally died. The physicians dissected his body and found that the inside of the abdomen presented an extraordinary sight: The tissues were stained a dark rusty color. Several blades were found inside the intestines, one of them piercing the colon. This alone would have been enough to kill him. But that wasn’t all:

The stomach, viewed externally, bore evident marks of altered structure. It was not examined internally at this time, but was opened soon afterwards, in the presence of Sir Astley Cooper and Mr Smith, surgeon of the Bristol infirmary, who happened to be present at that moment, when a great many portions of blades, knife-springs, and handles, were found in it. These fragments were between thirty and forty in number, thirteen or fourteen of them being evidently the remains of blades; some of which were remarkably corroded, and prodigiously reduced in size, while others were comparatively in a state of tolerable preservation.

A close examination of the abdominal organs also cleared up one question that had puzzled the doctors: Why was it that some knives had traveled through the gut virtually unaltered, while others had been partly digested?

When the stomach was able to expel them quickly, they passed through the intestines, enclosed within their handles, and therefore comparatively harmless; while at a later period, the knives were detained in the stomach till the handles, which were mostly of horn, had been dissolved, or at least too much reduced to afford any protection against the metallic part.

There are lessons to be learned here. Trying to impress your friends while under the influence of industrial quantities of alcohol is more often than not a really terrible idea. And more importantly, the correct answer to the question “Can you swallow more knives?” is never “All the knives aboard the ship.”

THE GOLDEN PADLOCK

INFIBULATION, n: The action of infibulating; spec. the fastening of the sexual organs with a fibula or clasp.

[OED]

This is not a word one encounters very often, so I had to look it up.* It seems to have made its first appearance in John Bulwer’s Anthropometamorphosis (Transformation of Humanity), a treatise on tattoos, piercings and other forms of body modification published in 1650. Bulwer reveals that in ancient Greece, infibulation was used to keep young male actors chaste:

Among the Ancients, to prevent young effeminate inamoratos, especially comedians, from untimely venery, and cracking their voices, they were wont to fasten a ring or buckle on the foreskin of their yard.*

I probably would have remained in blissful ignorance of this cruel practice had it not been for this entertaining article, published in The London Medical and Physical Journal in 1827:

Some years ago M. Dupuytren was consulted by Dr Petroz, upon the case of M, the head of one of the most important manufactories in France.

This is the nineteenth-century equivalent of the CEO of Airbus or Ford walking into your hospital with an embarrassing problem. And this particular “problem” was very embarrassing indeed.

He was about fifty years of age, of a strong and good constitution. For a long time he had had an abundant and foetid discharge from the penis: he made water with difficulty; the prepuce was much swollen, hard, and ulcerated in different parts.

The prepuce is, of course, the foreskin. And this specimen certainly sounds as if it had seen better days.

So far the case presented nothing remarkable; but the curiosity of the attendants was strongly excited by observing that the prepuce had been pierced through in several places, and that the aperture and borders of these small orifices were completely covered by a perfectly-organized cutaneous tissue.

“Perfectly-organized” means that new skin had formed over the edges of the wounds, in much the same way that an ear piercing will become lined with new skin after a few weeks, as long as an earring or stud is left inside it to keep the hole open. This observation turned out to be significant.

M. Dupuytren determined, before he proceeded to any decisive mode of treatment, to ascertain in what manner these perforations in the prepuce had happened. The patient stated that, when a young man, he had visited Portugal, where he had remained several years. He there formed a tender liaison with a young female of strong passions, and equally strong jealousy. He was devotedly attached to her, and she acquired over him the most absolute influence.

A caring relationship between a successful French businessman and his passionate Portuguese lover. How sweet.

One day during the transports of their mutual passion, he felt a slight pricking sensation in the prepuce; but, having his attention completely abstracted by the caresses of his fair mistress, he did not even examine from whence arose the disagreeable feeling he had experienced. But, on retiring from the embraces of the lady, he found the prepuce secured by a little golden padlock, beautifully made, of which she had kept the key!

Rather less sweet. It’s romantic in a way, I suppose, but not the sort of gesture that everybody would appreciate.

It would appear that the lady was not deficient in eloquence, for she kept her lover in good humour by her rhetoric, assisted, indeed, by occasional caresses, and persuaded him not only to permit the padlock to remain, but to consider it a very ornamental appendage. She even gained permission to re-apply it each time, that the skin which was pierced appeared weakened; and, however incredible it may seem, she at length, “to make assurance doubly sure”, put on two locks.

This seems a little excessive, and it’s surprising that her paramour agreed to it. On the other hand, it may be that “M” was finding the whole thing more pleasurable than he cared to admit to his doctors.

M remained in this state for four or five years, constantly wearing one or two of the locks appended to the prepuce, the key of which was of course taken especial care of by his mistress. The consequence ultimately was that the prepuce became diseased, and a cancerous affection was threatened, when M. Dupuytren was consulted.

Cancerous was sometimes used to describe persistent ulceration rather than a malignant growth, so this may simply have been a chronic infection in a uniquely delicate area.

The safest and most effectual course was then adopted. The prepuce was removed by an operation nearly resembling circumcision. Under the care of M. Sanson, the cure was complete in less than three weeks. The patient has remained in perfect health.

Let’s hope that this French captain of industry managed to keep the episode secret from his employees. It’s not the sort of anecdote you want cropping up at the staff Christmas party.

