Part 44

Sec. 418. Should it be impossible to extract the Bodies mentioned Sec. 410, and all such as it must be dangerous to admit into the Stomach, we must then prefer the least of two Evils, and rather run the Hazard of pushing them down, than suffer the Patient to perish dreadfully in a few Moments. And we ought to scruple this Resolution the less, as a great many Instances have demonstrated, that notwithstanding several bad Consequences, and even a tormenting Death, have often followed the swallowing of such hurtful or indigestible Substances; yet at other times they have been attended with little or no Disorder.

Sec. 419. One of these four Events is always the Case, after swallowing such Things. They either, 1, go off by Stool; or, 2, they are not discharged and kill the Patient. Or else, 3, they are discharged by Urine; or, 4, are visibly extruded to the Skin. I shall give some Instances of each of these Events.

Sec. 420. When they are voided by Stool, they are either voided soon after they have been swallowed, and that without having occasional scarce any troublesome Symptom; or the voiding of them has not happened till a long Time after swallowing, and is preceded with very considerable Pain. It has been seen that a Bone of the Leg of a Fowl, a Peach-stone, the Cover of a small Box of Venice Treacle, Pins, Needles, and Coins of different Sorts, have been voided within a few Days after they had slipt down into the Stomach; and that with little or no Complaint. A small Flute, or Pipe also, four Inches long, which occasioned acute Pains for three Days, has been voided happily afterwards, besides, Knives, Razors, and one Shoe-buckle. I have seen but a few Days since a Child between two and three Years old, who swallowed a Nail above an Inch long, the Head of which was more than three Tenths of an Inch broad: it stopt a few Moments about the Neck, but descended while its Friends were looking for me; and was voided with a Stool that Night, without any bad Consequence. And still more lately I have known the entire Bone of a Chicken's Wing thus swallowed, which only occasioned a slight Pain in the Stomach for three or four Days.

Sometimes such Substances are retained within for a long Time, not being voided till after several Months, and even Years, without the least ill Effect: and some of them have never either appeared, nor been complained of.

Sec. 421. But the Event is not always so happy; and sometimes though they are discharged through the natural Passages, the Discharges have been preceded by very acute Pains in the Stomach, and in the Bowels. A Girl swallowed down some Pins, which afflicted her with violent Pains for the Space of six Years; at the Expiration of which Term she voided them and recovered. Three Needles being swallowed brought on Cholics, Swoonings and Convulsions for a Year after: and then being voided by Stool, the Patient recovered. Another Person who swallowed two, was much happier in suffering but six Hours from them; when they were voided by Stool, and he did well.

It sometimes happens that such indigestible Substances, after having past all the Meanders, the whole Course of the Intestines, have been stopt in the Fundament, and brought on very troublesome Symptoms; but such however, as an expert Surgeon may very generally remove. If it is practicable to cut them, as it is when they happen to be thin Bones, the Jaw-bones of Fish, or Pins, they are then very easily extracted.

Sec. 422. The second Event is, when these fatal Substances are never voided, but cause very embarrassing Symptoms which finally kill the Patient; and of these Cases there have been but too many Examples.

A young Girl having swallowed some Pins, which she held in her Mouth, some of them were voided by Stool; but others of them pricked and pierced into her Guts, and even into the Muscles of her Belly, with the severest Pain; and killed her at the End of three Weeks.

A Man swallowed a Needle, which pierced through his Stomach, and into his Liver, and ended in a mortal Consumption.

I saw a very similar Instance and Event in a Lady's little favourite Bitch, whole Body she desired to be opened, from suspecting her to have been poisoned. But it appeared that a small Needle with fine Thread, which she had swallowed, had passed out of the Stomach into the Duodenum (one of the Guts) through which the Point had pierced and pricked and corroded the concave Part of the Liver, which was all rough and putrid. The whole Carcase was greatly bloated and extremely offensive, very soon after the poor Animal's Death, which happened two or three Months after the Accident, and was preceded by a great Wheezing, Restlessness and Loss of Appetite. The Needle was rusty, but the Thread entire, and very little altered. K.

