SURGICAL ANOMALIES OF THE THORAX AND ABDOMEN. 4 page

swallowing a knife, voided it at the groin. In the sixteenth century

Laurentius Joubert relates a similar case, the knife having remained in

the body two years. De Diemerbroeck mentions the fact that a knife ten

inches long was extracted by gastrotomy, and placed among the rarities

in the anatomic chamber of the University at Leyden. The operation was

done in 1635 at Koenigsberg, by Schwaben, who for his surgical prowess

was appointed surgeon to the King of Poland. The patient lived eight

years after the operation.

It is said that in 1691, while playing tricks with a knife 6 1/2 inches

long, a country lad of Saxony swallowed it, point first. He came under

the care of Weserern, physician to the Elector of Brandenburgh, who

successfully extracted it, two years and seven months afterward, from

the pit of the lad's stomach. The horn haft of the knife was

considerably digested. In 1720 Hubner of Rastembourg operated on a

woman who had swallowed an open knife. After the incision it was found

that the knife had almost pierced the stomach and had excited a slight

suppuration. After the operation recovery was very prompt.

Bell of Davenport, Iowa, performed gastrotomy on a man, who, while

attempting a feat of legerdemain, allowed a bar of lead, 10 1/8 inches

long, 1 1/2 inches wide, and 9 1/2 ounces in weight, to slip into his

stomach. The bar was removed and the patient recovered. Gussenbauer

gives an account of a juggler who turned his head to bow an

acknowledgment of applause while swallowing a sword; he thus brought

his upper incisors against the sword, which broke off and slipped into

his stomach. To relieve suffocation the sword was pushed further down.

Gastrotomy was performed, and the piece of sword 11 inches long was

extracted; as there was perforation of the stomach before the

operation, the patient died of peritonitis.

An hour after ingestion, Bernays of St. Louis successfully removed a

knife 9 1/2 inches long. By means of an army-bullet forceps the knife

was extracted easily through an incision 5/8 inch long in the walls of

the stomach. Gross speaks of a man of thirty who was in the habit of

giving exhibitions of sword-swallowing in public houses, and who

injured his esophagus to such an extent as to cause abscess and death.

In the Journal of the American Medical Association, March 1, 1896,

there is an extensive list of gastrotomies performed for the removal of

knives and other foreign bodies, from the seventeenth century to the

present time.

The physiologic explanation of sword-swallowing is quite interesting.

We know that when we introduce the finger, a spoon, brush, etc., into

the throat of a patient, we cause extremely disagreeable symptoms.

There is nausea, gagging, and considerable hindrance with the function

of respiration. It therefore seems remarkable that there are people

whose physiologic construction is such that, without apparent

difficulty, they are enabled to swallow a sword many inches long. Many

of the exhibitionists allow the visitors to touch the stomach and

outline the point of the sabre through the skin. The sabre used is

usually very blunt and of rounded edges, or if sharp, a guiding tube of

thin metal is previously swallowed. The explanation of these

exhibitions is as follows: The instrument enters the mouth and pharynx,

then the esophagus, traverses the cardiac end of the stomach, and

enters the latter as far as the antrum of the pylorus, the small

culdesac of the stomach. In their normal state in the adult these

organs are not in a straight line, but are so placed by the passage of

the sword. In the first place the head is thrown back, so that the

mouth is in the direction of the esophagus, the curves of which

disappear or become less as the sword proceeds; the angle that the

esophagus makes with the stomach is obliterated, and finally the

stomach is distended in the vertical diameter and its internal curve

disappears, thus permitting the blade to traverse the greater diameter

of the stomach. According to Guyot-Daubes, these organs, in a straight

line, extend a distance of from 55 to 62 cm., and consequently the

performer is enabled to swallow an instrument of this length. The

length is divided as follows:--

Mouth and pharynx, . . . . . . . . . . . . 10 to 12 cm.