THE BOY WHO GOT HIS WICK STUCK IN A CANDLESTICK

As the most celebrated and successful surgeon in early-nineteenth-century France, Guillaume Dupuytren had a few things to be proud of. He was a virtuoso technician, the master of every operation in the surgical repertoire and the inventor of several new ones. Medical students came from all over Europe for the chance to squeeze into the back of a lecture theater and witness his eloquence at first hand. He became so fabulously wealthy that he once offered to lend Charles X a million francs to relieve the privations of exile.* Dupuytren was good, and he knew it. When one of his juniors complimented him on the seemingly infallible perfection of his surgery, he replied, “Je me suis trompé, mais je crois m’être trompé moins que les autres” (“I’ve made mistakes, but I think I’ve made fewer than everybody else”).

Dupuytren’s career was one studded with daring surgical feats and landmark cases. And then there’s this one. Published in a Parisian journal in 1827, it appeared under a headline that translates, roughly, as “Strangulation of the Penis by a Candlestick.”

A boy, an apprentice cooper, came to the Hôtel-Dieu: from his groans, his swollen red features, his painful gait, the way he leaned while walking, stamped his feet and clutched at his genitals, one could see that he was in a great deal of pain, and that the cause of this pain was probably the urinary tract. While hastily taking off his underwear he managed to stammer that he was suffering from retention of urine, and then produced a penis which was purple, enormously swollen, and divided in the middle by a deep furrow. On separating the folds of skin which formed the edges of this depression, M. Dupuytren discovered a yellow metallic foreign body; he parted the skin further and recognised, to his amazement, the socket of a candlestick, the wider end of which was facing forward, that is to say towards the pubis.

“Socket” is perhaps not the best translation for the original French word bobèche, which is a sort of ring or collar around the outside of a candlestick, intended to catch drips of hot wax. Or a teenage boy’s penis, in this case.

The torments of the patient were terrible. He had not urinated for three days; his bladder was greatly distended and extended right up to the navel; the penis was threatened by imminent gangrene. It was essential to remove the cause of this strangulation and the retention of urine without delay. While the instruments for the operation were being prepared, the patient, who had been pressed with questions, confessed that during a debauched and drunken game he had taken the socket of his candlestick for something else, and stuck his penis in it.

Boys, eh?

Once it had been forced into the tube of this utensil he could not pull it out, and all his efforts to do so merely had the effect of increasing his misery; moreover, the sharp and narrow opening of the socket was facing forwards and pressing against the edge of the glans, which it had started to gouge.

Ouch.

M. Dupuytren first cut the wide end of the socket at two opposite points; then with considerable difficulty, because of the swelling of the parts, separated it into two portions by extending his incision. An assistant was then able to insert the smaller ends of two spatulas between the edges of the divided cylinder, which soon yielded to the efforts of the surgeon and his aide, and separated into two parts which immediately liberated the penis.

It sounds as if the operation really called for a team of firefighters rather than a surgeon. Either way, I suspect most men would demur at having cutting equipment employed in such close proximity to their, ahem, equipment. After three days without urination, the boy’s bladder contents must have been at enormous pressure, so it does not take much imagination to work out what happened when that pressure was released.

M. Dupuytren learned that the strangulation had been successfully relieved when a jet of urine was projected against him.

Charming.

The patient, who was simultaneously ashamed and delighted, immediately ran off without bothering to put on his undergarments; and as he passed through the crowd he left on them—and on the square in front of Notre Dame—abundant liquid proofs of the success of the operation, which had at once removed the torments he had endured from retention of urine, as well as the danger of gangrene and even death.

As M. Dupuytren wrung out his sodden clothes, I’m sure he shared in the young man’s delight.

SHOT BY A TOASTING FORK

Until the nineteenth century, most people believed that a wound to the heart meant instant death. According to centuries of tradition, the organ was the seat of the emotions, the locus of the soul and the center of the human organism. It was natural to assume that injuring this “fountain of the vital spirits” (as the sixteenth-century surgeon Ambroise Paré called it) would put an end to life. Many doctors were of the same opinion: After all, hadn’t the great Galen, the most revered authority in the history of Western medicine, written that cardiac wounds were inevitably fatal? It must be true.

As the better class of medic knew, there was already plenty of evidence to prove otherwise. Paré himself examined the body of a duelist who had managed to run two hundred paces with a large sword wound in his heart. Others found scars in the cardiac tissue of patients who had died from natural causes—the remnants of injuries inflicted months or years earlier. Galen’s assertion was thoroughly debunked, but in some quarters, it clung on stubbornly, a persistent medical myth. Cases of prolonged survival (or even recovery) after cardiac injury were still of sufficient novelty value in the 1830s to merit publication. This example, submitted to a journal in 1834 by Thomas Davis from Upton-upon-Severn in Worcestershire, is one of the best. Davis described himself as a surgeon but, like many provincial medics of the period, was in fact an apothecary without any formal qualifications.*

On Saturday evening, January the 19th, 1833, I was summoned to attend William Mills, aged 10, living at Boughton, two miles from Upton. When I arrived, his parents informed me that their son had shot himself with a gun made out of the handle of a telescope toasting-fork.

Certainly an unusual way to greet a doctor. If you’ve decided to construct an improvised firearm, a toasting fork is unlikely to be the first implement that comes to mind.

