The eighteenth-century surgeon William Boys, although a distinguished clinician and Fellow of the Royal Society, was perhaps better known as an antiquary and historian of his home county of Kent. Among his published works is an account of the Luxborough Galley, a notorious shipwreck in which the few survivors resorted to cannibalism to keep themselves alive – one of them the surgeon’s father.
This case, published in the London Medical Journal in 1785, is not quite as sensational as a shipwreck – but it does show that Mr Boys was a resourceful surgeon when circumstances demanded it:
A neighbour’s child was brought to me the other day, who had just swallowed a pin. The young woman, who came with her, said it was lodged in the child’s throat, and that she had felt it there, in the fore part of the throat.
A particularly dangerous accident – and one that was far more common in an age when clothes were made or repaired in virtually every household.
I introduced my finger, I thought, as far as I could, and could feel nothing: but the young woman persisting in it that the pin was there, I tried again, and could plainly trace the length of the pin directly across the fore part of the passage, but so remote, that I could only touch it with the extremity of my finger.
An appalling predicament, particularly for a small child. The pin had become lodged across the inside of the oesophagus, with both ends apparently embedded in tissue.
The child was continually making efforts to vomit, and was in great distress. It was therefore necessary to attempt to remove the pin as soon as possible.
As the surgeon was no doubt aware, pins and needles have an unfortunate tendency to migrate around the body if accidentally ingested. This one, lodged inside the oesophagus, might easily have pierced a major blood vessel or travelled through the wall of the gut. But how to remove it? The solution Mr Boys came up with was imaginative:
I happened to have some very long lace pins, out of which I selected three… These I turned, with a pair of small pliers, at their heads, so as to form hooks; taking care to turn the heads rather inwards, that there might be no hazard of their taking hold of the rugous parts of the oesophagus.
‘Rugous’ is an old and obscure medical word meaning ‘wrinkled’ or ‘corrugated’. The interior surface of the oesophagus has a number of ridges, and Mr Boys was concerned that his improvised hooks might snag on one of them. The surgeon bent the hooks at quite an acute angle, hoping that one would trap the head of the pin and so pull it away.
I ran these pins out and in several times through the forefinger of my buckskin glove, and turned the points on the inside of the glove, so that it seemed impossible they should give way in the least.
The surgeon includes a drawing of this hastily improvised instrument:
Upon introducing my finger thus armed into the child’s throat, I was foiled by her struggles ; but, on a second attempt, I found my finger entangled with something, and could not disengage it with a very considerable effort. With a force, however, that was frightful to use, I got my finger back again; but, to my great concern, without the pin.
An alarming moment for patient and surgeon alike: with no means of visualising the oesophagus, Mr Boys must have been terrified about the damage his ‘frightful’ force had done.
Blood followed immediately both from the mouth and nose, and I concluded, at the instant, that the hooks, notwithstanding my precautions, had lacerated the parts, and that I must have done considerable mischief; but I was soon a good deal relieved from my anxiety by the child’s saying she was well, and that the pin was gone.
What a relief! And we should acknowledge that the real hero of the hour was not the surgeon but the little girl, who bore this ordeal with great stoicism.
I gave her a glass of water, which she drank off without the least difficulty, and went home. I desired her mother to examine her stools for some days; and, the fourth day, she found the pin, bent as represented at b, though it was straight when swallowed.
I should observe, that the hook, marked x, was drawn in the manner represented at c, and the point had torn its way through the glove, as at d; so great was the force necessary to disengage the pin! It is clear that the head of the pin stood fast; that the effort I made tore the point through the flesh; that the point slipped from the hook; and that the child immediately swallowed the pin.
No inconvenience has happened from the laceration. The child is eight years old. In emergencies like these, one must act from the suggestion of the present moment.
I have a feeling that Mr Boys was lucky as well as skilful in this case: pulling violently at the pin might have caused serious injury. But we must give him credit for the imaginative manner in which he dealt with a tricky problem.