In 1868 the Medical and Surgical Reporter contained a report of an unusual case received from the physicians of the insane asylum at Zutphen, a town in the Netherlands.
The patient was a woman 64 years old, affected with lypemania…
Lypemania is an archaic term, meaning an excessive fondness for melancholy. Today a patient suffering from these symptoms would probably be diagnosed with chronic depression.
…who had swallowed a silver fork for the purpose of committing suicide. She was received into the asylum two days after accomplishing this feat, and the physician had no difficulty in detecting the foreign body in the stomach. The teeth of the fork were in the cardiac portion, directed upward and forward, the handle lying backward, in the pyloric extremity. The patient complained of no pain, only a sensation of weight and oppression at the stomach.
For the first few days, the woman’s doctors simply imposed a severe diet and confined her to bed. This had little effect, but the patient soon began to complain of pain on the left side of her abdomen:
These symptoms continued without aggravation during three months, and then gradually subsided. At this time the teeth of the fork disappeared from the place where for so long they had been plainly perceptible, and instead was discovered a singular tumor in the abdomen, to the left of the umbilicus, which occasionally had the air of a gravid uterus at four months. It was impossible to decide upon the nature of the contents of this tumor, in which no sign of the fork could be perceived.
The pain was mild, and the woman was still able to eat and digest her food, so the doctors did nothing further.
Five months later, the tumor, which till then had been quite round, began to point. The abdominal walls were not adherent. In the course of the following month an abscess formed; the integuments gradually reddened and thinned, and the tumor opened spontaneously, and gave issue, first, to a small quantity of pus, then to liquid fecal matters.
Yuck.
About a week later, at the morning visit, the physician was surprised at perceiving the four teeth of a fork behind the abdominal wall, close by the fistulous opening. By prudent manipulation, it became evident that the foreign body was only retained in place by the integuments, and in effect, after a couple of lateral incisions, the fork was easily extracted in the perpendicular direction that it occupied to the abdominal wall. The handle was entirely surrounded by extremely fetid fecal matters; a great number of crystals of phosphate of lime covered the teeth of the fork, which had turned black from a coating of sulphate of silver.
The patient had been in a great deal of pain, but after the fork was removed she was immediately relieved. There were some signs of infection, but the wound was dressed and healed within a month.
It is extremely remarkable that the general health was so slightly deranged by the ten months’ sojourn and peregrinations of a foreign body in the stomach and intestines. Perhaps the mental alienation of the patient may be presumed to have blunted the general physical sensibilities, a circumstance frequently observed in “the pathology of the insane.”