To form the breech of the gun, he had driven a plug of wood about three inches in length into the handle of the fork. The touch hole of the gun was made after the charge of powder had been deposited in the hollow part of the handle.

Ingenious, if not particularly wise.

The consequence was that when the gunpowder exploded it forced the artificial breech, or piece of stick, from the barrel part of the gun, with such violence that it entered the thorax of the boy, on the right side, between the third and fourth ribs, and disappeared. Immediately after the accident the boy walked home, a distance of about forty yards.

The fact that he was still able to walk appeared a good sign, and when the doctor examined the boy, the case did not immediately seem a serious one.

By the time I saw him, he had lost a considerable quantity of blood, and appeared very faint; when I turned him on his right side, a stream of venous blood issued from the orifice through which the stick entered the thorax. Several hours elapsed before any degree of reaction took place. He complained of no pain.

Indeed, in the aftermath of the incident, he hardly seemed to have been affected by it.

For the first ten days or a fortnight after the accident he appeared to be recovering, and once, during that time, walked into his garden, and back, a distance of about eighty yards; and whilst there, he amused himself with his flowers, and even stirred the mould.

Hobbies: horticulture and firearms. A slightly odd combination for a ten-year-old.

He always said he was well, and was often cheerful, and even merry. There was no peculiar expression of countenance, excepting that his eyes were rather too bright. After the first fortnight he visibly emaciated, and had frequent rigors, which were always followed by faintness. The pulse was very quick. There was no cough nor spitting of blood. The secretions were healthy. He had no pain throughout his illness. He died on the evening of the 25th of February, exactly five weeks and two days after the accident occurred.

The doctor was essentially helpless to intervene. He had no way of finding out where in the body the piece of wood had ended up, and without anesthetics (still over a decade away), it was impossible to perform an exploratory operation. There was an autopsy; Dr. Davis was joined by three colleagues and, strangely, the boy’s father:

On opening the thorax, a small cicatrix* was visible between the cartilages of the third and fourth ribs, on the right side, about half an inch from the sternum. The lungs appeared quite healthy, excepting that there was a small tubercle* in the right lung, and at its root, near to the pulmonary artery, a small blue mark in the cellular tissue, corresponding, in size, with the cicatrix on the parietes* of the chest.

All this is consistent with a wound caused by the piece of wood, which had apparently passed through the chest between two ribs and entered the right lung. But then came a surprise.

The heart, externally, appeared healthy. When an incision was made into the heart so as to expose the right auricle and ventricle we were astonished to find, lodged in that ventricle, the stick which the boy had used as the breach of the gun, the one end of it pressing against the extreme part of the ventricle, near the apex of the heart, and forcing itself between the columnae carneae and the internal surface of the heart; the other end resting upon the auriculo-ventricular valve, and tearing part of its delicate structure, and being itself encrusted with a thick coagulum, as large as a walnut.

The stick had lodged in the right side of the heart, the side that propels deoxygenated blood toward the lungs. The right auricle (known today as the right atrium) is the chamber by which blood enters the heart, before passing through the tricuspid (auriculo-ventricular) valve into the pumping chamber of the right ventricle. The columnae carneae (from the Latin, literally “meaty ridges”) are a series of muscular columns that project into the ventricle. The stick had somehow become wedged underneath them, and a large clot had formed around it—as one would expect when a foreign body spends any length of time in the bloodstream.

We searched, in vain, for any wound, either in the heart itself, or in the pericardium, by which the stick could have found its way into the ventricle.

Highly significant. If the stick had simply pierced the wall of the heart, two things are likely to have happened. First, the boy would almost certainly have died within minutes: A wound big enough to admit such a large object would have caused catastrophic bleeding. Second, in the unlikely event that he had survived, it would have left a significant scar on the heart muscle.

This case strikes me as one of the most interesting on record. In the first place, that this child should have survived such an accident as the lodgement of a stick, three inches in length, in the right ventricle, and have been afterwards equal to so much muscular exertion as he was, appears wonderful, especially if we consider the mechanical difficulty which the heart had thereby to encounter in carrying on the circulation of the blood. In the next place, it appears somewhat difficult to point out how the stick found its way into the right ventricle of the heart. There was no wound, nor remnant of a wound, either in the pericardium, or in the muscular structure of the heart.

Dr. Davis now comes up with an explanation that must have seemed deeply implausible to many of his colleagues. But it’s probably correct. During the First World War, surgeons encountered a number of soldiers who had a bullet in the cardiac chambers that had been swept there in the bloodstream, having entered through a blood vessel such as the vena cava (the body’s largest vein, which takes deoxygenated blood back to the heart). Something similar seems to have happened in this case:

I am inclined, myself, to think that the stick, after wounding the lung, passed into the vena cava, and was carried by the stream of blood first into the right auricle, and then into the right ventricle, where it became fixed, in the manner before specified, and as is shewn in the accompanying plate.

This was indeed a remarkably interesting case, so we’re lucky that the doctor took the trouble to commission an illustration. Bear in mind that the boy lived for over a month with this stick in situ.

MR. DENDY’S EGGCUP CASE

Although Walter Cooper Dendy practiced as a surgeon, his most lasting contribution to the world of medicine was not an operation or instrument, but a word. In 1853, he wrote an article entitled “Psychotherapeia, or the Remedial Influence of Mind” detailing his interest in the therapeutic possibilities of the new science of psychology. Dendy’s books about skin diseases and chicken pox may have been forgotten, but the discipline he named, psychotherapy, marches on.

