Jumping over a broomstick

During a meeting of the New York Pathological Society in 1872, a local physician called Dr Post gave a short talk about one of his patients, who had discovered a highly novel method of injuring himself:

On the 9th August, 1872, I was requested to see Mr. B., a young man 19 years of age, who, about four months before, in jumping over a broomstick, had become impaled…

Had he really been ‘jumping over a broomstick’? I suspect many emergency medics would roll their eyes if offered this explanation for a rectal injury.

…the stick entering the anus without any external wound, and penetrating the bladder, so that the urine was discharged by the rectum.

A nasty-sounding injury.

A hole, an inch in length and three-quarters of an inch in breadth, with loss of substance, was found in the seat of his pantaloon!

Annoying, no doubt, but the damage to his trousers was the least of the young man’s concerns.

The injury was followed by a severe attack of peritonitis, which yielded to full doses of morphia.

If it really was peritonitis (inflammation of the membrane around the viscera, usually caused by an infection) he was lucky to survive.

The bladder was left in an irritable condition, and his physician, in attempting to introduce an instrument through the urethra, was unable to pass it much beyond an inch from the external orifice. The patient denied ever having suffered from any disease or injury of the urethra. He said that he had never passed his urine in a full stream, but had not been aware that he was different from other boys in that respect.

Dr Post now visited the patient for the first time, and found that the young man had a stricture – a congenital narrowing of the urethra. This he was able to treat by using a tiny blade to cut through the obstruction. But this wasn’t quite the end of the case:

On the 29th August, the doctor called on me to say that the urethra remained free at the seat of the stricture…The operation had scarcely been followed by any irritation at the seat of the incision but he had discovered a calculus in the bladder, and the organ continued very irritable, so that be passed his urine very frequently, with much pain, and small quantities at a time.

Frustrating. The patient now had a bladder stone which was severely curtailing his recovery. But that wasn’t all – he had developed an unwanted curve in an intimate part of his anatomy.

I visited the patient, and found that some longitudinal contraction had taken place at the seat of the incision which I had made in dividing the stricture, giving to that portion of the penis a curvature with downward concavity, constituting a sort of chordee without erection.

Chordee is an abnormal curvature of the head of the penis, usually congenital. In this case, the  formation of scar tissue had contracted the tissues asymmetrically.

Dr Post wanted to insert an instrument known as a lithotrite to crush the bladder stone, but doing so through the distorted penis took some ingenuity. Eventually, however, he managed it.

I passed into the bladder a medium-sized duck-bill lithotrite.

This was a long, thin instrument with jaws vaguely resembling a duck’s bill:

Although the bladder was contracted on the stone, and contained very little urine, I had no great difficulty in seizing the stone by a diameter of three-quarters of an inch. As the stone was of soft consistence, it was easily crushed.

Over the course of the next week, Dr Post repeated the operation several times – not a particularly enjoyable experience for the patient. Each time he crushed the stone or its fragments, hoping that the tiny particles would be washed out with the patient’s urine. On 6 September, the doctor made a breakthrough:

I introduced the lithotrite, and grasped a foreign body, which I removed with considerable difficulty, and found to be a piece of cashmere from his pantaloons— the piece which the end of the broomstick had carried into the bladder.

That’s right: the doctor succeeded in removing a fairly large piece of the patient’s trousers from inside his bladder! After this unusual therapeutic procedure the patient’s recovery continued apace. For the next fortnight he continued to pass fragments of stone in  his urine, but by the time of the doctor’s final visit on 14 September he was almost back to full health.

When Dr Post had finished talking about this case, one of his colleagues revealed that he had also heard of a similarly wince-inducing case:

Dr. Buck remarked that having had occasion to attend a case in Hudson, N.Y., a surgeon of that place related an instance where the same sort of rupture of the bladder had occurred, as the result of an attempt to leap over a churn. The churn tilted at the wrong time, the handle of which found its way into the rectum and thence into the bladder.

Got it? Leaping over broomsticks and milk churns is a Bad Idea.