Sometimes the smallest objects can turn out to be the most useful. And the most frightening.
Who doesn’t feel at least a vague repulsion, a little shiver upon seeing a needle entering the skin?
You guessed it: this article is devoted to needles in bizarre clinical contexts. If you are among the 10% of the population who suffer from needle phobia, then you should skip this post… or maybe not.
An invention older than Man himself
Let’s begin with a little curiosity that isn’t really relevant to this article, but I find fascinating: pictured above is the most ancient needle ever recovered by archaeologists… and it’s not a human artifact.
7 centimeters-long, carved from the bone of an unidentified bird, this perfect needle (complete with an eye to insert a thread) was produced more than 50.000 years ago – not by proper Homo sapiens, but by the mysterious Denisova hominin: settled on mount Altaj in Siberia, these human predecessors are partly still an enigma for paleontologists. But this needle, found in 2016 from their cave, is a proof of their technological advancement.
Needles Under The Skin
The inexplicable delay of Western medicine
Going from sewing needles to medical needles was a much later conquest than you might imagine.
It shouldn’t have been that difficult to see how injecting a drug directly under the skin might be an effective kind of treatment. Norman Howard-Jones begins his Critical Study of the Origins and Early Development of Hypodermic Medication (1947) by noting that:
The effects of the bites of venomous snakes and insects pointed clearly to the possibility of the introduction of drugs through punctures in the skin. In primitive societies, the application for therapeutic purposes of plant and animal products through cutaneous incisions is practiced […], and the use of poisoned arrows may be regarded as a crude precursor of hypodermic and intramuscular medication.
We could trace another “crude precursor” of intramuscular injections back to Sir Robert Christison‘s 1831 proposal, suggesting that whalers fix a vial of prussic acid to their harpoons in order to kill whales more quickly.
And yet, despite of all these clues, the first proper hypodermic injection for strict medical purposes did not take place before mid-Nineteenth Century. Until then, syringes (which had been around for centuries) were mainly used for suction, for instance to draw the fluids which accumulated in abscesses. Enemas and nasal irrigation were used since Roman times, but nobody had thought to inject medications under the skin.
Physicians had tried, with varying results, to scar the epydermis with irritants and to deposit the drug directly on the resultin ulcer, or they sliced the skin with a lancet, as in bloodletting, and inserted salts (for example morphine) through the cut. In 1847, G. V. Lafargue was the first to have the intuition of combining inoculation with acupuncture, and to build a long and thick hollow needle filled with morphine paste. But other methods were being tested, such as sawing a silk thread, imbued in drugs, directly into the patient’s skin.
The first true hypodermic syringe was invented in 1853 by Scottish doctor Alexander Wood, as reported in his New Method of Treating Neuralgia by Subcutaneous Injection (1855). Almost at the same time, the French physician Charles Pravaz had devised his own version. By the end of the Nineteenth Century, hypodermic injections had become a widespread procedure in the medical field.
Needles In The Flesh
The bizarre clinical case of the “needle woman”
Published in 1829 by Giuseppe Ferrario, Chief Surgeon at the Ospedale Maggiore in Milan, La donna dagli aghi reports a strange case that began in June 1828.
A young 19-year-old woman, Maria Magni, “peasant, of scrofulous appearance, but with a passionate temper” was admitted to the hospital because of severe pain.
One April morning, the year before, she had found a light blue piece of paper on the ground which contained 70/80 steel sewing needles. In order not to lose them, she had pinned them on her blouse cuff. But Maria suffered from epileptic fits, and a few hours later, as she was working in the vineyard, “she fell victim of the usual spasms, and convulsive bouts. Under these abnormal and violent muscular movements […] she believes that she unwillingly pushed the needles she had pinned to her shirt through her right arm – which was naked, as is the case among our peasants – as well as through her breast”. The needles didn’t cause her any trouble until three months later, when the pain had become unbearable; she then decided to go to the hospital.
The doctor on duty hesitated to admit her, for fear she had syphilis: Magni had tried alternative treatments, and had applied “many varied remedies, catplasms, ointments, blistering drugs and other ulcerating substances, etc, with the intention of exciting the needles out of her skin”, but this only resulted in her body being covered by sores.