If there’s any justice in this world, he will also be remembered for a gem of a story he contributed to The Lancet in 1834. The heading at the top of each page refers to it simply as “Mr Dendy’s Egg-Cup Case”—a splendid description of a splendid case:

Mr Adams, a man 60 years of age, had been afflicted with inguinal hernia 25 years, which, although very frequently descending into the scrotum, had never been strangulated.

Even if you’ve no idea what this means, phrases like “descending into the scrotum” and “strangulated” make it abundantly clear that it’s not much fun. An inguinal hernia is one affecting the groin. This relatively common condition occurs when part of the abdominal contents (usually a portion of intestine) drops through the inguinal canal, a passage between the abdominal cavity and the external genitalia. It usually manifests as a soft swelling around the pubic bone, although in more severe cases in men, the hernia can even protrude into the scrotum. A “strangulated” hernia is one in which the compression of local blood vessels leads eventually to tissue death.

Three months previous to his death he laboured under diarrhoea, which terminated in dysentery, from which he was partially relieved.

Dysentery, diarrhea accompanied by blood, may have been caused by some degree of strangulation. The doctors first tried using leeches, laxatives and emetics in an attempt to reduce inflammation—a regime known as the antiphlogistic plan and very much in vogue in the 1830s. If you can imagine donating blood while simultaneously throwing up and enduring constant diarrhea, you’ll have a rough idea of how enjoyable it was for the patient. The initial signs in this case were encouraging; but then . . .

About a week subsequent to this the acute symptoms returned, with other signs, indicating strangulation or obstruction, such as stercoraceous vomiting and singultus, tumefaction of the abdomen, etc.—the bowels however repeatedly ejecting very scanty fluid evacuations.

Stercoraceous is an unpleasant word for an unpleasant phenomenon: The patient was vomiting what appeared to be feces. Singultus is an unnecessary piece of medical jargon meaning “hiccups.” Mr. Dendy knew that such symptoms indicated that the small intestine was blocked, so he had another look at the hernia to see if he could identify the affected part of the gut.

On minute examination I discovered a very small knuckle of intestine deeply situated, which appeared to be intimately adherent to the mouth of the sac. As there was in this tumour extreme tenderness, I did not hesitate, after a brief endeavour to return it by the taxis, to propose an immediate operation.

Taxis is manipulation. Strangulated hernia is a medical emergency that is rarely, if ever, resolved without surgical intervention; Mr. Dendy’s instincts were absolutely correct.

The friends consented, but the patient refused, stating no reason but that he did not like to be cut.

In 1833, this certainly would have been a frightening prospect, but the patient may have had other reasons for declining the operation, as it later transpired.

I therefore contented myself with palliative means, having by repeated gentle pressure returned the knuckle to the mouth of the sac, after which the stercoraceous vomiting ceased.

A positive sign, but deceptive.

He sank gradually, the abdomen becoming more and more distended, and on the 4th of December he died at three p.m., without having at any time during his illness made the slightest allusion to the circumstance which was eventually proved to have been the essential cause of his severe disorder.

This “circumstance” became clear as soon as Mr. Dendy performed a postmortem: The man’s bowels contained an unexpected item of crockery.

On opening the abdomen the small intestines were seen much distended and discoloured, and on turning the superior folds aside, my finger came in contact with a hard substance which projected through the coats of the intestine. This intestine was the cross-fold of the ileum, and on further examination we were astonished to discover, through its attenuated* coats, an earthenware eggcup closely impacted within it—the bevelled and indented edge of the cup resting on the spine—the broken stem of the cup, which projected through the bowel, near the crista of the left ilium.

The “crista,” or crest, of the ilium is the curved part at the top of the pelvic bone. The eggcup had actually pierced the intestine—at this date, an inevitably fatal injury, as the gut contents would rapidly cause infection. Mr. Dendy found that there were therefore two separate injuries to the bowel: the hernia and the puncture caused by the eggcup. Naturally enough, he was keen to establish how this unusual foreign object had found its way into the patient’s small intestine.

I therefore requested my friend, Mr Stephens (as I was engaged with my pencil at this point), to trace the colon from the caecum downwards.

The cecum is a blind pouch at the junction of the small and large intestines.

This inspection demonstrated the whole course of the large intestines to be in a comparatively healthy condition. The small intestines, on the contrary, the ileum especially, were extremely distended and discoloured—the graduated tints of crimson and dull purple evincing long-continued disease, which was still further confirmed by numerous patches of ulceration.

What does this tell us about the eggcup’s likely route of ingress? Let’s face it, the options for eggcup self-insertion are somewhat limited. Mr. Dendy concluded that the patient had swallowed the item of breakfast crockery rather than inserting it through the anus, his reasoning being that the lower part of the gut appeared healthy, while the small intestine was obviously diseased. But, as he admits, most people would be incapable of getting such a large object past the back of the throat. Mr. Dendy dismisses this objection to his theory with the observation that the circumstances “render it one of the most curious instances of which we have any record.”*

I suspect that most modern experts would agree, if only on psychological grounds, that it’s far more likely that a patient would stick an eggcup up their bottom than swallow it. This would also explain why the unfortunate patient was so unwilling to mention the large foreign body lodged in his gut. The article concludes with a drawing of the eggcup (presumably the work of Mr. Dendy, who was a talented artist), complete with its charmingly naïve decoration.

