The tin box

Cases of unusual foreign objects can make entertaining reading, though often for the ‘wrong’ reasons. The medical literature is full of tales of bizarre items inserted in orifices where they weren’t meant to go, but such stories seldom add much to the sum of human knowledge – except perhaps provide yet more evidence of our capacity for folly.

This example is different. It was originally reported in 1901 by a Dr Czarnecki from the Prussian city of Gnesen – now in Poland and known as Gniezno. Five years later it was translated for an article in The Practitioner by J.B. Hellier, an obstetrician at Leeds General Infirmary: foreign bodies in the uterus

A girl, aged 12, alarmed at the onset of menstruation, introduced into the vagina a tin box such as schoolchildren then used for holding steel pens, her idea being to prevent further loss of blood.

A circumstance that should prompt no other response but pity. This is what happens when children are not adequately taught about their own bodies.

The box is described as being of an oval shape 10 cm. in diameter and 4 cm. in height. After this she menstruated regularly, but all attempts to extract the box were fruitless. She subsequently used a syringe for slight leucorrhoeal discharge, and could always feel the box in the vagina.

The ‘leucorrhoeal discharge’ was probably a sign of inflammation – but luckily this did not develop into anything more serious, such as infection.

There were practically no symptoms, and she never sought advice or told anyone about it. She married at 25, and her husband is said not to have found out that anything was amiss.

An indication that the tin box had been inserted – or had made its way – quite a long way inside the girl’s body.

Five months after marriage she became pregnant, but aborted at four months, being attended by neither physician nor midwife.

‘Abortion’ is a word now usually applied to the deliberate termination of a pregnancy, but at this date it also denoted a miscarriage.

After the abortion, she could no longer perceive the foreign body in the vagina, although she knew that it had not slipped out. There seems to be no doubt that it had entered the uterus at this time.

It’s surprising that she was able to conceive at all, but would it be possible with the tin box actually inside the womb? Apparently so:

Finally she became pregnant again and went to term, being then a well-developed, healthy woman of 27. Dr. Czarnecki, of Gnesen, was called to her (September 9, 1900). He found the os externum [cervix] dilated to somewhat less than the size of a florin, and the foreign body in question lying between the head of the foetus and the os.

It’s amazing, when you think about it: a foetus had grown for nine months while sharing the womb with a pencil case! Before the baby could be born, the doctor first had to ‘deliver’ the tin box:

He removed the tin box by first getting off and extracting the lid, and then crushing the box with a pair of bone forceps.

The box had caused a number of adhesions, lines of scar tissue which the doctor had to cut through to enable the cervix to dilate.

Delivery was completed with forceps. The mother and child did a great deal better than might have been expected, for the child was a well-developed, healthy male, and the patient rose from childbed well on the twelfth day. The foreign body was thus tolerated 13 years in the vagina, and then in the uterus, with a singular absence of symptoms, and gestation ran a normal course in spite of the presence of the tin box in utero!

Pretty astonishing, and until now I’d never heard of a pregnancy proceeding normally despite a foreign body in the womb – and this object was 10 cm in diameter! If you’re aware of anything faintly comparable, please feel free to share it in the comments.

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