The missing tobacco pipe

tobacco pipe earIn 1855 The Lancet reported the proceedings of the most recent meeting of the London Medical Society. Here is one highlight: 

clay pipe smokerMr. Henry Smith showed a portion of tobacco pipe, nearly two inches in length, which he had extracted from behind the ear of a boy who, between two and three years previously, had fallen down whilst holding a long clay pipe between his teeth. 

When the boy arrived at hospital there was a swelling just behind his ear, with a small opening in it…

…by which some foreign body was detected, which at first was thought to be dead bone, as no history of the accident with the pipe had been obtained. When, however, the foreign body was extracted, the mother of the child first mentioned it. She stated that after the accident the boy had been seized with a severe illness, accompanied with great pain in the head. These symptoms, together with an inability to open the mouth, continued for some months, at the end of which they subsided, when the swelling first appeared behind the ear, and continued there for two years. 

You’d think that these alarming symptoms might have rung a few alarm bells. As it transpired, everybody thought the boy had an abscess, and he was treated accordingly. He is lucky it did not kill him.

On examining the interior of the mouth, which could only be opened about half-way, Mr. Smith could see an opening in the mucous membrane, just at the base and inner side of the ascending ramus of the lower jaw, through which the piece of pipe had penetrated. It must have passed along the inner and posterior border of the jaw, amongst the important vessels and nerves, and gradually made its way towards the surface, where it had remained for two years. 

If the pipe had pierced a major vessel he might have bled to death. If it had severed a nerve he could have lost all sensation in the bottom half of his face. A lucky escape!

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