It’s obviously one of the imitation Chinese designs that became enormously popular toward the end of the eighteenth century: This particular example is a pattern called Broseley, which was used by many china and porcelain manufacturers of the period. But there is one quirk of the design that may permit an even more specific identification: The figures crossing the bridge are holding a parasol and a shepherd’s crook. Of all the firms that used the Broseley pattern, only one seems to have included these props: Rathbone, a company active in the Staffordshire Potteries between 1812 and 1835. We may be no nearer to understanding how Mr. Dendy’s patient came to have an eggcup inside his small intestine, but at least we know where it came from.

BROKEN GLASS AND BOILED CABBAGE

A significant proportion of the strangest medical cases on record fall neatly into a category we might call “unbelievably stupid things done by young men.” As a student, I made my own contribution to this sizable canon when I somehow contrived to burn my nose while ironing a shirt.*

An even more idiotic self-inflicted injury was recorded in a book about emergency medicine published in 1787 by the anatomist Antoine Portal, personal physician to Louis XVIII and the founder of the French Royal Academy of Medicine. In a chapter dealing with the accidental ingestion of various dangerous substances, he recalls his inventive treatment of one particularly tricky patient:

I saw a young man who during a drinking bout challenged his companions to swallow a part of his glass; he broke fragments from his glass with his teeth and then swallowed them; but not with impunity.

One would rather expect there to be consequences of some kind.

He was soon seized with frightful cardialgia;* convulsive movements came on, and fears were entertained for the life of this giddy-headed young fellow, when his friends came for me.

Giddy-headed seems quite mild under the circumstances.

I first had him bled; but as the principal object of the treatment was to extract the glass which caused the symptoms, I was much embarrassed as to the means of doing so. On the one hand, I saw that tartar emetic would increase the irritation and contraction of the stomach, and that the glass would get more closely into its parietes; on the other hand, purgatives would drive the glass into the intestinal canal, the long extended surfaces of which would probably become excoriated.

A subtle and suitably cautious train of thought. There were only two options: The glass had to be either vomited out or evacuated through the anus. Portal knew that he could use tartar emetic to provoke vomiting, but he also realized that the muscular contractions could drive the shards of glass through the stomach wall. The alternative was even worse: If the glass were allowed to get any lower into the digestive tract, with its many coils and turns, it would certainly cause a massive hemorrhage. A dilemma indeed. The solution he came up with was beautifully ingenious:

I thought it right, therefore, to advise the patient to fill his stomach with some food which might serve as a recipient to the glass, and then to produce vomiting. Some cabbages were procured and boiled; the patient ate a considerable quantity of them, and I then gave him two grains of tartar emetic in a glass of water.

I’d love to know how many cabbages constituted “a considerable quantity,” but I’m guessing it was more than two. Let’s hope the patient liked cabbage.

The patient soon vomited, and threw up a considerable quantity of glass among the cabbage. He subsequently took a good deal of milk, was put into a bath, and had some emollient clysters.

Physicians of the period had a bewildering variety of formulations for their enemas, or clysters, as they were generally known. One writer distinguishes between eight types, known as purgative, emetic, tonic, exciting, diffusible, narcotic, laxative and emollient. An “emollient” (softening) clyster was, in the words of one authority, “called for in dysentery and other diseases attended with much irritability of the bowels.” There were apparently as many recipes for preparing it as there were doctors using it. The eighteenth-century physician Richard Brookes used palm oil, cow’s milk and an egg yolk; Richard Reece’s Medical Guide (1828) suggests that it should include “gelatinous and oily articles, as the decoction of the roots and leaves of the marshmallow, linseed, barley, starch, calves’ feet and flesh, hartshorn shavings, etc.”; Thomas Mitchell’s Materia Medica and Therapeutics (1857), on the other hand, declares that

From two to four ounces of fresh butter, or the same quantity of sweet oil, in a half-pint of thin starch or slippery elm infusion, will make a good emollient clyster. An ounce of mutton suet well grated and boiled in a pint of milk will give an excellent injection, and one that has been very useful in dysenteric affections.

None of these preparations sounds terribly pleasant. Nevertheless, for Portal’s patient, it seems to have done the trick:

As he had become very lean in spite of these methodical aids, I advised him to drink asses’ milk, which he did for more than a month, and which restored him to his former state of health.

Cabbage and asses’ milk make rather unlikely therapeutic bedfellows, but Dr. Portal clearly knew what he was doing.

HONKING LIKE A GOOSE

Humans have a remarkable capacity for misadventure, and over the years almost any object you care to think of has been extracted from some patients’ airways. Nails, nuts, leeches, sheep’s teeth, bullets, even part of a walking stick: All these objects and more were recorded within the space of a few years in the early nineteenth century.

But I think the following tale takes the prize for sheer outlandishness. In 1850, The British and Foreign Medico-Chirurgical Review printed a report by a German surgeon, Karl August Burow. A professor at the University of Königsberg, Burow was a pioneer of facial reconstruction and invented the Burow triangle, a technique still used by plastic surgeons today. Though this case report shows a certain ingenuity, it cannot claim quite the same historical significance, for the object he was asked to remove from a patient’s throat was . . . another throat. A goose’s throat, to be precise:

The children in Dr Burow’s vicinity are very fond of blowing through the larynx of a recently-killed goose, in order to produce some imitation of the sound emitted by this animal.