Esophagus, . . . . . . . . . . . . . . . . 25 to 28 cm.

Distended stomach, . . . . . . . . . . . . 20 to 22 cm.

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55 to 62 cm.

These acrobats with the sword have rendered important service to

medicine. It was through the good offices of a sword-swallower that the

Scotch physician, Stevens, was enabled to make his experiments on

digestion. He caused this assistant to swallow small metallic tubes

pierced with holes. They were filled, according to Reaumur's method,

with pieces of meat. After a certain length of time he would have the

acrobat disgorge the tubes, and in this way he observed to what degree

the process of digestion had taken place. It was also probably the

sword-swallower who showed the physicians to what extent the pharynx

could be habituated to contact, and from this resulted the invention of

the tube of Faucher, the esophageal sound, ravage of the stomach, and

illumination of this organ by electric light. Some of these individuals

also have the faculty of swallowing several pebbles, as large even as

hen's eggs, and of disgorging them one by one by simple contractions of

the stomach. From time to time individuals are seen who possess the

power of swallowing pebbles, knives, bits of broken glass, etc., and,

in fact, there have been recent tricky exhibitionists who claimed to be

able to swallow poisons, in large quantities, with impunity. Henrion,

called "Casaandra," a celebrated example of this class, was born at

Metz in 1761. Early in life he taught himself to swallow pebbles,

sometimes whole and sometimes after breaking them with his teeth. He

passed himself off as an American savage; he swallowed as many as 30 or

40 large pebbles a day, demonstrating the fact by percussion on the

epigastric region. With the aid of salts he would pass the pebbles and

make them do duty the next day. He would also swallow live mice and

crabs with their claws cut. It was said that when the mice were

introduced into his mouth, they threw themselves into the pharynx where

they were immediately suffocated and then swallowed. The next morning

they would be passed by the rectum flayed and covered with a mucous

substance. Henrion continued his calling until 1820, when, for a

moderate sum, he was induced to swallow some nails and a plated iron

spoon 5 1/2 inches long and one inch in breadth. He died seven days

later.

According to Bonet, there was a man by the name of Pichard who

swallowed a razor and two knives in the presence of King Charles II of

England, the King himself placing the articles into the man's mouth. In

1810 Babbington and Curry are accredited with citing the history of an

American sailor in Guy's Hospital, London, who frequently swallowed

penknives for the amusement of his audiences. At first he swallowed

four, and three days later passed them by the anus; on another occasion

he swallowed 14 of different sizes with the same result. Finally he

attempted to gorge himself with 17 penknives, but this performance was

followed by horrible pains and alarming abdominal symptoms. His

excrement was black from iron. After death the cadaver was opened and

14 corroded knives were found in the stomach, some of the handles being

partly digested; two were found in the pelvis and one in the abdominal

cavity. Pare recalls the instance of a shepherd who suffered

distressing symptoms after gulping a knife six inches long. Afterward

the knife was abstracted from his groin. Fabricius Hildanus cites a

somewhat similar case.

Early in the century there was a man known as the "Yankee

knife-swallower," whose name was John Cummings, an American sailor, who

had performed his feats in nearly all the ports of the world. One of

his chief performances was swallowing a billiard ball. Poland mentions

a man (possibly Cummings) who, in 1807, was admitted to Guy's Hospital

with dyspeptic symptoms which he attributed to knife-swallowing. His

story was discredited at first; but after his death, in March, 1809,

there were 30 or 40 fragments of knives found in his stomach. One of

the back-springs on a knife had transfixed the colon and rectum. In

the Edinburgh Philosophical Journal for 1825 there is an account of a

juggler who swallowed a knife which remained in his stomach and caused

such intense symptoms that gastrotomy was advised; the patient,

however, refused operation.

