The human pincushion

HIstory of a patient from whom four hundred needles were extracted

This extraordinary tale appeared in The Medico-Chirurgical Review in 1825:

Rachel Hertz had lived in the enjoyment of good health up to her fourteenth year; she was then of a fair complexion, and rather of the sanguineous temperament. In August 1807, she was seized with a violent attack of cholic, which induced her to apply to Professor Hecholdt, and this was the first acquaintance which the Professor had with the case. From that time to March 1808 she experienced frequent attacks of erysipelas [a bacterial skin infection] and fever, which left her in a very debilitated state. Many symptoms of an hysterical character showed themselves, but which the ordinary remedies failed to remove. From March to May 1809, a period of fourteen months, she suffered in this way from repeated and violent hysteric attacks, accompanied with, or rather followed by, fainting, which sometimes continued so long, that people considered her dead. Occasionally she was attacked with epileptic fits, at other times with drowsiness and hiccough, and sometimes with delirium.

The next development says a lot for the reading habits of Danish teenagers in the early 19th century.  I don’t suppose many modern patients display this symptom:

During the paroxysms of her madness, she delivered, with a loud voice and correct enunciation, long passages from the works of Goethe, Schiller, Shakspeare, and Othlenschläger, just as accurately as any sane person could do, and although she kept her eyes closed, she accompanied the declamation with suitable gesticulations.

Another journal, in its report of this case, included ‘long fits of theatrical recitations from tragic poets’ in its list of her symptoms.  The association between Romantic literature and melancholy was frequently made: after the publication of Goethe’s The Sorrows of Young Werther in 1774, young men took to dressing like Goethe’s tragic hero.

The delirium continued to increase until it assumed a very alarming height; she gnashed her teeth, kicked about, and fought with whatever came in her reach, and disturbed with her ravings, not only her own household, but the whole neighbourhood.

Her obvious mental distress was now compounded by physical ailments: constipation and difficulty in urinating required the daily use of a catheter.  She sank into a deep depression.

In May, 1809, Professor Collisen was consulted, who, during the lethargic state of the patient, recommended snuff to be pushed up her nostrils, the effect of which was so favourable that, without sneezing, she soon came to her senses. She complained of nothing during that day, and the snuff frequently produced equally good effects, for a time only. The delirium continued from May 1809, to December 1810, with little variation of importance, and then gradually subsided.

She was in much better health for the next few years, until a brief relapse in 1813.

Nothing particular occurred from that time to May 1816, except the formation of a carbuncle in the thigh, but she was then seized with violent pains in the left hypochondriac region, with vomiting of blood, from which she again recovered, and remained free from any particular complaint until January 1819, when severe cholic pains made their appearance, with fever, vomiting of blood, and purging of black faecal matter, from which it was considered impossible that she could recover—but recover she did. On examination of the abdomen, a large tumour was found, having three distinct elevations just below the umbilicus. To this tumour, emollient cataplasms were applied, without producing much benefit, and the worn out and desperate condition of the patient induced Professor Hecholdt to lay open the tumour by a deep incision.

And this is where things start to get really interesting:

It was expected that a copious discharge of pus would follow, but no pus came, and the bleeding was very slight. When the wound was examined with a probe, a curious sensation was communicated to the hand, just as if a metallic body had been thrust against the probe; this was repeated, a forceps was introduced, the substance was laid hold of, and, to his great astonishment, out came a needle. The extraction of this needle produced some alleviation of the sufferings of the patient, but it was of very short duration; great pain with vomiting of blood returned, another tumour appeared in the left lumbar region, the touching of which caused great uneasiness. On the 15th of February, an incision was made into it, and another black oxydized needle drawn out.

Similar lumps started to appear all over the young woman’s body.  Each time one did, the doctors cut into it, always with the same result:

From the 12th of February 1819, to the 10th of August 1820, a period of eighteen months, severe pains, followed by tumours, were felt in various parts of the body, from which two hundred and ninety-five needles were extracted, viz.—

From the left breast, 22—from the right breast, 14—from the epigastric region, 41—from the left hypochondriac region, 19—from the right hypochondriac region, 20—from the umbilicus, 31—from the left lumbar region, 39—from the right lumbar region, 17—from the hypogastric region, 14—from the right iliac region, 23—from the left iliac region, 27—from the left thigh, 3—from the right shoulder, 23—between the shoulders, 1—from under the left shoulder, 1.

Total – 295.

Between August 1820 and March 1821 no further needles appeared; thinking the case concluded, Professor Hecholdt wrote an account of these strange events for the medical journals.  But this turned out to be premature:

A large tumour formed in the right axilla, from which, between the 26th of May and the 10th of July, 1822, no less than one hundred needles were taken out!  From the 1st of July, 1822, to the 10th of December, 1823, five needles were at different times extracted, making the total number of Four Hundred!!

The multiple exclamation marks are in the original; the author can barely restrain his excitement.

The patient has amused herself during her convalescence by learning Latin, and writing a journal of her own case. She is at present living at Frederick’s hospital, at Copenhagen, and enjoys good health.

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