An odd pastime, but it’s better than selling drugs or robbing little old ladies, I suppose.

A boy aged 12, while so engaged, was seized with a cough and swallowed the instrument; a sense of suffocation immediately ensued, which was after a while replaced by great dyspnoea.* Dr Burow found him labouring under this eighteen hours after, his face swollen, of a bluish-red colour, and covered with perspiration. At every inspiration the muscles of the neck contracted spasmodically, and a clear, whistling sound was heard; and at each expiration, a hoarse sound, not very unlike that of a goose, was emitted.

Overlooking the fact that his life was in danger, I must admit that I would like to have heard a child honking like a goose.

As on passing the finger down to the rima glottides* it was found closed, Dr Burow felt convinced (improbable as, from the relative size of the two bodies, it seemed) that the larynx of the goose had passed through it. Tracheotomy was at once performed; but owing to the homogeneousness of structure of the foreign body and of the parts it was in contact with, the greatest difficulty existed in distinguishing it by the forceps.

Tracheotomy is one of the oldest surgical procedures known, described by many ancient authors. In this case the inhaled goose larynx (a phrase I never expected to write) had entirely obstructed the boy’s airway, so making an incision in the throat to help him breathe was the sensible thing to do.

Moreover, so sensitive was the mucous membrane that the instant an instrument touched it, violent efforts at vomiting were produced, and the entire larynx was drawn up behind the root of the tongue. At last, after repeated attempts, Dr Burow having fixed the larynx in the neck by his forefinger so that it could no longer be drawn up on these occasions, he contrived to remove the entire larynx of the animal. The child was quite well by the ninth day.

Tracheotomies were fraught with danger in this era, since postoperative infections were common. This was undoubtedly an excellent result.

Dr Burow says that it was a matter of great congratulation for him that many pupils were present during this operation, and thus able to confirm the correctness of a statement so incredible as to stand much in need of such confirmation.

Well, it’s certainly an unlikely thing to happen; but, on the other hand, who’d make up something like that?

PENIS IN A BOTTLE

Most doctors have found themselves treating a patient with injuries so embarrassing that they are unwilling or unable to provide a plausible explanation. In his book Urological Oddities (1948), the American physician Wirt Bradley Dakin gives a number of feeble excuses provided by patients with strange objects stuck in their bladders, ranging from “I was taking my temperature and it slipped from my grasp” (a thermometer) to “I wanted to see what would happen” (a six-foot coil of wire). Others declined to proffer any explanation, such as the “dignified and prominent citizen” who sought treatment after introducing an earthworm into his own urethra.*

Just occasionally, however, an outlandish-sounding excuse turns out to be entirely truthful. Just such a case was reported in 1849 by Dr. Azariah Shipman, a surgeon from Syracuse in New York. When summoned to treat a young man with a glass bottle stuck on his penis, he was probably not expecting the scenario to have a perfectly innocent explanation:

A few months ago I was called in great haste to a young gentleman, who was in a most ludicrous yet painful condition. I found on examination a bottle holding about a pint, with a short neck and small mouth, firmly attached to his body by the penis, which was drawn through the neck and projected into the bottle, being swollen and purple. The bottle, which was a white one, with a ground-glass stopper and perfectly transparent, had an opening of three fourths of an inch in diameter only; and the penis being much swollen rendered its extraction utterly impossible. The patient was greatly frightened, and so urgent for its removal that he would give me no account of its getting into its present novel situation, but implored me to liberate it instantly, as the pain was intense and the mental anguish and fright intolerable.

I think if I sought medical assistance in such a condition, I would also be hoping for treatment first, explanation second.

Seeing no hopes of getting an explanation in his present predicament, and after endeavouring to pull the penis out with my fingers without success, I seized a large knife lying on the table, and with the back of it I struck a blow on the neck of the bottle, shivering it to atoms and liberating the penis in an instant, much to the delight of the terrified youth.

The tip of the newly liberated member was enormously swollen and black, and blistered as if it had been burned in a fire. As for its owner:

He complained of smarting and pain in the penis, after the bottle was removed; and inflammation, swelling and discoloration continued for a number of days, but by scarification* and cold applications, subsided; yet not without great apprehensions on the part of the patient, and a good degree of real pain in the penis. The reader is probably anxious to know, by this time, how a penis, belonging to a live man, found its way into so unusual a place as the mouth of a bottle.

I have no doubt that everybody who has ever read this case report in the 165 years since it was written has wondered exactly this.

I was extremely curious myself; but the fright and perturbation of the patient’s mind, and his apprehensions of losing his penis entirely, either by the burn, swelling, inflammation, or by my cutting it off to get it out of the bottle, all came upon him at once and overwhelmed him with fear.

That’s one possible reason for his reticence, certainly.

Now for the explanation. A bottle in which some potassium had been kept in naphtha,* and which had been used up in experiments, was standing in his room; and wishing to urinate without leaving his room, he pulled out the glass stopper and applied his penis to its mouth. The first jet of urine was followed by an explosive sound and flash of fire, and quick as thought the penis was drawn into the bottle with a force and tenacity which held it as firmly as if in a vice. The burning of the potassium created a vacuum instantaneously, and the soft yielding tissue of the penis effectually excluding the air, the bottle acted like a huge cupping glass to this novel portion of the system. The small size of the mouth of the bottle compressed the veins, while the arteries continued to pour their blood into the glans, prepuce, etc. From this cause, and the rarefied air in the bottle, the parts swelled and puffed up to an enormous size.