Drake reports a curious instance of polyphagia. The person described

was a man of twenty-seven who pursued the vocation of a

"sword-swallower." He had swallowed a gold watch and chain with a seal

and key attached; at another time he swallowed 34 bullets and voided

them by the anus. At Poughkeepsie, N.Y., in August, 1819, in one day

and night he swallowed 19 pocket-knives and 41 copper cents. This man

had commenced when a lad of fifteen by swallowing marbles, and soon

afterward a small penknife. After his death his esophagus was found

normal, but his stomach was so distended as to reach almost to the

spine of the ilium, and knives were found in the stomach weighing one

pound or more. In his exhibitions he allowed his spectators to hear the

click of the knives and feel them as low down as the anterior superior

spine of the ilium.

The present chief of the dangerous "profession" of sword-swallowing is

Chevalier Cliquot, a French Canadian by birth, whose major trick is to

swallow a real bayonet sword, weighted with a cross-bar and two

18-pound dumbbells. He can swallow without difficulty a 22-inch cavalry

sword; formerly, in New York, he gave exhibitions of swallowing

fourteen 19-inch bayonet swords at once. A negro, by the name of Jones,

exhibiting not long since in Philadelphia, gave hourly exhibitions of

his ability to swallow with impunity pieces of broken glass and china.

Foreign Bodies in the Alimentary Canal.--In the discussion of the

foreign bodies that have been taken into the stomach and intestinal

tract possibly the most interesting cases, although the least

authentic, are those relating to living animals, such as fish, insects,

or reptiles. It is particularly among the older writers that we find

accounts of this nature. In the Ephemerides we read of a man who

vomited a serpent that had crept into his mouth, and of another person

who ejected a beetle that had gained entrance in a similar manner. From

the same authority we find instances of the vomiting of live fish,

mice, toads, and also of the passage by the anus of live snails and

snakes. Frogs vomited are mentioned by Bartholinus, Dolaeus,

Hellwigius, Lentilus, Salmuth, and others. Vege mentions a man who

swallowed a young chicken whole. Paullini speaks of a person who, after

great pain, vomited a mouse which he had swallowed. Borellus,

Bartholinus, Thoner, and Viridet, are among the older authorities

mentioning persons who swallowed toads. Hippocrates speaks of asphyxia

from a serpent which had crawled into the mouth.

Borellus states that he knew a case of a person who vomited a

salamander. Plater reports the swallowing of eels and snails. Rhodius

mentions persons who have eaten scorpions and spiders with impunity.

Planchon writes of an instance in which a live spider was ejected from

the bowel; and Colini reports the passage of a live lizard which had

been swallowed two days before, and there is another similar case on

record. Marcellus Donatus records an instance in which a viper, which

had previously crawled into the mouth, had been passed by the anus.

There are also recorded instances in French literature in which persons

affected with pediculosis, have, during sleep, unconsciously swallowed

lice which were afterward found in the stools.

There is an abundance of cases in which leeches have been accidentally

swallowed. Pliny, Aetius, Dioscorides, Scribonius-Largus, Celsus,

Oribasius, Paulus Aegineta, and others, describe such cases.

Bartholinus speaks of a Neapolitan prince who, while hunting, quenched

his thirst in a brook, putting his mouth in the running water. In this

way he swallowed a leech, which subsequently caused annoying hemorrhage

from the mouth. Timaeus mentions a child of five who swallowed several

leeches, and who died of abdominal pains, hemorrhage, and convulsions.

Rhodius, Riverius, and Zwinger make similar observations. According to

Baron Larrey the French soldiers in Napoleon's Egyptian campaign

occasionally swallowed leeches. Grandchamp and Duval have commented on

curious observations of leeches in the digestive tract. Dumas and

Marques also speak of the swallowing of leeches. Colter reports a case

in which beetles were vomited. Wright remarks on Banon's case of

fresh-water shrimps passed from the human intestine. Dalton, Dickman,

and others, have discussed the possibility of a slug living in the

stomach of man. Pichells speaks of a case in which beetles were

expelled from the stomach; and Pigault gives an account of a living

lizard expelled by vomiting. Fontaine, Gaspard, Vetillart, Ribert,

MacAlister, and Waters record cases in which living caterpillars have

been swallowed.

