“A Tiny Red Hole”: Horrible Stories of Needles

Jan19

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.

Prehistoric Needles
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.

I wonder what would Ferrario say today, if he could see some practices such as play piercing or body suspension performances.

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).

In more recent cases, recorded in Tunisia, China and Brazil, it was discovered that the children had respectively three, twelve and even fifty needles stuck in their bodies.

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.

The Abominable Vice

Nov16

Among the bibliographic curiosities I have been collecting for years, there is also a little book entitled L’amico discreto. It’s the 1862 Italian translation of The silent friend (1847) by R. e L. Perry; aside from 100 beautiful anatomical plates, the book also shows a priceless subtitle: Observations on Onanism and Its Baneful Results, Including Mental and Sexual Incapacity and Impotence.

Just by skimming through the table of contents, it’s clear how masturbation was indicated as the main cause for a wide array of conditions: from indigestion to “hypoconriac melancholy”, from deafness to “bending of the penis”, from emaciated complexion to the inability to walk, in a climax of ever more terrible symptoms preparing the way for the ultimate, inevitable outcome — death.
One page after the other, the reader learns why onanism is to be blamed for such illnesses, specifically because it provokes an

excitement of the nervous system [which] by stimulating the organs to transient vigour, brings, ere middle life succeeds the summer of manhood, all the sensible infirmities and foibles of age; producing in its impetuous current, such an assemblage of morbid irritation, that even on trivial occasions its excitement is of a high and inflammable character, and its endurance beyond the power of reason to sustain.

But this is just the beginning: the worst damage is on the mind and soul, because this state of constant nervous stimulation

places the individual in a state of anxiety and misery for the remainder of his existence, — a kind of contingency, which it is difficult for language adequately to describe; he vegetates, but lives not: […] leading the excited deviating mind into a fertile field of seductive error — into a gradual and fatal degradation of manhood — into a pernicious, disgraceful, and ultimately almost involuntary application of those inherent rights which nature wisely instituted for the preservation of her species […] in defiance of culture, moral feeling, moral obligation, and religious impressions: thus the man, who, at the advent of youth and genius was endowed with gaiety and sociality, becomes, ere twenty-five summers have shed their lustre on him, a misanthrope, and a nadir-point of discontent! What moral region does that man live in? […] Is it nothing to light the gloomy torch that guides, by slow and melancholy steps to the sepulchre of manhood, in the gay and fascinating spring-time of youth and ardent desire; when the brilliant fire of passion, genius, and sentiment, ought to electrify the whole frame?

This being a physiology and anatomy essay, today its embellishments, its evocative language (closer to second-rate poetry than to science) seem oddly out of place — and we can smile upon reading its absurd theories; yet The Silent Friend is just one of many Nineteeth Century texts demonizing masturbation, all pretty popular since 1712, when an anonymous priest published a volume called Onania, followed in 1760 by L’Onanisme by Swiss doctor Samuel-Auguste Tissot, which had rapidly become a best-seller of its time.
Now, if physicians reacted in such a harsh way against male masturbation, you can guess their stance on female auto-eroticism.

Here, the repulsion for an act which was already considered aberrant, was joined by all those ancestral fears regarding female sexuality. From the ancient vagina dentata (here is an old post about it) to Plato’s description of the uterus (hystera) as an aggressive animale roaming through the woman’s abdomen, going through theological precepts in Biblical-Christian tradition, medicine inherited a somber, essentially misogynistic vision: female sexuality, a true repressed collective unconscious, was perceived as dangerous and ungovernable.
Another text in my library is the female analogue of Tissot’s Onania: written by J.D.T. de Bienville, La Ninfomania ovvero il Furore Uterino (“Nymphomania, or The Uterine Fury”) was originally published in France in 1771.
I’m pasting here a couple of passages, which show a very similar style in respect to the previous quotes:

We see some perverted young girls, who have conducted a voluptuous life over a long period of time, suddenly fall prey to this disease; and this happens when forced retirement is keeping them from those occasions which facilitated their guilty and fatal inclination. […] All of them, after they are conquered by such malady, occupy themselves with the same force and energy with those objects which light in their passion the infernal flame of lewd pleasure […], they indulge in reading lewd Novels, that begin by bending their heart to soft feelings, and end up inspiring the most depraved and gross incontinence. […] Those women who, after taking a few steps in this horrible labyrinth, miss the strength to come back, are drawn almost imperceptibly to excesses, which after corrupting and damaging their good name, deprive them of their own life.

The book goes on to describe the hallucinatory state in which the nymphomaniacs fall, frantically hurling at men (by nature all chaste and pure, it seems), and barely leaving them “the time to escape their hands“.
Of course, this an Eighteenth Century text. But things did not improve in the following century: during the Nineteenth Century, actually, the ill-concealed desire to repress female sexuality found one of its cruelest incarnations, the so-called “extirpation”.

This euphemism was used to indicate the practice of clitoridectomy, the surgical removal of the clitoris.
Everybody kows that female genital mutilations continue to be a reality in many countries, and they have been the focus of several international campaigns to abandon the practice.
It seems hard to believe that, far from being solely a tribal tradition, it became widespread in Europe and in the United States within the frame of modern Western medicine.
Clitoridectomy, a simple yet brutal operation, was based on the idea that female masturbation led to hysteria, lesbianism and nymphomania. The perfect circular reasoning behind this theory was the following: in mental institutions, insane female patients were often caught masturbating, therefore masturbation had to be the cause of their lunacy.

One of the most fervent promoters of extirpation was Dr. Isaac Baker Brown, English gynaecologist and obstetrical surgeon.
In 1858 he opened a clinic on Notting Hill, ad his therapies became so successful that Baker Brown resigned from Guy’s Hospital to work privately full time. By means of clitoridectomy, he was able to cure (if we are to trust his own words) several kinds of madness, epilepsy, catalepsy and hysteria in his patients: in 1866 he published a nice little book on the subject, which was praised by the Times because Brown “brought insanity within the scope of surgical treatment“. In his book, Brown reported 48 cases of female masturbation, the heinous effects on the patients’ health, and the miraculous result of clitoridectomy in curing the symptoms.

We don’t know for sure how many women ended up under the enthusiastic doctor’s knife.
Brown would have probably carried on with his mutilation work, if he hadn’t made the mistake of setting up a publicity campaign to advertise his clinic. Even then, self-promotion was considered ethically wrong for a physician, so on April 29, 1866, the British Medical Journal published a heavy j’accuse against the doctor. The Lancet followed shortly after, then even the Times proved to have changed position and asked if the surgical treatment of illness was legal at all. Brown ended up being investigated by the Lunacy Commission, which dealt with the patients’ welfare in asylums, and in panic he denied he ever carried out clitoridectomies on his mentally ill patients.

But it was too late.
Even the Royal College of Surgeons turned away from him, and a meeting decided (with 194 approving votes against 38 opposite votes) his removal from the Obstetric Society of London.
R. Youngson and I. Schott, in A Brief History of Bad Medicine (Robinson, 2012), highlight the paradox of this story:

The extraordinary thing was that Baker Brown was disgraced, not because he practised clitoridectomy for ridiculuous indications, but because, out of greed, he had offended against professional ethics. No one ever suggested that there was anything wrong with clitoridectomy, as such. Many years were to pass before this operation was condemned by the medical profession.

And many more, until eventually masturbation could be freed from medical criminalization and moral prejudice: at the beginning of the Twentieth Century doctors still recommended the use of constrictive laces and gears, straight-jackets, up to shock treatments like cauterization or electroconvulsive therapy.

1903 patent to prevent erections and nocturnal pollutions through the use of spikes, electric shocks and an alarm bell.

