Albert Vander Veer was a distinguished New York surgeon of the late nineteenth and early twentieth centuries. A Civil War veteran, he was a notable pioneer in an age when operating inside the abdomen was almost a mission into terra incognita. An expert on the surgery of the uterus, he also performed daring operations on the gall bladder, intestines and throat.
His interests were wide-ranging. In 1899 the Clinical Review published an article of his on a subject which remains of importance to doctors now, as it was a century ago:
Dr Vander Veer begins with a general statement of the problem:
Of the conditions called emergencies, in the practice of surgery, there are few that require such prompt action on the part of the physician as the treatment of cases of foreign bodies either in the air passages or oesophagus. No period of life escapes: — The infant, playing with some toy, inhales or swallows it, and the life of many a little one has been saved by the energetic action of the mother or grandmother, whose finger being introduced at the critical moment, grants prompt relief.
Fathers and grandfathers, naturally, are encouraged to stand back and let the womenfolk get on with it.
The young child who has some toy, generally in the form of a musical instrument, is subjected to these dangers, and perhaps one of the most serious has been the toy balloon which the little one sucks back and forth in its mouth until it becomes distended, is suddenly drawn back into the pharynx and causes immediate suffocation.
Health and safety regulations often get a bad press, but in the case of children’s toys it is not difficult to see how necessary they were.
Adults, eating in a great hurry, will take into the oesophagus such large substances as portions of meat, and other articles of food, causing a pressure upon the trachea that will result in death from suffocation.
A problem that is rather more difficult to legislate for.
These cases are of the class that the young physician, as well as the one in advanced life, may be called to attend at a moment’s notice to render assistance.
Choking hazards are of course still a major problem – but the early medical literature
Dr Vander Veer then gives a series of fourteen cases in which various objects were swallowed by accident – many of them dentures. But perhaps the most unusual is Case IV:
Mr. T. H., a cattle dealer by occupation, had a reputation for being an enormous eater, that is, he would eat a very large meal, and then fast for a day or two without any discomfort. A story is told about him that while loading his stock on a cattle barge he went into a neighboring hotel for dinner. The landlord said to him that the meal was not quite ready, but, inasmuch as Mr H. was in great haste, he might go into the dining room and help himself. Roast pig was part of the dinner. The landlord was absent from the room for some little time, and on his return the guest asked him with some earnestness, “Landlord, have you any more of those little pigs?”
We’ve all done it. You get a bit peckish, and wander into the nearest pub for a quick pig.
This is but an illustration of his enormous appetite at times. Some few years after, while eating at a restaurant, and in great haste, he swallowed a large portion of meat, choking to death before anyone could give him relief.
A drastically sudden termination to Mr H’s story. The case history is illustrated with a drawing of the piece of meat, still in situ in the unfortunate man’s throat. It had lodged in a seriously awkward position, blocking both his windpipe and gullet.
It will be observed that the meat was some four inches or more in length, and that part of it lodged in the oesophagus and part in the trachea, rather more in the latter than in the former. A good, vigorous introduction of a finger here by some grandmother would probably have saved his life.
What a shame there wasn’t ‘some grandmother’ standing by for just such an emergency.