A very serious situation. And not at all funny.

How much potassium was in the bottle at the time is not known, but it is probable that but a few grains were left, and those broken off from some of the larger globules, and so small as to have escaped the man’s observation. I was anxious to test the matter (though not with the same instruments which the patient had done) . . .

I’m glad to hear that, at least.

 . . . and for that purpose took a few small particles of potassium, mixed with about a teaspoonful of naphtha, and placed them in a pint bottle. Then I introduced some urine with a dash, while the end of one of my fingers was inserted into the mouth of the bottle, but not so tightly as to completely close it, and the result was a loud explosion like a percussion cap, and the finger was drawn forcibly into the bottle and held there strongly—thus verifying, in some degree, this highly interesting philosophical experiment, which so frightened my friend and patient.

This sounds entirely plausible. In case you haven’t seen what happens when a stream of urine hits a piece of potassium, it is every bit as dramatic as Dr. Shipman describes. The metal is highly reactive and even a small fragment will explode violently when thrown into water. It also oxidizes rapidly in air, which is why the young chemistry enthusiast kept his samples under naphtha.

The novelty of this accident is my apology for spending so many words in reporting it, while its ludicrous character will, perhaps, excite a smile; but it was anything but a joke at the time to the poor sufferer, who imagined in his fright that if his penis was not already ruined, breaking the bottle to liberate it would endanger its integrity by the broken spicules* cutting or lacerating the parts.

Once you’ve dried your tears of mirth, perhaps you’ll spare a thought for the poor fellow.

THE COLONIC CARPENTRY KIT

In 1840 an Irish visitor to Brest in northern France was given a tour of the local prison. It was a vast edifice built to accommodate six thousand inmates and, at its peak, contained a tenth of the city’s population. The prisoners were also slaves: Condemned to hard labor, they provided a large and reluctant workforce whose employment ranged from large-scale construction work to making sails. Opened in 1751, the building was innovative in its design, constructed in such a way that even in their cells the inmates were under constant surveillance from their guards. Nevertheless, as Andrew Valentine Kirwan observed, the prison was still a hotbed of

every crime and every vice, where the indifferent become bad, and the bad, unabashed and unamended, become daily worse.

Kirwan quickly learned that, far from being a place of moral correction, the jail had become a sort of finishing school for those wishing to perfect their education in the criminal arts. But instead of deportment and flower arranging, the crooks were taking classes in housebreaking and deception:

The forger learns from the thief the art of making a false key, and the thief in return is initiated into the mystery of counterfeiting signatures.

This was not a pleasant place to live: The work was hard, the diet poor and the death toll appallingly high. Unsurprisingly, prisoners made frequent attempts to escape. Kirwan witnessed a thriving trade in replica keys, counterfeit passports and other paraphernalia needed by the would-be fugitive. Few, however, went to the lengths of the convict who became the unwitting subject of an article in the Medical Times:*

A very curious case of this affection occurred a short time ago in the bagno of Brest.

The term bagno (usually bagne in French) was used in southern European countries to describe a prison whose inmates were made to perform hard labor.

A dangerous convict, who had already once escaped from prison, suddenly complained of abdominal pain, constipation, sickness, fever, etc. No hernia could be found, but the symptoms, which soon increased in severity, left no doubt of the existence of an internal incarceration of the bowel.

The doctor suspected that a loop of intestine had become trapped. This was potentially very serious: If its blood supply had been cut off, the tissue would quickly die, resulting in gangrene.

The vomiting became obstinate, the pain very intense, and the meteorism considerable.

Meteorism (also known as tympanites) is a condition in which the abdomen becomes tight and distended. It is caused by a buildup of gas in the intestinal tract—a classic symptom of bowel necrosis.

As the patient, in spite of treatment, continued to grow worse, he confided at last to his medical attendant that he had placed a little leathern bag with money in the rectum, in order to hide it from the gaoler. An examination of the rectum was then made, but nothing was found in it.

The prisoner was not, it transpired, being entirely truthful. Having tried to conceal the self-inflicted nature of his malady, he now resorted to another lie. Yes, he had stuck something up his bottom—but not a purse.

The symptoms continually increased, and after a time a tumour became visible at the left side of the abdomen, corresponding to the site of the descending colon. The convict, at this stage of the disease, said that he had introduced an étui of wood into the rectum, and having been surprised, he had, in the hurry, placed it with the top upwards, instead of with the bottom.

The truth, at last! An étui is a small ornamental case used to carry personal effects such as penknives or a sewing kit; many surgeons used them to carry their instruments. This example was not symmetrical, since one end was apparently easier to get a grip on than the other. Why the patient thought it less embarrassing to have inserted a purse up his own bottom than a wooden case remains a mystery.

A week after the onset of symptoms, the prisoner died, and a postmortem was carried out. The surgeon who performed it found that the patient had suffered acute peritonitis; the bowel was “immensely distended by gas.” But the strangest finding was in the colon, where

a voluminous foreign body was found, which proved to be a cylindrico-conical box, the conical end of which looked towards the caecum.* The box consisted of two pieces of sheet-iron, was about 6 inches long and 5 inches broad, weighed nearly 22 ounces, and was covered by a piece of skin, no doubt for protecting the mucous membrane of the rectum from the contact with the metal, and for facilitating the expulsion of the box.