Within this dreadful galaxy of old anti-masturbation devices, there’s one looking quite harmless and even healthy: corn flakes, which were invented by famous Dr. Kellogg as an adjuvant diet against the temptations of onanism. And yet, whenever cereals didn’t do the trick, Kellogg advised that young boys’ foreskins should be sewn with wire; as for young girls, he recommended burning the clitoris with phenol, which he considered

an excellent means of allaying the abnormal excitement, and preventing the recurrence of the practice in those whose will-power has become so weakened that the patient is unable to exercise entire self-control.
The worse cases among young women are those in which the disease has advanced so far that erotic thoughts are attended by the same voluptuous sensations that accompany the practice. The author has met many cases of this sort in young women, who acknowledged that the sexual orgasm was thus produced, often several times daily. The application of carbolic acid in the manner described is also useful in these cases in allaying the abnormal excitement, which is a frequent provocation of the practice of this form of mental masturbation.

(J. H. Kellogg, Plain Facts for Old And Young, 1888)

It was not until the Kinsey Reports (1948-1953) that masturbation was eventually legitimized as a natural and healthy part of sexuality.
All in all, as Woody Allen put it, it’s just “sex with someone you love“.

On the “fantastic physiology” of the uterus, there is a splendid article (in Italian language) here. Wikipedia has also a page on the history of masturbation. I also recommend Orgasm and the West. A History of Pleasure from the Sixteenth Century to the Present, by R. Muchembled.

My week of English wonders – II

Jun19

(Continued from the previous post)

The Viktor Wynd Museum of Curiosities, Fine Art & Natural History still resides in its original location, in Mare Street, Hackney, East London (some years ago I sent over a trusted correspondant and published his ironic reportage).
Many things have changed since then: in 2014, the owner launched a 1-month Kickstarter campaign which earned him £ 16,000, allowing him to turn his eclectic collection into a proper museum, complete with a small cocktail bar, an art gallery and an underground dinining room. Just a couple of tables, to be precise; but it’s hard to think of another place where guests can dine around an authentic 19th century skeleton.

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The outrageous bad taste of placing human remains inside a dinner table is a good example of the sacrilegious vein that runs through the whole disposition of objects collected by Viktor: here the very idea of the museum as a high-culture institution is deconstructed and openly mocked. Refined works of art lay beside pornographic paperbacks, rare and precious ancient artifacts are on display next to McDonald’s Happy Meal toy surprises.

But this is not a meaningless jumble — it goes back to the original idea of a Museum being the domain of the Muses, a place of inspiration, of mysterious and unexpected connections, of a real attack to the senses. And this wunderkammer could infuriate wunderkammern purists.

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When I met up with him, Viktor Wynd didn’t even need to talk about himself. Among dodo bones, giant crabs, anatomical models, skulls and unique books, unmatched from their very titles — for instance Group Sex: A How-To Guide, or If You Want Closure in Your Relationship, Start with Your Legs — the museum owner was immersed in the objectification of his boundless imagination. As he moved along the display cases in his immense collection (insured for 1 million pounds), he looked like he was wandering through the rooms of his own mind.
Artist, surrealist and intellectual dandy, his life story as fascinating as his projects, Viktor always talks about the Museum as an inevitable necessity: “I need beauty and the uncanny, the funny and the silly, the odd and the rare. Rare and beautiful things are the barrier between me and a bottomless pit of misery and despair“.

And this strange bistro of wonders, where he holds conferences, cocktail parties, masqued balls, exhibitions, dinners, is certainly a rare and beautiful thing.

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I then moved to the London Bridge area. In front of Borough Market is St. Thomas Street, where old St. Thomas church stands embedded between modern buildings. It was not the church itself I was interested in, but rather its garret.
The attic under the church’s roof hosts a little known museum with a peculiar history.

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The Old Operating Theatre Museum and Herb Garret is located in the space where all pharmaceuticals were prepared and stored, to be used in the annexed St. Thomas Hospital. A first section of the museum is dedicated to medicinal plants and antique therapeutic instruments. On display are several devices no longer in use, such as tools for cupping, bleeding and trepanation, and other quite menacing contraptions. But, together with its unique location, what gives this part of the museum its almost fantastic dimension is the sharp fragrance of dried flowers, herbs and spices (typical of other ancient pharmacies).

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If the pharmacy is thought to have been active since the 18th Century, only in 1822 a part of the garret was transformed into operating theatre — one of the oldest in Europe.
Here the patients from the female ward were operated. They were mostly poor women, who agreed to go under the knife before a crowd of medicine students, but in return were treated by the best surgeons available at the time, a privilege they could not have afforded otherwise.
Operations were usually the last resort, when all other remedies had failed. Without anestetics, unaware of the importance of hygiene measures, surgeons had to rely solely on their own swiftness and precision (see for instance my post about Robert Liston). The results were predictable: despite all efforts, given the often already critical conditions of the patients, intraoperative and postoperative mortality was very high.

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The last two places awaiting me in London turned out to be the only ones where photographs were not allowed. And this is a particularly interesting detail.

The first was of course the Hunterian Museum.
Over two floors are displayed thousands of veterinary and human anatomical specimens collected by famed Scottish surgeon John Hunter (in Leicester Square you can see his sculpted bust).
Among them, the preparations acquired by John Evelyn in Padua stand out as the oldest in Europe, and illustrate the vascular and nervous systems. The other “star” of the Museum is the skeleton of Charles Byrne, the “Irish giant” who died in 1783. Byrne was so terrified of ending up in an anatomical museum that he hired some fishermen to throw his corpse offshore. This unfortunately didn’t stop John Hunter who, determined to take possession of that extraordinary body, bribed the fishermen and paid a huge amount of money to get hold of his trophy.

The specimens, some of which pathological, are extremely interesting and yet everything seemed a bit cold if compared to the charm of old Italian anatomy museums, or even to the garret I had just visited in St. Thomas Church. What I felt was missing was the atmosphere, the narrative: the human body, especially the pathological body, in my view is a true theatrical play, a tragic spectacle, but here the dramatic dimension was carefully avoided. Upon reading the museum labels, I could actually perceive a certain urgency to stress the value and expressly scientific purpose of the collection. This is probably a response to the debate on ethical implications of displaying human remains in museums, a topic which gained much attention in the past few years. The Hunterian Museum is, after all, the place where the bones of the Irish giant, unscrupulously stolen to the ocean waves, are still displayed in a big glass case and might seem “helpless” under the visitors’ gaze.

My last place of wonder, and one of London’s best-kept secrets, is the Wildgoose Memorial Library.
The work of one single person, artist Jane Wildgoose, this library is part of her private home, can be visited by appointment and reached through a series of directions which make the trip look like a tresure hunt.
And a tresure it is indeed.

Jane is a kind and gentle spirit, the incarnation of serene hospitality.
Before disappearing to make some coffee, she whispered: “take your time to skim the titles, or to leaf through a couple of pages… and to read the objects“.
The objects she was referring to are really the heart of her library, which besides the books also houses plaster casts, sculptures, Victorian mourning hair wreaths, old fans and fashion items, daguerrotypes, engravings, seashells, urns, death masks, animal skulls. Yet, compared to so many other collections of wonders I have seen over the years, this one struck me for its compositional grace, for the evident, painstaking attention accorded to the objects’ disposition. But there was something else, which eluded me at that moment.