A Plummet which slipt down, while the Throat of a Patient was searching, killed him at the End of two Years.

It is very common for different Coins, and of different Metals, to be swallowed without any fatal or troublesome Effects. Even a hundred Luidores have been swallowed, and all voided. Nevertheless these fortunate Escapes ought not to make People too secure and incautious on such Occasions, since such melancholy Consequences have happened, as may very justly alarm them. One single Piece of Money that was swallowed, entirely obstructed the Communication between the Stomach and the Intestines, and killed the Patient. Whole Nuts have often been inadvertently swallowed; but there have been some Instances of Persons in whom a Heap of them has been formed, which proved the Cause of Death, after producing much Pain and Inquietude.

I knew a Man of the Name of Poole, who being taken in the same Ship with me, 1717 or 18, by Pirates, had swallowed four Ginueas, and a gold Ring, all which he voided some Days after without any Injury or Complaint, and saved them. I forget the exact Number of Days he retained them, but the Pirates staid with us from Saturday Night to Thursday Noon. K.

Many fatal Examples of this Kind may be seen in the Philosophical Transactions; and they should caution People against swallowing Cherry-stones, and still more against those of Prunes, or such as are pointed, though not very acutely. K.

Sec. 423. The third Issue or Event is, when these Substances, thus swallowed down, have been discharged by Urine: but these Cases are very rare.

A Pin of a middling Size has been discharged by Urine, three Days after it slipt down; and a little Bone has been expelled the same Way, besides Cherry-stones, Plumb-stones, and even one Peach-stone.

Sec. 424. Finally, the fourth Consequence or Event is, when the indigestible Substances thus swallowed, have pierced through the Stomach or Intestines, and even to the Skin itself; and occasioning an Abscess, have made an Outlet for themselves, or have been taken out of the Abscess. A long Time is often required to effect this extraordinary Trajection and Appearance of them; sometimes the Pains they occasion are continual; in other Cases the Patient complains for a Time, after which the Pain ceases, and then returns again. The Imposthume, or Gathering, is formed in the Stomach, or in some other Part of the Belly: and sometimes these very Substances, after having pierced through the Guts, make very singular Routs, and are discharged very remotely from the Belly. One Needle that had been swallowed found its Way out, at the End of four Years, through the Leg; another at the Shoulder.

Sec. 425. All these Examples, and many others of cruel Deaths, from swallowing noxious Substances, demonstrate the great Necessity of an habitual Caution in this Respect; and give in their Testimony against the horrid, I had almost said, the criminal Imprudence, of People's amusing themselves with such Tricks as may lead to such terrible Accidents; or even holding any such Substance in their Mouths, as by slipping down through Imprudence or Accident, may prove the Occasion of their Death. Is it possible that any one, without shuddering, can hold Pins or Needles in their Mouths, after reflecting on the dreadful Accidents, and cruel Deaths, that have thus been caused by them.

Sec. 426. It has been shewn already, that Substances obstructing the Passage of the Gullet sometimes suffocate the Patient; that at other Times they can neither be extracted nor thrust down; but that they stop in the Passage, without killing the Patient, at least not immediately and at once. This is the Case when they are so circumstanced, as not to compress the Trachaea, the Wind-pipe, and not totally to prevent the swallowing of Food; which last Circumstance can scarcely happen, except the Obstruction has been formed by angular or pointed Bodies. The Stoppage of such Bodies is sometimes attended, and that without much Violence, with a small Suppuration, which loosens them; and then they are either returned upwards through the Mouth, or descend into the Stomach. But at other Times an extraordinary Inflammation is produced, which kills the Patient. Or if the Contents of the Abscess attending the Inflammation tend outwardly, a Tumour is formed on the external Part of the Neck, which is to be opened, and through whose Orifice the obstructing Body is discharged. In other Instances again they take a different Course, attended with little or no Pain, and are at length discharged by a Gathering behind the Neck, on the Breast, the Shoulder, or various other Parts.