Enter Doctor Ferrario, who during the first 35 days of treatment submitted her to bloodletting for 16 times, applied more than 160 leeches to her temples, administered vesicants, frictions, decoctions, salts and various tinctures. But the daily epileptic fits were terrible, and nothing seemed to work: “all the physicians, stunned by the woman’s horrible condition, predicted an approaching and inevitable death”.
Upon hearing the story of the needles, though, Ferrario began to wonder if some of them were still sticking inside the young woman’s body. He examined her wounds and actually started feeling something thin and hard within the flesh; but touching those spots triggered some epileptic fits of unheard violence. Ferrario described these bouts with typical 19th-Century literary flourishes, in the manner of Gothic novels, a language which today sounds oddly inappropriate in a medical context:
the poor wretched girl, pointing her nape and feet, pushed her head between her shoulders while jumping high above the bed, and arched her bust and arms on the account of the spasmodic contraction of dorsal muscles […] she was shaking and screaming, and angrily wrapped her body in her arms at the risk of suffocating […]. There was involuntary loss of urine and feces […]. Her gasping, suffocated breath, her flaccid and wrinkled breast which appeared beneath her hirst, torn to pieces; the violence with which she turned her head on her neck, and with which she banged it against the walls and threw it back, hanging from the side of the bed; her red and bulging eyes, sometimes dazed, sometimes wide open, almost coming out of their socket, glassy and restless; the obscene clenching of her teeth, the foamy, bloody matter that she squirted and vomited from her dirty mouth, her swollen and horribly distorted face, her black hair, soaked in drool, which she flapped around her cranium […] all this inspired the utmost disgust and terror, as it was the sorrowful image of an infernal fury.
Ferrario then began extracting the needles out of the woman’s body, performing small incisions, and his record went on and on much in the same way: “this morning I discovered a needle in the internal superior region of the right breast […] After lunch, having cut the upper part of the arm as usual, I extracted the needle n. 14, very rusty, with its point still intact but missing the eye […] from the top of the mons pubis I extracted the needle n. 24, rusty, without point nor eye, of the length of eight lines.”
The pins were hard to track down, they moved across the muscles from one day to the other, so much so that the physician even tried using big horseshoe magnets to locate the needles.
The days went by, and as the number of extracted needles grew, so did the suspect that the woman might be cheating on the doctors; Maria Magni just kept expelling needles over and over again. Ferrario began to wonder whether the woman was secretly inserting the needles in her own body.
But before accusing her, he needed proof. He had them searched, kept under strict surveillance, and he even tried to leave some “bait” needles lying around the patient’s bed, to see if they disappear. Nothing.
In the meantime, starting from extraction number 124, Miss Magni began throwing up needles.
The physician had to ask himself: did these needles arrive into the digestive tract through the diaphragm? Or did Magni swallow them on purpose? One thing is sure: vomiting needles caused the woman such distress that “having being so unwell, I doubt she ever swallowed any more after that, but she might have resorted to another less uncomfortable and less dangerous opening, to continue her malicious introduction of needles in the body”.
The “less uncomfortable opening” was her vagina, from which many a new needle was removed.
As if all this was not enough, rumors had spread that the “needle woman” was actually a witch, and hospital patients began to panic.
An old countrywoman, recovering in the bed next to Magni’s, became convinced that the woman had been victim of a spell, and then turned into a witch on the account of the magic needles. Being on the bed next to her, the old lady believed that she herself might fall under the spell. She didn’t want to be touched by the young woman, nor by me, for she believed I could be a sorcerer too, because I was able to extract the needles so easily. This old lady fell for this nonsense so that she started screaming all day long like a lunatic, and really became frenzied and delirious, and many leeches had to be applied to her head to calm her down.
Eventually one day it was discovered where Magni had been hiding the needles that she stuck in her body:
Two whole needles inside a ball of yarn; four whole needles wrapped in paper between the mattress and the straw, all very shiny; a seventh needle, partly rusted, pinned under a bed plank. Several inmates declared that Maria Magni had borrowed four needles from them, not returning them with the excuse that they had broken. The ill-advised young woman, seeing she was surrounded and exposed […] faked violent convulsions and started acting like a demon, trashing the bed and hurting the assistants. She ended by simulating furious ecstasy, during which she talked about purely fictional beings, called upon the saints and the devils, then began swearing, then horribly blasphemed angels, saints, demons, physicians, surgeons and nurses alike.