This was a seriously large object to be lodged in anybody’s intestine. When the medics opened the box, they found it contained the following:

A piece of a gun-barrel, four inches long.

A screw of steel.

A mother-screw also of steel.

A screw-driver; from which four instruments a pulley may be formed strong enough for removing iron railings.

A saw of steel for cutting wood, four inches long.

Another saw for cutting metal.

A boring syringe.

A prismatic file.

One two-franc piece and four one-franc pieces tied together with thread.

A piece of tallow for oiling the instruments.

A complete escape kit, in other words. You have to admire his attention to detail, even if the execution left something to be desired.

After this extraordinary discovery had been made, an inquiry was instituted into the habits of the galley-slaves, and the chief gaoler said that convicts of the worst description used to conceal suspicious objects, as instruments, money, etc., in the rectum.

Some things never change.

These items, however, were generally of small size, being scarcely ever larger than an inch or so, and they were called ‘necessaries’ by the convicts.

Today’s “necessaries” include the smallest cell phone on the market, an item familiar to any prison officer who has ever had to conduct an internal cavity search.

The gaoler had never seen one similar to the box just described.

I should think not!

These étuis have almost always the same shape, one extremity being conical and the other blunt. They are always introduced in such manner that the conical end looks towards the anus, whereby the expulsion of it is facilitated. In the present instance the convict had been obliged to conceal his necessaire in a hurry on the approach of a person, and confounded the ends of the étui.

Instead of sitting just inside the rectum, where it could be easily removed when nobody was looking, the box had escaped from the prisoner’s grasp and made its way a surprising distance into the large intestine.

My advice? If you’re planning to break out of prison, just get a friend to bake a file inside a cake.

SUFFOCATED BY A FISH

Surgeons in Pondicherry, southern India, were just about to begin a routine operation in 2004 when an urgent beeping indicated that all was not well with their patient. A fit and healthy young man, he had been under general anesthesia for only a few minutes when his heart rate plummeted and monitors showed that he was being starved of oxygen. Suspecting that the tube inserted into the patient’s airways had been dislodged, the anesthetist pulled it out and started to ventilate him by hand. The man’s condition quickly stabilized, but when the anesthetist looked at what he had just removed from the patient’s airways, he nearly passed out in shock: Coiled around the end of the tube was the cause of the trouble—a huge parasitic worm.*

Foreign objects lodged in the airway are a common cause of hospital admission, particularly among children—but generally speaking, the items that get into the “wrong tube” are not alive at the time. However, there are well-documented cases of worms, leeches and even fish being inhaled by mischance or misadventure—as in this “news in brief” item published in 1863:

A warder of the Bagne at Toulon has just met his death in the following manner: he was amusing himself, while off duty, with fishing in the dock, when having caught a fish about seven inches long and two broad, and not knowing where to place it while baiting his hook conceived the idea of holding it between his teeth. The fish struggling in the convulsions of death, ended by slipping its head first into the mouth, and thence, owing to the viscous matter with which the scales were covered, down his throat, completely filling up the cavity. The man rushed about for aid, but soon dropped dead from suffocation.

Extraordinary, but not unique. Four years earlier, a similar case had been reported in a colonial medical journal, The Indian Lancet:

In 1859, Dr White reported the case of a strong Madras Bheestee,* into whose mouth a fish had jumped while he was bathing. On opening the mouth, the tail of a large catfish presented itself with the body firmly fixed within the fauces, and filling up the isthmus completely.

The fauces is the arch of tissue at the back of the mouth; the isthmus of the fauces is the opening it surrounds. All things considered, it’s surprising he hadn’t already suffocated.

It had entered flat, so that the fin of one side was posterior to the velum,* and opened out on any attempt being made to withdraw the fish. The operation of oesophagotomy was commenced and abandoned. A piece of cane was made into a probang,* and with it attempts were made to press the fish downwards into the oesophagus. It did pass downwards, when the patient at once ceased to breathe, gave one convulsive struggle, and died to all appearance.

Not so good. As soon became clear, the fish had not been pushed into the stomach as intended, but instead had become lodged in the trachea, obstructing the airway. The doctor quickly realized that the only option was to attempt a tracheotomy.

The trachea was immediately opened, and respiration was restored. In the course of the night the man coughed up the fish, the fins having become softened by decomposition.

Nice. Nevertheless, better to cough up a decomposing fish than to die because it’s stuck in your throat.

Dr White states that “this is by no means an uncommon accident in India. Natives bathing and swimming, which they always do with their mouths wide open . . .

Really?

“. . . in tanks that abound in fish, are not unfrequently brought to hospital dying from suffocation and alarm with a large catfish firmly impacted in the fauces. It is a coarse kind of fish, with long bony fins very sharp indeed at their extremities.”

It seems difficult to believe that there really was an epidemic of fish inhalation in nineteenth-century India, but at least two virtually identical cases were reported over the next few years. One patient survived for an astonishing thirty-four hours with the rotting corpse of the unfortunate creature lodged in his airway. And it still happens today: A recent review found no fewer than seventy-five documented cases of live fish in the airways. After surveying the available evidence, the authors of the article make this helpful observation:

Live fish aspiration is frequently accidental or the result of poor judgment involving placing a live fish in the mouth.

A conclusion that I suspect most readers will have reached for themselves.