As Jane came back into the room holding the coffee tray, I noticed her smile looked slightly tense. In her eyes I could guess a mixture of expectation and faint embarassement. I was, after all, an outsider she had intentionally let into the cosiness of her home. If the miracle of a mutual harmony was to happen, this could turn out to be one of those rare moments of actual contact between strangers; but the stakes were high. This woman was presenting me with everything she held most sacred — “a poet is a naked person“, Bob Dylan once wrote — and now it all came down to my sensibility.

We began to talk, and she told me of her life spent safeguarding objects, trying to understand them, to recognize their hidden relationships: from the time when, as a child, she collected seashells on the southern shores of England, up to her latest art installations. Little by little, I started to realize what was that specific trait in her collection which at first I could not clearly pinpoint: the empathy, the humanity.
The Wildgoose Memorial Library is not meant to explore the concept of death, but rather the concept of grief. Jane is interested in the traces of our passage, in the signs that sorrow inevitably leaves behind, in the absence, in the longing and loss. This is what lies at the core of her works, commissioned by the most prestigious institutions, in which I feel she is attempting to process unresolved, unknown bereavements. That’s why she patiently fathoms the archives searching for traces of life and sorrow; that’s why her attention for the soul of things enabled her to see, for instance, how a cold catalogue accompanying the 1786 sale of Margaret Cavendish’s goods after her death could actually be the Duchess’s most intimate portrait, a key to unearthing her passions and her friendships.

This living room, I realized, is where Jane tries to mend heartaches — not just her own, but also those of her fellow human beings, and even those of the deceased.

And suddenly the Hunterian Museum came to my mind.
There, as in this living room, human remains were present.
There, as in this living room, the objects on display spoke about suffering and death.
There, as in this living room, pictures were not allowed, for the sake of respect and discretion.

Yet the two collections could not be more distant from each other, placed at opposite extremes of the spectrum.
On one hand, the aseptic showcases, the modern setting from which all emotion is removed, where the Obscene Body (in order to be explained, and accepted by the public) must be filtered through a detached, scientific gaze. The same Museum which, ironically, has to deal with the lack of ethics of its founders, who lived in a time when collecting anatomical specimens posed very little moral dilemmas.
On the other, this oasis of meditation, a personal vision of human beings and their impermanence enclosed in the warm, dark wood of Jane Wildgoose’s old library; a place where compassion is not only tangible, it gets under your skin; a place which can only exist because of its creator’s ethical concerns. And, ultimately, a research facility addressing death as an essential experience we should not be afraid of: it’s no accident the library is dedicated to Persephone because, as Jane pointed out, there’s “no winter without summer“.

Perhaps we need both opposites, as we would with two different medicines. To study the body without forgetting about the soul, and viceversa.
On the express train back to the airport, I stared at a clear sky between the passing trees. Not a single cloud in sight. No rain without sun, I told myself. And so much for the preconceptions I held at the beginning of my journey.

Nicolae Minovici

Dec28

Physician’s is a strange job: on one hand it is a profession, on the other an “absolute” vocation, which should not depend from personal gain and well-being. In fact, from the moment he takes the Hippocratic Oath, every doctor is required to provide first aid even outside the strictly professional sphere, and there are many doctors who put their own health in danger to cure, or even just understand, a disease.

Nicolae Minovici (1868-1941) was one of these men determined to get his hands dirty in order to help others.
Most of his life was spent giving assistance to the weak, the poor and the outcasts who in Romania at the beginning of the XX Centry received little or no support from authorities: he founded one of the first ambulance and emergency services, provided care and assistance to more than 13.000 homeless people giving them the opportunity of working for the emergency units. He also helped out single mothers, opening shelters where they could find assistance before and after giving birth. He was even appointed mayor of the Băneasa district, where he modernized the sewage system, the fountains, the night shelters.
His professional and academic career was just another variation of Minovici’s interest in social issues. Having worked as a coroner, he touched first hand the most dramatic realities of his time; his studies in forensics, pathological anatomy, psychiatry and anthropology led him to take interest in delinquency (after all, his father was Mina Minovici, Romanian founder of criminological disciplines). In 1899 Nicolae published an essay on the alleged relationship between tattoos and criminal personality, coming to the conclusion — atypical in those times — that this relationship does not exist. HE founded the Romanian Association of Legal Medicine, and the Romanian Journal of Legal Medicine.
But his name is above all remembered for another work, his Study on hanging (1904).

Minovici’s humanist sensibility led him to believe that the physician’s vocation had to be both scientific and moral, as we said in the beginning. After all, he was not the kind of man who backs up before danger.
When, at the beginning of his studies on strangulation, he realized that he could not understand the dynamics of hanging without first hanging himself, Minovici did not hesitate.

In his first experiment, Minovici tried to personally adjust the intensity of asphyxiation. He passed a rope through a pulley fixed on the ceiling, and attached a dynamometer to the (non contracting) noose: he then pulled as hard as he could on the other end of the rope. Immediately his face turned purple red, and Minovici heared a prolonged hiss in his ears, as his visual became blurred. After just six seconds, he lost consciousnees.

This system allowed him to discontinue the rope’s tension in the exact moment he was about to faint. After experimenting with this method several other positions, recording symptoms and timing his resistance, Minovici moved to a new phase of decidedly more dangerous tests. With the help of some assistants, he decided he would be lifted from his neck, once again using a non contracting knot.

A couple of assistants pulled on the rope, one of them counted loudly as the seconds went by, so that Minovici could hear them over the tinnitus. But the first time the professor was lifted from the ground, and his feet lost contact with the floor, an excruciating pain went through his throat, as his airways were strangled and his eyes involountarily shut. Minovici frantically signaled the assistants to bring him back down, after few seconds.

Not at all discouraged, Minovici decided he needed a little practice. “I let myself hang six to seven times for four to five seconds to get used to it“. After this training, the professor was able to resist up to 25 seconds as he was hanging with his feet a couple of meters from the floor: the reckoning for this experiment were two weeks of sharp pain in his neck and throat muscles.

Eventually, Minovici was ready for the most dangerous and extreme endeavour: being hanged with a slip knot.

As usual, his assistants began to pull the rope, but this time the noose tightened in a split second, squeezing his neck in a grip of burning pain. The shock was so intense that after just three seconds Minovici signaled to let go of the rope. His feet had never even left the floor: the professor nevertheless swallowed with great difficulty and pain during the following month.

Besides experimenting on himself, Minovici ran some tests — albeit less dramatic ones — on some volunteers, who were chocked by applying pressure on the carotid and jugular. In these cases, as the subject’s face turned purple, he recorded sight problems, paresthesia (tingling sensensation, or numb limbs), a sensation of heat in the head, and tinnitus.
Minovici’s research, published in Romania in 1904 and in France in 1906, was extensively quoted in successive studies on the topic. His essay, in fact, was not limited to these singular hanging experiments, but related clinical records, statistics, information on the knots most frequently used by suicide victims, anatomy notes and so on.

Nicolae Minovici, who was passionate about Romanian folklore, had been collecting folk art objects all of his life. When in 1941 he died a bachelor, he donated his estate and collection to his Country, and today his former villa in Bucarest houses an ethnological museum.

The premature babies of Coney Island

Dec1

Once upon a time on the circus or carnival midway, among the smell of hot dogs and the barkers’ cries, spectators could witness some amazing side attractions, from fire-eaters to bearded ladies, from electric dancers to the most exotic monstrosities (see f.i. some previous posts here and here).
Beyond our fascination for a time of naive wonder, there is another less-known reason for which we should be grateful to old traveling fairs: among the readers who are looking at this page right now, almost one out of ten is alive thanks to the sideshows.

This is the strange story of how amusement parks, and a visionary doctor’s stubbornness, contributed to save millions of human lives.