Sundry Cases.--The variety of foreign bodies that have been swallowed

either accidentally or for exhibitional or suicidal purposes is

enormous. Nearly every imaginable article from the minutest to the most

incredible size has been reported. To begin to epitomize the literature

on this subject would in itself consume a volume, and only a few

instances can be given here, chosen in such a way as to show the

variety, the effects, and the possibilities of their passage through

the intestinal canal.

Chopart says that in 1774 the belly of a ravenous galley-slave was

opened, and in the stomach were found 52 foreign bodies, including a

barrel-hoop 19 inches long, nails, pieces of pipe, spoons, buckles,

seeds, glass, and a knife. In the intestines of a person Agnew found a

pair of suspenders, a mass of straw, and three roller-bandages, an inch

in width and diameter. Velpeau mentions a fork which was passed from

the anus twenty months after it was swallowed. Wilson mentions an

instance of gastrotomy which was performed for the extraction of a fork

swallowed sixteen years before. There is an interesting case in which,

in a delirium of typhoid fever, a girl of twenty-two swallowed two iron

forks, which were subsequently expelled through an abdominal abscess. A

French woman of thirty-five, with suicidal intent, swallowed a

four-pronged fork, which was removed four years afterward from the

thigh. For two years she had suffered intense pain in both thighs. In

the Royal College of Surgeons in London there is a steel button-hook 3

1/2 inches in length which was accidentally swallowed, and was passed

three weeks later by the anus, without having given rise to any symptom.

Among the insane a favorite trait seems to be swallowing nails. In the

Philosophical Transactions is an account of the contents of the stomach

of an idiot who died at thirty-three. In this organ were found nine

cart-wheel nails, six screws, two pairs of compasses, a key, an iron

pin, a ring, a brass pommel weighing nine ounces, and many other

articles. The celebrated Dr. Lettsom, in 1802, spoke of an idiot who

swallowed four pounds of old nails and a pair of compasses. A lunatic

in England e swallowed ten ounces of screws and bits of crockery, all

of which were passed by the anus. Boardman gives an account of a child

affected with hernia who swallowed a nail 2 1/2 inches long. In a few

days the nail was felt in the hernia, but in due time it was passed by

the rectum. Blower reports an account of a nail passing safely through

the alimentary canal of a baby. Armstrong mentions an insane

hair-dresser of twenty-three, in whose stomach after death were found

30 or more spoon handles, 30 nails, and other minor articles.

Closmadenc reported a remarkable case which was extensively quoted. The

patient was an hysteric young girl, an inmate of a convent, to whom he

was called to relieve a supposed fit of epilepsy. He found her

half-asphyxiated, and believed that she had swallowed a foreign body.

He was told that under the influence of exaggerated religious scruples

this girl inflicted penance upon herself by swallowing earth and holy

medals. At the first dose of the emetic, the patient made a strong

effort to vomit, whereupon a cross seven cm. long appeared between her

teeth. This was taken out of her mouth, and with it an enormous rosary

220 cm. long, and having seven medals attached to it. Hunt recites a

case occurring in a pointer dog, which swallowed its collar and chain,

only imperfectly masticating the collar. The chain and collar were

immediately missed and search made for them. For several days the dog

was ill and refused food. Finally the gamekeeper saw the end of the

chain hanging from the dog's anus, and taking hold of it, he drew out a

yard of chain with links one inch long, with a cross bar at the end two

inches in length; the dog soon recovered. The collar was never found,

and had apparently been digested or previously passed.

Fear of robbery has often led to the swallowing of money or jewelry.

