Hook, line and Liston

A course of lectures on practical surgeryIn 1844 the great surgeon Robert Liston gave an influential series of lectures at University College London on the technique of surgery. The second lecture in this series, concerning operations on the neck, includes this unusual case:

Occasionally you find very curious foreign bodies lodged in the throat. The following case came under my notice years ago, though the patient was not under my care. A boy engaged in herding cattle was preparing his fishing-tackle. He had a hook for catching jack, which he put in his mouth in order to repair it in some way.

‘Jack’ is an obsolete slang term for pike, the muscular and aggressive freshwater species much prized by anglers.

The cattle, meanwhile, wandered amongst the corn; he shouted out on observing them, and in recovering his breath, filling his lungs again, the hook slipped back into the gullet, and there it stuck.

Oh dear me.

You are aware that in fishing for jack, there are used three large hooks, tied back to back like a grappling-iron, by means of brass wire.triple hookLooking much like the object above, in fact. An item you really don’t want stuck inside your gullet.

There was much fuss made about this case; the boy was brought from a great distance to the hospital, and he was kept as a show for some time. Every one suggested some plan or other for getting out the foreign body. It was a case in which, had it been in the hands of a very energetic surgeon, oesophagotomy ought to have been at once performed.

One suspects that Liston had one particular ‘very energetic surgeon’ in mind. Evidently he was rather keen to do it himself. The operation he is here contemplating is similar to a tracheotomy – opening the windpipe with an incision at the front of the neck in order to extract the foreign body.

trachaeotomy

There appeared but little chance of the three hooks coming out again, and the only apparent way of getting the boy out of the scrape would have been to make an opening below, and extricate them by pulling them downwards. The lad had a long chain hanging out of his mouth for weeks together…

This does not sound terribly convenient.

…and at last it was proposed to use a bone probang, a large ivory ball with a hole in it; and this was to be pushed down to disentangle the barbs. By this time, however, extensive ulceration of the pharynx had taken place, and the foreign body was gulped up, to the relief both of the patient and of the medical men.

The best possible outcome! But you can almost hear Liston’s regret that he was not in charge of the case; clearly itching to cut the boy open.

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