Until the end of XIX Century, premature babies had little or no chance of survival. Hospitals did not have neonatal units to provide efficient solutions to the problem, so the preemies were given back to their parents to be taken home — practically, to die. In all evidence, God had decided that those babies were not destined to survive.
In 1878 a famous Parisian obstetrician, Dr. Étienne Stéphane Tarnier, visited an exhibition called Jardin d’Acclimatation which featured, among other displays, a new method for hatching poultry in a controlled, hydraulic heated environment, invented by a Paris Zoo keeper; immediately the doctor thought he could test that same system on premature babies and commissioned a similar box, which allowed control of the temperature of the newborn’s environment.
After the first positive experimentations at the Maternity Hospital in Paris, the incubator was soon equipped with a bell that rang whenever the temperature went too high.
The doctor’s assistant, Pierre Budin, further developed the Tarnier incubator, on one hand studying how to isolate and protect the frail newborn babies from infectious disease, and on the other the correct quantities and methods of alimentation.

Despite the encouraging results, the medical community still failed to recognize the usefulness of incubators. This skepticism mainly stemmed from a widespread mentality: as mentioned before, the common attitude towards premature babies was quite fatalist, and the death of weaker infants was considered inevitable since the most ancient times.

Thus Budin decided to send his collaborator, Dr. Martin Couney, to the 1896 World Exhibition in Berlin. Couney, our story’s true hero, was an uncommon character: besides his knowledge as an obstetrician, he had a strong charisma and true showmanship; these virtues would prove fundamental for the success of his mission, as we shall see.
Couney, with the intent of creating a bit of a fuss in order to better spread the news, had the idea of exhibiting live premature babies inside his incubators. He had the nerve to ask Empress Augusta Victoria herself for permission to use some infants from the Charity Hospital in Berlin. He was granted the favor, as the newborn babies were destined to a certain death anyway.
But none of the infants lodged inside the incubators died, and Couney’s exhibition, called Kinderbrutanstalt (“child hatchery”) immediately became the talk of the town.

This success was repeated the following year in London, at Earl’s Court Exhibition (scoring 3600 visitors each day), and in 1898 at the Trans-Mississippi Exhibition in Omaha, Nebraska. In 1900 he came back to Paris for the World Exhibition, and in 1901 he attended the Pan-American Exhibition in Buffalo, NY.

L'edificio costruito per gli incubatori a Buffalo.

The incubators building in Buffalo.

The incubators at the Buffalo Exhibition.

But in the States Couney met an even stronger resistence to accept this innovation, let alone implementing it in hospitals.
It must be stressed that although he was exhibiting a medical device, inside the various fairs his incubator stand was invariably (and much to his disappointment) confined to the entertainment section rather than the scientific section.
Maybe this was the reason why in 1903 Couney took a courageous decision.

If Americans thought incubators were just some sort of sideshow stunt, well then, he would give them the entertainment they wanted. But they would have to pay for it.

Couney definitively moved to New York, and opened a new attraction at Coney Island amusement park. For the next 40 years, every summer, the doctor exhibited premature babies in his incubators, for a quarter dollar. Spectators flowed in to contemplate those extremely underweight babies, looking so vulnerable and delicate as they slept in their temperate glass boxes. “Oh my, look how tiny!“, you could hear the crowd uttering, as people rolled along the railing separating them from the aisle where the incubators were lined up.

In order to accentuate the minuscule size of his preemies, Couney began resorting to some tricks: if the baby wasn’t small enough, he would add more blankets around his little body, to make him look tinier. Madame Louise Recht, a nurse who had been by Couney’s side since the very first exhibitions in Paris, from time to time would slip her ring over the babies’ hands, to demonstrate how thin their wrists were: but in reality the ring was oversized even for the nurse’s fingers.

Madame Louise Recht con uno dei neonati.

Madame Louise Recht with a newborn baby.

Preemie wearing on his wrist the nurse’s sparkler.

Couney’s enterprise, which soon grew into two separate incubation centers (one in Luna Park and the other in Dreamland), could seem quite cynical today. But it actually was not.
All the babies hosted in his attractions had been turned down by city hospitals, and given back to the parents who had no hope of saving them; the “Doctor Incubator” promised families that he would treat the babies without any expense on their part, as long as he could exhibit the preemies in public. The 25 cents people paid to see the newborn babies completely covered the high incubation and feeding expenses, even granting a modest profit to Couney and his collaborators. This way, parents had a chance to see their baby survive without paying a cent, and Couney could keep on raising awareness about the importance and effectiveness of his method.
Couney did not make any race distinction either, exhibiting colored babies along with white babies — an attitude that was quite rare at the beginning of the century in America. Among the “guests” displayed in his incubators, was at one point Couney’s own premature daughter, Hildegarde, who later became a nurse and worked with her father on the attraction.

Nurses with babies at Flushing World Fair, NY. At the center is Couney’s daughter, Hildegarde.

Besides his two establishments in Coney Island (one of which was destroyed during the 1911 terrible Dreamland fire), Couney continued touring the US with his incubators, from Chicago to St. Louis, to San Francisco.
In forty years, he treated around 8000 babies, and saved at least 6500; but his endless persistence in popularizing the incubator had much lager effects. His efforts, on the long run, contributed to the opening of the first neonatal intensive care units, which are now common in hospitals all around the world.

After a peak in popularity during the first decades of the XX Century, at the end of the 30s the success of Couney’s incubators began to decrease. It had become an old and trite attraction.
When the first premature infant station opened at Cornell’s New York Hospital in 1943, Couney told his nephew: “my work is done“. After 40 years of what he had always considered propaganda for a good cause, he definitively shut down his Coney Island enterprise.

Martin Arthur Couney (1870–1950).

The majority of information in this post comes from the most accurate study on the subject, by Dr. William A. Silverman (Incubator-Baby Side Shows, Pediatrics, 1979).

(Thanks, Claudia!)

A precariously balanced wonder

Nov11

An interview with a pathologist

Some days ago I was contacted by a pathologist who recently discovered Bizzarro Bazar, and said she was particularly impressed by the website’s “lack of morbidity”. I could not help but seize the opportunity of chatting a bit about her wonderful profession: here is what she told me about the different aspects of this not so well-known job, which is all about studying deformity, dissimilarities and death to understand what keeps us alive.

What led you to become a pathologist?

When I was sixteen I decided I had to understand disease and death.
The pathologist’s work is very articulated and varied, and mostly executed on living persons… or at least on surgically removed parts of living persons; but undoubtedly one of the routine activities is the autoptical diagnosis, and this is exactly one of the reasons behind my choice, I won’t deny it. Becoming a pathologist was the best way to draw on my passion for anatomy, turning it into a profession, and what’s more I would also have the opportunity of exorcising my fear of death by getting accustomed to it… getting my hands dirty and looking at it up close. I wanted to understand and investigate how people die. Maybe part of it had to do with my visual inclination, and pathology is a morphologic discipline which requires sharp visual memory and attention to macro and microscopic details, to differences in shape, to nuances in color.

Is there some kind of common prejudice against your job? How did you explain your “vocation” to friends and relatives?

