The man who coughed up a knife

Here’s an arresting story from 1870, reported to the Chicago Medical Times by a Dr J.F. Snyder: 

James Thompson, sixty years of age, stout and robust, usually of active habits, suddenly commenced declining in health, without apparent cause. When I was consulted, he had been, as he expressed it, “under the weather for five or six weeks.” His symptoms were a troublesome, dry cough, furred tongue, loss of appetite, emaciation, hectic night sweats, and pain in the right side. Previous to the initiation of this train of symptoms, which he attributed to “catching cold,” he had always enjoyed excellent health, “excepting,” as he said, “occasional twinges of rheumatism, for the last dozen years, under the right shoulder-blade,” whenever he exerted himself at any kind of manual labor.

When Dr Snyder examined the man’s chest he found that a portion of the right lung sounded dull on percussion, which he decided was a symptom of pneumonia.

The treatment ordered consisted of stimulating expectorants, mineral acids, and counter-irritants. For four weeks more the case continued without change, save a gradual aggravation of all the symptoms, increased dyspnoea, and free expectoration, when one day, in a hard paroxysm of coughing, the patient threw up, from the right bronchia, an ounce or two of pus and a hard substance, which attracted his attention, by the force with which it struck the floor. On examining the substance, it proved to be the point of a knife-blade, an inch in length, half an inch in width, and weighing half a drachm.

Unsurprisingly, this shard of metal (iron, presumably) was heavily corroded after its stay in the body.

The patient now remembered a circumstance he had entirely forgotten—that twelve years before this, in a street fight, at Beardstown, in which himself and several others had been engaged, he had been “stabbed in the back, about the lower point of the shoulder-blade,” but as the wound gave him no pain and soon healed, he had no suspicion that any part of the blade had remained embedded in his body. The true pathology of the case was now manifest, and the patient rapidly recovered his health.

Dr Snyder concludes by pointing out the remarkable features of his case – though these will probably have been obvious to his readers, then as now:

1st. That such a foreign body should have so long remained fastened in the bone (either the scapula or rib) without causing necrosis or other disturbance, save occasional slight pains, attributed by the patient to rheumatism.

2d. That, supposing the knife had passed through the bone at once, or had penetrated the thoracic cavity, between the ribs, it failed at the time to excite severe inflammation and produce exhaustive suppuration.

3d. That, having penetrated the substance of the lung, into the bronchia, by adhesive inflammation and suppuration, it should have been so easily expelled through the thyroarytenoid ligaments and the glottis.