Rare and peculiar

“How did it happen?” is a question every emergency physician will ask hundreds if not thousands of times during their career. The answer is usually mundane: “I fell off a ladder”; “I was playing rugby”; “I’d had a bit too much to drink.”  But just occasionally the patient is mysteriously coy about the reasons for their admission to hospital, suddenly afflicted by amnesia or acute embarrassment.

This patient, whose story appeared in the French Journal de Médecine in 1786, was quite happy to admit what his problem was, but rather less keen on explaining how it had happened: Corps etranger

On the 28th of July, 1785, a man from the countryside by the name of Philibert, aged twenty-two, came to consult me ​​about a rare and peculiar case: he informed me that he had a fork in his penis.

That certainly qualifies as rare and peculiar.

I was quite startled: I examined the part and after palpating the foreign body, which had already reached the root of the penis, became convinced that it was indeed a fork – but one of the type used by peasants, which fits into the handle of the knife. 

An ingenious arrangement – like something you’d take on a camping expedition.

It was four inches and nine lines in length, and the distance between one prong and the other, measured at their points, which were very sharp, was six lines.

A ‘line’ was a twelfth of a (French) inch, around 2.25 mm. This makes the fork about 1.3 cm in diameter at its broadest – not large, unless it happens to be stuck inside your urethra.  fork

The handle, which was made from horn, in the shape of an inverted pyramid, was three lines in breadth. This foreign body had been introduced two days earlier; the patient’s member was already very taut, inflamed and swollen to three times its natural size.

This sounds most unpleasant: it must have hurt like hell. To have swelling on that scale after two days is some indication of how irritated the local tissues had become.

The volume, shape and two sharp points of the instrument make one realise the imminent danger to the patient.  In the circumstances I did not wish to act lightly; I summoned Dr Gaydan, and Messiers Bras, father and son, surgeons. They all agreed with me on the impossibility of extracting this foreign body unless it was done through an incision in the perinaeum, which was done on the spot.

The incision was made in the area between the man’s genitals and anus, an approach often used to remove bladder stones. From a surgical point of view, therefore, this was not a particularly tricky case.

The operation completed, the patient urinated two hours later, and happily a complete cure was effected within six days. I describe this fact on account of its peculiarity rather than to shed new light on the wounds of the urethral canal. All practitioners know that they are simple when made by a sharp instrument.

A very satisfactory outcome. But there is still one important question left unresolved…

No doubt many will be curious to learn how this fork was introduced. I too would have liked to know more about it; but the young man obstinately maintained that it had happened while he was asleep, that on waking up that morning he had found the knife in his hand. I leave it to those who read this observation to decide whether it could have happened in this way.

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