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 b
ottle.
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 fo
rmed 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.
The Mystery of the Exploding Teeth and Other Curiosities From the History of Medicine Page 4