Actually the general public is not precisely aware of what the pathologist does, hence a certain morbid curiosity on the part of non-experts. Most of them think of Kay Scarpetta, from Cornwell’s novels, or CSI. When people asked me about my job, at the beginning of my career, I gave detailed explanations of all the non-macabre aspects of my work, namely the importance of an hystological diagnosis in oncology, in order to plan the correct treatment. I did this to avoid a certain kind of curiosity, but I was met with puzzled looks. To cut it short, I would then admit: “I also perform autopsies”, and eventually there was a spark of interest in their eyes. I never felt misjudged, but I sometimes noticed some sort of uneasiness. And maybe some slightly sexist prejudice (the unasked question being how can a normal girl be into this kind of things); those female sexy pathologists you find in novels and TV series were not fashionable yet, and at the postgraduate school I was the only woman. As for friends and relatives… well, my parents never got in the way with my choices… I believe they still haven’t exactly figured out exactly what I do, and if I try to tell them they ask me to spare them the details! As for my teenage kids, who are intrigued by my job, I try to draw their attention to the scientific aspects. In the medical environment there is still this idea of a pathologist being some kind of nerd genius, or a person who is totally hopeless in human interactions, and therefore seeks shelter in a specialization that is not directly centered on doctor-patient relationship. Which is not necessarily true anymore, by the way, as often pathologists perform biopsies, and therefore interact with the patient.

Are autopsies still important today?

Let’s clarify: in Italy, the anatomopatologo is not a forensic pathologist, but is closer to what would be known in America as a surgical pathologist. The autopsy the pathologist performs is on people who died in a hospital (and not on the deceased who fell from a height or committed suicide, for instance) to answer to a very specific clinical inquiry, while the legal autopsy is carried out by the legal MD on behalf of the DA’s office.
One would think that, with the development of imaging radiology tests, the autoptic exam would have by now become outdated. In some facilities they perform the so-called “virtual autopsy” through CAT scans. In reality, in those cases in which a diagnosis could not be determined during the deceased’s life, an autopsy is still the only exam capable of clarifying the final cause of death. Besides direct examination, it allows to take organ samples to be studied under the microscope with conventional coloring or to be submitted for more refined tests, such as molecular biology. In the forensic field, direct examination of the body allows us to gather information on the chronology, environment and modality of death, all details no other exam could provide.

There is of course a great difference (both on a methodological and emotional level) between macroscopic and microscopic post mortem analysis. In your experience, for scientific purposes, is one of the two phases more relevant than the other or are they both equally essential?

They are both essential, and tightly connected to each other: one cannot do without the other. The visual investigation guides the following optic microscopy exam, because the pathologist samples a specific area of tissue, and not another, to be submitted to the lab on the grounds of his visual perception of dissimilarity.

In my experience of autopsy rooms, albeit limited, I have noticed some defense strategies being used to cope with the most tragic aspects of medical investigation. On one hand a certain humor, though never disrespectful; and, on the other, little precautions aimed at preserving the dignity of the body (but which may also have the function of pushing away the idea that an autopsy is an act of violation). How did you get used to the roughest side of your job?

I witnessed my first autopsy during my first year in medical school, and I still remember every detail of it even today, 30 years later. I nearly fainted. However, once I got over the first impact, I learned to focus on single anatomical details, as if I were a surgeon in the operating room, proceeding with great caution, avoiding useless cuts, always keeping in mind that I’m not working on a corpse, but a person. With his own history, his loved ones, presumably with somebody outside that room who is now crying for the loss. One thing I always do, after the external exam and before I begin to cut, is cover up the face of the dead person. Perhaps with the illogical intent of preventing him to see what I’m about to do… and maybe to avoid the unpleasant feeling of being watched.

Are there subjects that are more difficult to work with, on the emotional level?

Children.

Are autopsies, as a general rule, open to a non-academic public in Italy? Would you recommend witnessing an autopsy?

No, all forensic autopsies are not accessible, for obvious reasons, since there is often a trial underway; neither are the diagnostic post mortem examinations in hospitals. I wouldn’t know whether to recommend seeing an autopsy to anyone. But I do believe every biology or medicine student should be allowed in.

One of the aspects that always fascinated me about pathological anatomy museums is the vitality of disease, the exuberant creativity with which forms can change: the pathological body is fluid, free, forgetful of those boundaries we think are fixed and insurmountable. You just need to glance at some bone tumors, which look like strange mineral sponges, to see the disease as a terrible blooming force.
Maybe this feeling of wonder before a Nature both so beautiful and deadly, was the one animating the first anatomists: a sort of secret respect for the disease they were fighting off, not much different from the hunter’s reverential fear as he studies his prey before the massacre. Have you ever experienced this sense of the sublime? Does the apparent paradox of the passionate anatomist (how can one be a disease enthusiast?) have something to do with this admiration?

To get passionate, in our case, means to feel inclined towards a certain field, a certain way of doing research, a certain method and approach which links a morphologic phenomenon to a functional phenomenon. We do not love disease, we love a discipline which teaches us to see (Domine, ut videam) in order to understand the disease. And, hopefully, cure it.
And yes, of course there is the everyday experience of the sublime, the aesthetic experience, the awe at shapes and colors, and the information they convey. If we know how to interpret it.

Speaking of the vitality of disease: today we recognize in some teratologic specimens a proof of the attempts through which evolution gropes around, one failed experiment after the other. How many of these maladies (literally, “being not apt”) are actually the exact opposite, an adaptation attempt? Is any example of mutation (which a different genetic drift might have elected to dominant phenotype) always pathological?
What I really mean to ask is, of course, another one of those questions that any pathological anatomy museum inevitably suggests: what are the actual boundaries of the Norm?

The norm is established on a statistical basis following a Gaussian distribution curve, but what falls beyond the 90th percentile (or before the 10th) is not forcibly unnatural, or unhealthy, or sick. It is just statistically less represented in the general population in respect to the phenotype we are examining. Whether a statistically infrequent character will be an advantage only time will tell.
The limits of the norm are therefore conventionally established on a mathematical basis. What is outside of the norm is just more uncommon. Biology undergoes constant transformation (on the account of new medicines or therapies, climatic and environmental change, great migrations…), and therefore we are always confronted with new specimens coming in. That is why our job is always evolving, too.

I didn’t expect such a technical answer… mine was really a “loaded” question. As you know, for years I have been working on the concepts of dissimilarity, exoticism and diversity, and I wanted to provoke you – to see whether from your standpoint a mutant body could also be considered as a somewhat revolutionary space, a disruptive element in a context demanding total compliance to the Norm.

Ask a loaded question… and you’ll get a convenient answer. You’re talking about a culture demanding compliance to a social norm, I replied in terms of the biology demanding compliance to a norm that is established by the scientific community on a frequency-based statistic calculation — which is therefore still conventional. In reality, deformity appears in unexpected ways, and should be more correctly described following a probabilistic logic, and not frequency. But I’m beginning to sound technical again.

I have seen respected professors lighten up like children before some pathological wet specimens. The feeling I had was that the medical gaze in some ways justified an interest for extreme visions, usually precluded to the general public. Is it an exclusively scientific interest? Is it possible to be passionate about this kind of work, without being somehow fascinated by the bizarre?

There could be a little self-satisfaction at times. But in general there is sincere passion and enthusiasm for the topic, and that surely cannot be faked. It is a job you can only do if you love it.
All our discipline is based on the differential diagnosis between “normal” and “pathological”. I could say that everything pathological is dysmorphic in respect to the norm, therefore it is bizarre, different. So yes, you have to feel a the fascination for the bizarre. And be very curious.

The passion for the macabre is a growing trend, especially among young people, and it is usually deemed negative or cheap, and strongly opposed by Italian academics. This does not happen in other realities (not just the US, but also the UK for instance) in which a common element of communication strategies for museums has become the ability of arousing curiosity in a vast public, sometimes playing on pop and dark aspects. Come for the macabre, stay for the science. If young people are drawn to the subject via the macabre imaginary, do you think in time this could lead to the education of new, trustworthy professionals?