Vaillant, the celebrated doctor and antiquarian, after a captivity of

four months in Algiers, was pursued by Tunis pirates, and swallowed 15

medals of gold; shortly after arriving at Lyons he passed them all at

stool. Fournier and Duret published the history of a galley slave at

Brest in whose stomach were found 52 pieces of money, their combined

weight being one pound, 10 1/4 ounces. On receiving a sentence of three

years' imprisonment, an Englishman, to prevent them being taken from

him, swallowed seven half-crowns. He suffered no bad effects, and the

coins not appearing the affair was forgotten. While at stool some

twenty months afterward, having taken a purgative for intense abdominal

pain, the seven coins fell clattering into the chamber. Hevin mentions

the case of a man who, on being captured by Barbary pirates, swallowed

all the money he had on his person. It is said that a certain Italian

swallowed 100 louis d'ors at a time.

It occasionally happens that false teeth are accidentally swallowed,

and even passed through the intestinal tract. Easton mentions a young

man who accidentally swallowed some artificial teeth the previous

night, and, to further their passage through the bowel, he took a dose

of castor oil. When seen he was suffering with pain in the stomach, and

was advised to eat much heavy food and avoid aperients. The following

day after several free movements he felt a sharp pain in the lower part

of his back. A large enema was given and the teeth and plate came away.

The teeth were cleansed and put back in his mouth, and the patient

walked out. Nine years later the same accident again happened to the

man but in spite of treatment nothing was seen of the teeth for a month

afterward, when a body appeared in the rectum which proved to be a gold

plate with the teeth in it. In The Lancet of December 10, 1881, there

is an account of a vulcanite tooth-plate which was swallowed and passed

forty-two hours later. Billroth mentions an instance of gastrotomy for

the removal of swallowed artificial teeth, with recovery; and another

case in which a successful esophagotomy was performed. Gardiner

mentions a woman of thirty-three who swallowed two false teeth while

supping soup. A sharp angle of the broken plate had caught in a fold of

the cardiac end of the stomach and had caused violent hematemesis.

Death occurred seventeen hours after the first urgent symptoms.

In the Museum of the Royal College of Surgeons in London there is an

intestinal concretion weighing 470 grains, which was passed by a woman

of seventy who had suffered from constipation for many years. Sixteen

years before the concretion was passed she was known to have swallowed

a tooth. At one side of the concretion a piece had been broken off

exposing an incisor tooth which represented the nucleus of the

formation. Manasse recently reported the case of a man of forty-four

whose stomach contained a stone weighing 75 grams. He was a joiner and,

it was supposed, habitually drank some alcoholic solution of shellac

used in his trade. Quite likely the shellac had been precipitated in

the stomach and gave rise to the calculus.

Berwick mentions a child of eight months who was playing with a

detached organ-handle, and put it in its mouth. Seeing this the mother

attempted to secure the handle, but it was pushed into the esophagus. A

physician was called, but nothing was done, and the patient seemed to

suffer little inconvenience. Three days later the handle was expelled

from the anus. Teakle reports the successful passage through the

alimentary canal of the handle of a music-box. Hashimoto,

Surgeon-General of the Imperial Japanese Army, tells of a woman of

forty-nine who was in the habit of inducing vomiting by irritating her

fauces and pharynx with a Japanese toothbrush--a wooden instrument six

or seven inches long with bristles at one end. In May, 1872, she

accidentally swallowed this brush. Many minor symptoms developed, and

in eleven months there appeared in the epigastric region a fluctuating

swelling, which finally burst, and from it extended the end of the

brush. After vainly attempting to extract the brush the attending

physician contented himself with cutting off the projecting portion.

The opening subsequently healed; and not until thirteen years later did

the pain and swelling return. On admission to the hospital in October,

1888, two fistulous openings were seen in the epigastric region, and

the foreign body was located by probing. Finally, on November 19, 1888,

the patient was anesthetized, one of the openings enlarged, and the

brush extracted. Five weeks later the openings had all healed and the

patient was restored to health.