Sec. 427. Some Persons, astonished at the extraordinary Course and Progression of such Substances, which, from their Size, and especially from their Shape, seem to them incapable of being introduced into, and in some Sort, circulating through the human Body, without destroying it, are very desirous of having the Rout and Progression of such intruding Substances explained to them. To gratify such Inquirers, I may be indulged in a short Digression, which perhaps is the less foreign to my Plan; as in dissipating what seems marvelous, and has been thought supernatural in such Cases, I may demolish that superstitious Prejudice, which has often ascribed Effects of this Sort to Witchcraft; but which admit of an easy Explanation. This very Reason is the Motive that has determined me to give a further Extent to this Chapter.

Wherever an Incision is made through the Skin, a certain Membrane appears, which consists of two Coats or Laminae, separated from each other by small Cells or Cavities, which all communicate together; and which are furnished, more or less, with Fat. There is not any Fat throughout the human Body, which is not inclosed in, or enveloped with, this Coat, which is called the adipose, fatty, or cellular Membrane.

This Membrane is not only found under the Skin, but further plying and insinuating itself in various Manners, it is extended throughout the whole Body. It distinguishes and separates all the Muscles; it constitutes a Part of the Stomach, of the Guts, of the Bladder, and of all the Viscera or Bowels. It is this which forms what is called the Cawl, and which also furnishes a Sheath or Envelopement to the Veins, Arteries, and Nerves. In some Parts it is very thick, and is abundantly replenished with Fat; in others it is very thin and unprovided with any; but wherever it extends, it is wholly insensible, or void of all Sensation, all Feeling.

It may be compared to a quilted Coverlet, the Cotton, or other Stuffing of which, is unequally distributed; greatly abounding in some Places, with none at all in others, so that in these the Stuff above and below touch each other. Within this Membrane, or Coverlet, as it were, such extraneous or foreign Substances are moved about; and as there is a general Communication throughout the whole Extent of the Membrane, it is no ways surprizing, that they are moved from one Part to another very distant, in a long Course and Duration of Movement. Officers and Soldiers very often experience, that Bullets which do not pass through the Parts where they have entered, are transferred to very different and remote ones.

The general Communication throughout this Membrane is daily demonstrated by Facts, which the Law prohibits; this is the Butchers inflating, or blowing up, the cellular Membrane throughout the whole Carcase of a Calf, by a small Incision in the Skin, into which they introduce a Pipe or the Nozzle of a small Bellows; and then, blowing forcibly, the Air evidently puffs up the whole Body of the Calf into this artificial Tumour or Swelling.

Some very criminal Impostors have availed themselves of this wicked Contrivance, thus to bloat up Children into a Kind of Monsters, which they afterwards expose to View for Money.

In this cellular Membrane the extravasated Waters of hydropic Patients are commonly diffused; and here they give Way to that Motion, to which their own Weight disposes them. But here I may be asked--As this Membrane is crossed and intersected in different Parts of it, by Nerves, Veins, Arteries, &c. the wounding of which unavoidably occasions grievous Symptoms, how comes it, that such do not ensue upon the Intrusion of such noxious Substances? To this I answer, 1, that such Symptoms do sometimes really ensue; and 2, that nevertheless they must happen but seldom, by Reason that all the aforesaid Parts, which traverse and intersect this Membrane, being harder than the Fat it contains; such foreign Substances must almost necessarily, whenever they rencounter those Parts, be turned aside towards the Fat which surrounds them, whose Resistance is very considerably less; and this the more certainly so, as these Nerves, &c. are always of a cylindrical Form.----But to return from this necessary Digression.

Sec. 428. To all these Methods and Expedients I have already recommended on the important Subject of this Chapter, I shall further add some general Directions.

1. It is often useful, and even necessary, to take a considerable Quantity of Blood from the Arm; but especially if the Patient's Respiration, or Breathing, is extremely oppressed; or when we cannot speedily succeed in our Efforts to remove the obstructing Substance; as the Bleeding is adapted to prevent the Inflammation, which the frequent Irritations from such Substances occasion; and as by its disposing the whole Body into a State of Relaxation, it might possibly procure an immediate Discharge of the offending Substance.