Revealed: the cure for hiccups

A striking report* was published in the Boston Medical and Surgical Journal in 1845 by Dr George Dexter, a physician from New York:

Some time since, a singular case of hiccough was placed under my treatment. Its origin evidently was from long-continued masturbation.

Dr Dexter appears remarkably confident in this assertion. On what grounds, you might reasonably ask – with good reason.

In the winter of 1840 I was requested by my partner to visit, in consultation, a case of “convulsions”, which he said had for twenty-four hours resisted every remedy. The patient was an Irish girl, 18 years old. Accordingly, late in the evening, we rode out to her residence, and found her lying on a small cot-bedstead, just recovering from a paroxysm of opisthotonos—her attendants stating that her heels absolutely touched the back part of her head.

Opisthotonos is a phenomenon caused by spasm of the spinal muscles, in which the patient’s neck and back arc into a bridge shape. It can be caused by a variety of conditions including brain injury and tetanus, such as this case painted by the Scottish surgeon Sir Charles Bell:

As soon as she had somewhat recovered from her fatigue, I examined her pulse, which was slow, full and hard. She was sweating freely from the violent effort she had been making, but her skin was not at the usual temperature. Her countenance was flushed, pupils dilated, tongue a little furred. The bowels had been moved that morning, but were slightly tender at the lower part. She answered questions readily, although she was inclined to sleep.

Although she was drowsy when the doctors arrived at her bedside, the patient now began to display a new symptom.

She did not remain quiet, however, more than ten minutes, when she commenced hiccoughing, gradually at first, and at intervals. This soon increased in frequency, until the convulsions resembled more the “roll ” of a drum or the clatter of a watchman’s rattle, than legitimate hiccough. There was no intermission; it was one continued roll, increasing in power, until every muscle of the body participated with the diaphragm, and she “went off” in paroxysms of general convulsion.

It was a hiccough/hiccup of quite unusual violence, and apparently immune to all treatment.

This had been her condition for the twenty-four hours previous, and she had been during that time bled and purged, and had run through the whole catalogue of remedies, both external and internal, without the least benefit. The hiccough still continued, and the intervals were shorter. Her strength was but little if any diminished, but she complained of soreness over the whole body.

She remained in this condition for several days, when the hiccupping abruptly ceased and she was able to get out of bed and resume her normal life.

Some four or six weeks after, I was called to her again. I found her in the same condition as before, with longer intervals, however, between the general spasms, but without any cessation of the hiccough, the paroxysms of which, alternated between the “roll” and the usual convulsion. She had not menstruated since her last attack. Bowels now constipated; pulse full and slow; tongue furred; breath very offensive; countenance flushed; head aching violently; abdomen tender.

The doctor prescribed a range of treatments including bleeding and laxatives – standard remedies employed at this date for a wide range of conditions.

The next day she was somewhat relieved, but still in the “hiccough.” During the day she requested her nurse to give her a piece of white sewing silk, saying she wished to cut off a wart on her leg. The nurse mentioned the circumstance to me, and 1 questioned her about the situation of the wart. She stated to me that it was not on her limb, but on her genitals.

An unexpected development. Could this possibly have any connection with the hiccupping?  Apparently it could:

No inducement or persuasions were of any effect. I could not prevail on her to permit me to examine it. She also stated that she had had several warts, and when she cut them off the hiccough subsided. At this time, by much questioning, I extracted from her the fact, that she had long been in the habit of masturbation, and that, too, in no limited extent—ordinarily producing orgasm four or five times daily, and that for a period of two years.

In the mid-nineteenth century, doctors in most of Europe and (particularly) America regarded masturbation as not merely a vice, but a practice which if unchecked would lead to serious illness and probable death. Some authorities believed that those who indulged in it were already labouring under mental disease.

She further stated that the paroxysms could be “stopped,” if I were to press my hand on the upper part of her external organs, and continue the pressure for a few minutes. She was all this time constantly hiccoughing, and it was with considerable difficulty that she conversed at all. However, to test her statements, I pressed gently but firmly upon the clitoris outside her linen, with my hand, and the convulsions gradually subsided, and she went to sleep.

An interesting finding, but one which raises certain questions about medical ethics – did the doctor really have a legitimate therapeutic reason for his behaviour?

The next day, as usual, I visited her. She was free from all convulsion, but complained of pain and soreness of the back. I was proceeding to examine her back, when, in turning over, she struck the back against the bar of the bedstead, and immediately went into a paroxysm of hiccough, which terminated in general spasm. While in this condition, most frightfully convulsed, I pressed my hand firmly upon the upper part of the genitals, and the convulsions subsided directly, and she lay perfectly quiet.

For the next four months she was plagued by further attacks of hiccupping, lasting for up to a week and continuing even in her sleep.

She informed me, during this time, that so great was the venereal passion, that she carried to bed with her, as a constant companion, a large piece of wood shaped like a penis.

The emphasis is in the original: Dr Dexter was truly shocked. Whatever would he have made of the modern age, when such objects are available for purchase on the high street of every major town?

Disgusting as these details were, she did not seem to have any hesitation in answering my questions. The paroxysms of hiccough could at any time be induced by hard pressure upon the lower lumbar vertebrae, which were exquisitely tender; and as readily could these paroxysms be allayed by pressure upon the upper part of the external organs. She was capricious in temper, and was subject to occasional periods of despondency. Yet she did not seem to realize her depraved condition, for she was at this time a member of one of the religious societies in town.

Dr Dexter wanted to be sure that there was no deception involved. To ensure that the surprising effect was indeed genuine, he regularly took his colleagues to see the young woman so that they could witness it for themselves.

In every instance could the hiccough be induced by pressure on the spine, and controlled by pressure on the clitoris. No restraints were of any avail; she still continued the revolting habit of masturbation until she left town, which she did without informing me of her intention to do so. I have not since heard of her.

You may notice that Dr Dexter failed to support his assertion that the hiccupping had been caused by masturbation; in fact it seems to have been arrested by clitoral stimulation. Bizarrely, the story may indeed be true. In 2000 two doctors from Israel published a case report entitled ‘Sexual intercourse as potential treatment for intractable hiccups’. Their patient, a 40-year-old man, developed persistent hiccups after seeking treatment for back pain. Nothing would stop them, until:

On the fourth day of continuous hiccuping, the patient had sexual intercourse with his wife. The hiccups continued throughout the sexual interlude up until the moment of ejaculation when they suddenly and completely ceased and did not recur over a follow-up period of 12 months.

The parallels are striking: the apparent involvement of the spine, and the immediate cessation of the hiccup as a result of sexual stimulation. The doctors observe that ‘No reports in the medical literature over the past 23 years show that sexual intercourse or ejaculation can terminate intractable hiccups.’  Maybe not; but Dr Dexter had pointed it out 150 years earlier.

*I am indebted to Andrea Sella, professor of inorganic chemistry at UCL, for bringing this important document to my attention.