Yes, it’s true, there is a growing interest, I’m thinking of some famous anatomical exhibitions which attracted so many visitors they had to postpone the closing date. There is also my kids’ favorite TV show about the most absurd ways to die. I believe that all this is really an incentive and should be used as a basis to arouse curiosity on the scientific aspects of these topics. I think that we can and must use this attraction for the macabre to bring people and particularly youngsters closer to science, even more so in these times of neoshamanic drifts and pseudo-scientific rants. Maybe it could also serve the purpose of admitting that death is part of our daily lives, and to find a way to relate to it. As opposed to the Anglo-Saxon countries, in Italy there still is a religious, cultural and legislative background that partially gets in the way (we have laws making it hard to dissect bodies for study, and I also think of the deeply-rooted idea that an autopsy is a violation/desecration of the corpse, up to those prejudices against science and knowledge leading to grotesque actions like the petition to close the Lombroso Museum).

Has your job changed your relationship with death and dying in any way?

I would say it actually changed my relationship with life and living. My worst fear is no longer a fear of dying. I mostly fear pain, and physical or mental decay, with all the limitations they entail. I hope for a very distant, quick and painless death.

With your twenty years experience in the field, can you think of some especially curious anecdotes or episodes you came across?

Many, but I don’t feel comfortable relating episodes that revolve around a person’s remains. But I can tell you that I often do not wonder how these people died, but rather how in the world they could be alive in the first place, given all the diseases I find! And, to me, life looks even more like a precariously balanced wonder.

SynDaver

May27

Talvolta, non c’è niente di meglio di un cadavere fresco.
Questa può sembrare una battuta, ma basta ragionarci un attimo e risulta subito evidente come lo studio della medicina non possa assolutamente prescindere dal confronto con l’anatomia reale. L’esame autoptico rimane ancora il metodo principe per acquisire quelle conoscenze che nessuna illustrazione, fotografia o modello tridimensionale, per quanto accurato, potranno mai rendere tangibile. Oltre alle dissezioni, i cadaveri possono essere utilizzati per la simulazione di alcuni interventi chirurgici: operare su un corpo morto non è come eseguire la stessa procedura su un corpo vivo, ma può rivelarsi comunque una palestra essenziale prima di un intervento particolarmente difficile. I cadaveri poi, storicamente, sono stati utilizzati anche per altri scopi di ricerca su traumi e ferite, come illustravamo ad esempio in questo vecchio articolo.

Ma l’impiego di corpi reali porta con sé diversi problemi. Innanzitutto vi è sempre una certa penuria di cadaveri su cui sperimentare liberamente: le autopsie vengono effettuate giornalmente a scopi legali, ma seguono procedure evidentemente rigide e controllate, mentre invece sono più rari almeno in Italia i casi di corpi donati alla scienza (complice, da noi, una certa assenza legislativa, come viene bene spiegato qui); ed è proprio sui corpi volontariamente donati alla ricerca che ai medici è consentito fare pratica chirurgica.
Un altro svantaggio dei cadaveri è quello di essere costosi da trasportare, conservare, smaltire. Infine, non sono riutilizzabili.

Ecco che entra in campo la SynDaver Labs. La ditta si occupa da anni di creare modelli ultrarealistici di tessuti, organi, e simulatori medici, realizzati in polimeri che replicano perfettamente le reali consistenze dei vari strati epidermici. Questi organi sintetici vengono utilizzati soprattutto per testare l’efficienza di macchinari clinici, eliminando il bisogno di provarli su vere parti anatomiche animali o umane. Ma è solo recentemente che la SynDaver ha fatto un salto più ambizioso, proponendo il primo cadavere sintetico modulare.

Si tratta di un modello a grandezza naturale dell’intero corpo umano, ed è “modulare” nel senso che a seconda della necessità può essere accessoriato e reso più complesso dall’aggiunta di sistemi muscolari, sistema circolatorio, tendini, nervi e organi che replicano piuttosto fedelmente le proprietà meccaniche, chimiche, termiche ed elettriche del tessuto vivente. Ma non è tutto.

Tramite un’applicazione installata su un tablet wireless, la simulazione delle funzioni vitali può essere controllata nei minimi dettagli. Questo “motore fisiologico” risponde agli stimoli come farebbe un corpo reale, adattando e riaggiustando vari parametri: ad esempio il movimento di braccia e gambe, la respirazione, il battito cardiaco ed eventuali aritmie, la dilatazione della pupilla, il battito delle palpebre, temperatura corporea, vasocostrizione, eccetera. Essendo poi il software open source, può essere modificato per adattarsi a qualsiasi situazione si intenda replicare.

Gli utilizzi, come è intuibile, sono innumerevoli: si va dall’apprendimento delle più basiche forme di pronto soccorso (come posizionare il ferito, come muoverlo, come intubarlo), allo studio dell’anatomia, alla pratica con gli strumenti diagnostici (è possibile usarlo per allenarsi nell’eseguire radiografie, ultrasuoni, fluoroscopie, TAC) fino alla simulazione di veri e propri interventi chirurgici, con tanto di sangue sintetico riscaldato che circola nel sistema vascolare.
Rispetto a un vero cadavere, il vantaggio sta proprio nel fatto che questo corpo è riutilizzabile, smontabile, e adattabile alle più diverse esigenze.

Certo, un corpo completo non è economico. Il prezzo di un SynDaver Patient dotato di tutti gli accessori è di 85.000 dollari. Ma si sta già lavorando a versioni “basic” più abbordabili, intorno ai 15.000 dollari.
E non dimentichiamo che siamo soltanto all’inizio. Senza dubbio con il passare del tempo la tecnologia diverrà sempre più raffinata, agile ed economica, e questi cadaveri sintetici potranno assumere un ruolo di sempre maggior rilievo in svariati settori clinici.

Ecco il sito ufficiale di SynDaver Labs.

Kegadoru, gli idoli feriti

Aug6

Il quartiere Harajuku di Tokyo è famoso in tutto il mondo per le sue Harajuku girls, ragazze dai vestiti stravaganti, multicolori e inevitabilmente kawaii, sempre pronte a capitalizzare qualsiasi cosa faccia tendenza al momento. In questa fucina di mode alternative potete vedere sfilare sui marciapiedi decine di gothic lolita, oppure adolescenti vestite con abiti tradizionali mischiati con capi di marca, o ancora giovani agghindati come se fossero ad un festival di cosplay.

Una moda degli ultimi anni è quella dei kegadoru, ossia gli “idoli feriti”, cioè giovani donne che mostrano segni di traumi fisici, bendaggi e garze oftalmiche o di primo soccorso.

Forse stanno soltanto cercando di attirare l’attenzione dei maschi orientali. Ma in realtà ricoprirsi di bende o fasciarsi un arto come se si fosse appena usciti dall’ospedale è un modo di strizzare l’occhio ad uno dei feticismi sessuali più in voga in Giappone: il medical fetish ha infatti sempre occupato una nicchia piuttosto apprezzata nell’Olimpo delle fantasie nipponiche, e non soltanto.

In effetti esistono riviste erotiche specializzate sul tema, in cui belle e procaci modelle sfoggiano fasciature mediche, tutori ed altri apparecchi terapeutici o protesici. Cosa affascina il pubblico maschile in queste fotografie?

A prima vista sembrerebbe controintuitivo: gli evoluzionisti ci hanno sempre insegnato (vedi ad esempio questo articolo) che, seppur inconsciamente, scegliamo i nostri partner per la loro prestanza e salute fisica – segnali di maggiori chance che la procreazione vada a buon fine.
Ma in questo particolare caso diversi fattori entrano in gioco.