Garcia reports an interesting instance of foreign body in a man between

forty-five and fifty. This man was afflicted with a syphilitic

affection of the mouth, and he constructed a swab ten inches long with

which to cleanse his fauces. While making the application alone one

day, a spasmodic movement caused him to relinquish his grasp on the

handle, and the swab disappeared. He was almost suffocated, and a

physician was summoned; but before his arrival the swab had descended

into the esophagus. Two weeks later, gastro-peritoneal symptoms

presented, and as the stick was located, gastrotomy was proposed; the

patient, however, would not consent to an operation. On the

twenty-sixth day an abscess formed on the left side below the nipple,

and from it was discharged a large quantity of pus and blood. Four days

after this, believing himself to be better, the man began to redress

the wound, and from it he saw the end of a stick protruding. A

physician was called, and by traction the stick was withdrawn from

between the 3d and 4th ribs; forty-nine days after the accident the

wound had healed completely. Two years afterward the patient had an

attack of cholera, but in the fifteen subsequent years he lived an

active life of labor.

Occasionally an enormous mass of hair has been removed from the

stomach. A girl of twenty a with a large abdominal swelling was

admitted to a hospital. Her illness began five years previously, with

frequent attacks of vomiting, and on three occasions it was noticed

that she became quite bald. Abdominal section was performed, the

stomach opened, and from it was removed a mass of hair which weighed

five pounds and three ounces. A good recovery ensued. In the Museum of

St. George's Hospital, London, are masses of hair and string taken from

the stomach and duodenum of a girl of ten. It is said that from the age

of three the patient had been in the habit of eating these articles.

There is a record in the last century of a boy of sixteen who ate all

the hair he could find; after death his stomach and intestines were

almost completely lined with hairy masses. In the Journal of the

American Medical Association, March 1, 1896, there is a report of a

case of hair-swallowing.

Foreign Bodies in the Intestines.--White relates the history of a case

in which a silver spoon was swallowed and successfully excised from the

intestinal canal. Houston mentions a maniac who swallowed a rusty iron

spoon 11 inches long. Fatal peritonitis ensued and the spoon was found

impacted in the last acute turn of the duodenum. In 1895, in London,

there was exhibited a specimen, including the end of the ileum with the

adjacent end of the colon, showing a dessert spoon which was impacted

in the latter. The spoon was seven inches long, and its bowl measured

1 1/2 inches across. There was much ulceration of the mucous membrane.

This spoon had been swallowed by a lunatic of twenty-two, who had made

two previous ineffectual attempts at suicide. Mason describes the case

of a man of sixty-five who, after death by strangulated hernia, was

opened, and two inches from the ileocecal valve was found an earthen

egg-cup which he had swallowed. Mason also relates the instance of a

man who swallowed metal balls 2 1/2 inches in diameter; and the case of

a Frenchman who, to prevent the enemy from finding them, swallowed a

box containing despatches from Napoleon. He was kept prisoner until the

despatches were passed from his bowels. Denby discovered a large

egg-cup in the ileum of a man. Fillion mentions an instance of recovery

following the perforation of the jejunum by a piece of horn which had

been swallowed. Madden tells of a person, dying of intestinal

obstruction, in whose intestines were found several ounces of crude

mercury and a plum-stone. The mercury had evidently been taken for

purgative effect. Rodenbaugh mentions a most interesting case of beans

sprouting while in the bowel. Harrison relates a curious case in which

the swallowed lower epiphysis of the femur of a rabbit made its way

from the bowel to the bladder, and was discharged thence by the urethra.

In cases of appendicitis foreign bodies have been found lodged in or

about the vermiform appendix so often that it is quite a common lay

idea that appendicitis is invariably the result of the lodgment of some

foreign body accidentally swallowed. In recent years the literature of

this subject proves that a great variety of foreign bodies may be

present. A few of the interesting cases will be cited in the following

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