After a couple of days of these performance, Magni confessed. She had implanted the needles herself under her skin, placed them inside her vagina and swallowed them, taking care of hiding the pierced areas until the “tiny red hole” had cicatrized and disappeared.
In total, 315 needles were retrieved from Maria Magni’s body.
In the epilogue of his essay, Ferrario points out that this was not even the first recorded case: in 1821, 363 needles were extracted from the body of young Rachel Hertz; another account is about a girl who survived for more than 24 years to the ingestion of 1.500 needles. Another woman, Genueffa Pule, was born in 1763 and died at the age of 37, and an autopsy was carried out on her body: “upon dissecting the cadaver, in the upper, inner part of each thigh, precisely inside the triceps, masses of pins and needles were found under the teguments, and all the muscles teemed with pins and needles”.
Ferrario ascribes the motivations of these actions to pica, or superstition. Maria claimed that she had been encouraged by other women of the village to swallow the needles in order to emulate the martyr saints, as a sort of apotropaic ritual. More plausibly, this was just a lie the woman told when she saw herself being cornered.
In the end, the physician admits his inability to understand:
It is undoubtedly a strange thing for a sane person to imagine how pain – a sensation shunned even by the most ignorant people, and abhorred by human nature – could be sometimes sought out and self-inflicted by a reasonable individual.
Needles In The Brain
A dreadful legacy
As I was going through pathology archives, in search of studies that could have some similarities with the Magni story, I came upon one, then two, then several other reports regarding an even more unbelievable occurrence: sewing needles found in the encephalon of adult patients, often during routine X-rays.
Intracranial foreign bodies are rare, and usually result from trauma and operations; but neither the 37-year-old patient admitted in 2004, nor the 45-year-old man in 2005, nor the 82-year-old Italian woman in 2010, nor the 48-year-old Chinese woman in 2015 had suffered any major cranial trauma or undergone head surgery.
An apparently impossible enigma: how did those needles get there?
The answer is quite awful. These are all cases of failed infanticide.
The possibility of infanticide by inserting pins through the fontanelle is mentioned in the Enciclopedia legale ovvero Lessico ragionato by F. Foramiti (1839), where the author includes a (chilling) list of all the methods with which a mother can kill her own child, among which appears the “puncturing the fontanelle and the brain with a thin sharp dagger or a long and strong needle”.
But the practice, properly documented in medical literature only by 1914, already appeared in Persian novels and texts: perhaps the fact that the method was well-known in the ancient Middle East, is the reason why most of the forty recorded cases were documented in Turkey and Iran, with a minority coming from Southeast Asia, Europe and the United States. In Italy there were two known cases, one in 1987 and the 2010 case mentioned above.
Most of these patients didn’t show any particular neurological symptom: the sewing needles, having been embedded in the brain for so many years, are not even removed; a surgical procedure, at this point, would be more dangerous than leaving them in situ.
This was the case for the only known occurrence reported in Africa, a 4-year-old child carrying a 4,5 cm needle through his brain. At the time the report was filed, in 2014, the needle was still there: “no complications were noted, the child had normal physical and mental development with excellent performance at school”.
Of course, discovering at the age of forty that someone – your parents, or maybe your grandparents – tried to kill you when you were just months old must be a shock.
It happened to Luo Cuifen, a chinese lady who was born in 1976, and who showed up at the hospital because of blood in her urine in 2007, and who discovered she had 26 sewing needles in her body, piercing vital organs such as lungs, liver, kidneys and brain. Her story is related to the discriminations towards female newborn children in rural China, where a son is more welcome than a daughter because he can carry on the family name, perform funeral rituals for ancestors, and so on. In Luo’s case, it was most likely her grandparents who attempted the infanticide when she was but months old (even if this theory cannot be proven, as her grandparents already passed away).
The cases of people surviving for decades with a needle in their brain are obviously an exception – as one of the studies put it, this is the “tip of the iceberg”.
A needle wound can be almost invisible. What is really disquieting is the thought of all those infanticides who are carried out “successfully”, without being discovered.
Sometimes the smallest objects can turn out to be the most useful. And the most lethal.
My gratitude goes to Mariano Tomatis, who recommended La donna dagli aghi, which he discovered during his studies on 19th-century magnetism, and which started this research.