Innanzitutto, le bende. Le fasciature che costringono il corpo, nell’ambito feticistico, rimandano al bondage e alle sue corde, ma con tutta la portata simbolica del contesto clinico. E tutti conosciamo bene il potere di un camice bianco sulla fantasia erotica: il mondo della medicina, in virtù del suo focalizzarsi sul corpo, è entrato prepotentemente nel comune immaginario sessuale, dall’infantile “gioco del dottore”, all’icona pop dell’infermiera sexy, fino ai feticismi che trasformano alcuni strumenti medici in oggetti di desiderio (speculum, clisteri, ecc.).

In secondo luogo, il concetto di kegadoru fa leva sull’istinto di protezione. In questo senso, è un tipo di roleplay simile a quello che esiste, in ambito BDSM, nel cosiddetto rapporto Daddy/Little, dove il maschio è figura paterna e premurosa (ma anche severa durante le necessarie “punizioni”) e la femmina diviene una bambina, viziosa e incorreggibile ma oltremodo bisognosa di cure e attenzioni. Qui invece, la ragazza occulta parte del suo viso e del suo corpo sotto le bende, e questa sua “imperfezione”, oltre ad esaltarne la bellezza (attraverso il classico effetto “vedo – non vedo”), domanda premura e tenerezza.

Infine, i kegadoru hanno anche una chiara connotazione masochistica. La donna, in questo gioco, è molto più che indifesa – è addirittura ferita; non può quindi opporre alcuna resistenza. Eppure nel suo esibire le proprie fasciature in pose maliziose, come fossero un tipo particolare di intimo o una divisa fetish, sta evidentemente accettando e scegliendo il suo ruolo.

Tutto questo contribuisce al complesso fascino degli injured idols, che ha ossessionato almeno due grandi artisti: Trevor Brown (di cui abbiamo parlato in questo articolo) e Romain Slocombe, fotografo, regista, pittore e scrittore parigino che ha fatto delle ragazze “ferite” le sue muse ispiratrici. Ecco alcune delle sue migliori foto.

Il volto del dolore

Apr26

All’inizio del secolo scorso la medicina stava entrando nella sua età più matura e progredita; eppure, come abbiamo spesso notato (vedi ad esempio i metodi per aprire una bocca descritti in questo articolo), la pratica terapeutica mancava ancora della doverosa attenzione per il paziente e per la sua sofferenza.

Nei primi anni ’30 il Dr. Hans Killian, uno dei più conosciuti anestesiologi e chirurghi tedeschi, sentì che era tempo di cambiare l’attitudine dei medici nei confronti del dolore. Secondo il Dr. Killian, non soltanto ne avrebbero beneficiato i pazienti in quanto esseri umani, con una propria dignità e sensibilità, ma perfino la pratica medica: riconoscere i sintomi della sofferenza, infatti, avrebbe dovuto essere parte integrante dell’anamnesi clinica. Come esporre la questione in maniera scientifica e al tempo stesso incisiva?

Il Dr. Killian era appassionato di arte e fotografia, ma fino ad allora aveva tenuto ben separati i suoi interessi estetici dalla professione medica. Il suo primo libro di fotografie, intitolato Farfalla, mostrava suggestive immagini delle farfalle che lui stesso allevava, e venne pubblicato sotto pseudonimo, per non mettere a repentaglio la “serietà” del suo status di chirurgo. Questa volta, però, la posta in gioco era troppo alta per non rischiare. Così il Dr. Killian decise di pubblicare a suo nome (anche a discapito della sua carriera) il progetto che più gli stava a cuore, e che avrebbe contribuito a cambiare il rapporto medico-paziente.

Il suo controverso libro, pubblicato nel 1934, si intitolava Facies Dolorosa: Das schmerzensreiche Antlitz (“l’aspetto del dolore”). Si trattava di 64 fotografie di bambini, uomini e donne di ogni età, ricoverati all’ospedale dell’Università di Freiburg in cui egli stesso esercitava come chirurgo. I soggetti dei ritratti erano suoi pazienti, alcuni dei quali terminali, fotografati nei loro letti.

Sfogliando il volume, si avvertiva subito un’evidente (e feconda) ambiguità. Da una parte, la raccolta poteva essere interpretata come testo prettamente medico, un’osservazione empirica relativa al primo stadio di ogni diagnosi, cioè l’esame esterno del paziente: in questo senso, il libro aveva lo scopo di illustrare e catalogare tutti i diversi modi in cui la malattia può manifestarsi sul volto, influenzandone l’espressione. Veniva per esempio mostrata la facies tragica dei malati di ipertiroidismo, in cui la retrazione spastica della palpebra superiore causa una peculiare mimica con “occhi sbarrati”, assieme a diversi altri tipi di “maschera” che indicano specifici disturbi.

Ma la forza del suo libro, il Dr. Killian ne era ben conscio, non stava nella cornice scientifica – che era anzi poco più che un alibi. Molte delle sue fotografie, infatti, non mostravano affatto i segni evidenti della malattia, bensì si focalizzavano sull’ansia, la tristezza e lo sconforto infinito veicolato dagli sguardi dei pazienti. Con la sua Rolleiflex, Killian si prefissava di catturare gli effetti della malattia sull’umore di quelle persone, il loro stato psicologico, la loro essenza umana sotto la fatica e la debilitazione.

Al di là dei dati statistici e misurabili, Killian era alla ricerca di ciò che definiva das Unwägbare, “l’imponderabile”: a suo dire, infatti, ogni diagnosi si affidava anche a una sorta di istinto suggerito dall’esperienza, una fulminea “impressione” che il medico aveva guardando il paziente durante la prima visita. Certo, le analisi in laboratorio avevano il loro peso, ma per Killian l’arte medica viveva innanzitutto di questo genere di intuito.

L’opera del Dr. Killian è tutta racchiusa in questa duplicità, in questa tensione fra la solidità apparente della presentazione scientifica e la dimensione emotiva della sofferenza. Paradossalmente le fotografie di Facies Dolorosa, nonostante non mostrino morbi o deformità particolarmente scioccanti, colpiscono in maniera ancora più profonda l’osservatore: in luogo dell’asetticità che ci si aspetterebbe da un atlante medico, propongono una visione partecipe dello sconforto e del dolore dei soggetti rappresentati. Talvolta i malati guardano in macchina, talvolta il loro sguardo sembra perdersi oltre l’obbiettivo, in una commovente contemplazione della propria condizione. I pochi e spogli dettagli, oltre al volto, concentrano tutta l’attenzione sul corpo, divenuto una gabbia penosa e desolata.
Che l’empatia fosse ciò che davvero interessava a Killian risulta evidente nei due casi in cui l’intimità dell’obbiettivo si spinge fino a fotografare il soggetto prima e dopo la morte.

Il libro ebbe probabilmente un ruolo fondamentale nell’evoluzione del rapporto medico-paziente; oltre a questo, Facies Dolorosa scavalcò coraggiosamente i confini tra scienza ed arte in un periodo in cui queste due discipline erano largamente considerate contrapposte. La sua aura di poetica umanità colpisce anche oggi, tanto che l’esperto di storia della fotografia Martin Parr lo ha definito “forse il più melanconico di tutti i libri fotografici”.

Mary Toft

Feb12

Il 19 novembre 1726 un breve ma insolito articolo apparve sul Weekly Journal, giornale inglese:

“Da Guildford ci arriva una strana ma ben testimoniata notizia. Che una povera donna che vive a Godalmin, vicino alla città, è stata il mese scorso aiutata da Mr. John Howard, Eminente Chirurgo e Ostetrico, a partorire una creatura che assomigliava ad un coniglio, ma con cuore e polmoni cresciuti fuori dal torace, 14 giorni dopo che lo stesso medico le aveva fatto partorire un coniglio perfettamente formato; e pochi giorni dopo, altri 4; e venerdì, sabato e domenica, un altro coniglio al giorno; e tutti e nove morti vedendo la luce. La donna ha giurato che due mesi fa, lavorando in un campo con altre donne, incontrarono un coniglio e lo rincorsero senza un motivo: questo creò in lei un desiderio così forte che (essendo incinta) abortì il suo bambino, e da quel momento non è capace di evitare di pensare ai conigli”.

Letta così sembra una di quelle leggende scaturite dall’idea, diffusa all’epoca, che qualsiasi cosa impressionasse la mente di una donna incinta (un sogno, o un animale veduto durante la gravidanza) poteva marchiare in qualche modo anche il feto, dando origine a difetti di nascita. Eppure questa storia si sarebbe presto tramutata in uno dei più grossi scandali medici degli albori.

La donna dell’articolo era Mary Toft, contadina di 24 o 25 anni, sposata e con tre figli. Come tutte le compaesane, Mary non aveva smesso il lavoro nei campi con la gravidanza; e quando, nell’agosto precedente, aveva avvertito dei dolori al ventre, si era accorta con orrore di aver espulso dei pezzi di carne. Poteva forse essere un aborto, ma stranamente la gravidanza continuò e quando il 27 settembre Mary partorì, uscirono soltanto delle parti che sembravano animali. Questi resti vennero inviati a John Howard, il medico citato nell’articolo, che inizialmente si dimostrò scettico. Si recò ciononostante a visitare Mary Toft ed esaminandola non trovò nulla di strano; eppure nei giorni successivi le doglie ricominciarono, e nuove parti di animali continuarono a essere espulse dall’utero della donna: gambe di gatto, gambe di coniglio, budella e altri pezzi di animali irriconoscibili.

A quel punto la storia stava cominciando a fare scalpore, anche perché la stampa esisteva da poco, ed era la prima volta che un caso simile veniva seguito contemporaneamente, “in diretta”, in tutta l’Inghilterra. Un altro chirurgo, Nathaniel St. André, si interessò al caso, e su ordine della Famiglia Reale si recò a Guildford, dove Howard aveva condotto Mary Toft offrendo a chiunque dubitasse della storia di assistere a uno degli straordinari parti. Nel frattempo la donna aveva infatti dato alla luce altri tre conigli, non completamente formati, che apparentemente scalciavano nell’utero prima di morire e venire espulsi.

St. André, arrivato a Guildford, potè quindi investigare il caso direttamente e restò impressionato: il 15 novembre, nel giro di poche ore, Mary Toft partorì il torso di un coniglio. St. André esaminò il torso, immerse i polmoni in acqua per vedere se l’animale avesse respirato aria (e infatti i polmoni galleggiavano) ed esaminò accuratamente la donna. La sua diagnosi fu che i conigli si sviluppavano sicuramente all’interno delle tube di Falloppio. Nei giorni seguenti dall’utero della donna uscirono un altro torso, la pelle di un coniglio e, pochi minuti dopo, la testa.

Il re Giorgio I, affascinato dalla storia, decise di inviare un altro medico a Guildford: si trattava di Cyriacus Ahlers – e questa fu la svolta. Ahlers, infatti, era segretamente scettico sull’intera vicenda, e tenne gli occhi ben aperti. Non trovò segni di effettiva gravidanza sulla donna, ma anzi notò una cosa piuttosto sospetta: prima dei famosi parti, la donna sembrava stringere le ginocchia come per impedire che qualcosa cadesse. Ahlers cominciò a dubitare anche di Howard, l’ostetrico, che si rifiutava di lasciare che fosse Ahlers ad assistere la donna durante le contrazioni. Non lasciò trapelare i suoi dubbi, ma disse a tutti i presenti di credere alla storia, e con una scusa lasciò Guildford, portando con sé alcuni pezzi di coniglio. Esaminandoli con più cura, scoprì che sembravano essere stati macellati con uno strumento da taglio, e notò tracce di grano e paglia nei loro intestini, come se provenissero da un allevamento. Riportò tutto questo al Re e in poco tempo lo scandalo esplose.

Mary fu portata a Londra e alloggiata in carcere, per ulteriori esami, e nella comunità scientifica si formarono immediatamente due fazioni: da una parte gli scettici, Ahlers in prima linea; dall’altra Howard e St. André, che erano convinti sostenitori della genuinità dei prodigiosi eventi. La stampa diede eccezionale risonanza al dibattito e le cose precipitarono quando un inserviente della prigione ammise di essere stato corrotto dalla cognata di Mary Toft affinché introducesse un coniglio nella cella della donna.

Il 7 dicembre, dopo essere stata esaminata da decine di medici e sottoposta ad estenuanti interrogatori e alle minacce di una dolorosa operazione chirurgica, Mary Toft cedette e confessò: era stata tutta una truffa. Dopo il suo aborto spontaneo, quando la cervice era ancora dilatata, aveva con l’aiuto di un complice inserito nell’utero le zampe e il corpo di un gatto, e la testa di un coniglio. In seguito, le parti di animali erano state posizionate più esternamente, nella vagina. Mary Toft venne immediatamente incarcerata con l’accusa di “vile truffa e impostura”. Anche i diversi medici implicati, Howard e St. André su tutti, vennero citati in tribunale e a loro discolpa si dichiararono all’oscuro della frode.

Ma lo smascheramento dell’inganno fu una bomba soprattutto per l’immagine della medicina nell’opinione pubblica: articoli satirici apparvero in ogni giornale, prendendosi beffa della credulità dei chirurghi implicati nel caso, e dei medici tout court. Le ballate popolari si incentrarono immediatamente sui dettagli più volgari della vicenda e le barzellette si affollarono di conigli maliziosi e grandi luminari della scienza fatti fessi da una contadina. La risonanza fu internazionale e persino Voltaire, dalla Francia, indicò il caso di Mary Toft come un esempio di quanto gli Inglesi protestanti fossero influenzati da una Chiesa ignorante e da antiche superstizioni.
La professione sanitaria venne talmente danneggiata in poco tempo che decine e decine di medici cercarono disperatamente di dichiararsi estranei ai fatti o di provare che erano stati fin dall’inizio scettici sul caso. Molte carriere vennero stroncate dall’abbaglio preso, e altre ci misero lustri a riprendersi dal tonfo.

La folla stazionava davanti alla prigione in cui Mary Toft era rinchiusa, nella speranza di vederla anche solo di sfuggita. Nel 1727 Mary fu liberata e tornò a casa. Da allora di lei si seppe poco, se non che ebbe una figlia e qualche altro piccolo guaio con la legge, fino alla sua morte nel 1763. Ma nonostante questo suo forzato “ritiro” dalle scene, il suo nome visse ancora a lungo nelle canzoni, e venne immancabilmente rispolverato ogni volta che i grandi geni della scienza facevano un clamoroso, ridicolo passo falso.

Bizzarro Bazar

Strange, macabre, wonderful!

Tag Archives: medico

“A Tiny Red Hole”: Horrible Stories of Needles

Prehistoric Needles
An invention older than Man himself

Needles Under The Skin
The inexplicable delay of Western medicine

Needles In The Flesh
The bizarre clinical case of the “needle woman”

Needles In The Brain
A dreadful legacy

The Abominable Vice

My week of English wonders – II

Nicolae Minovici

The premature babies of Coney Island

A precariously balanced wonder

An interview with a pathologist

SynDaver

Kegadoru, gli idoli feriti

Il volto del dolore

Mary Toft

Prehistoric Needles An invention older than Man himself

Needles Under The Skin The inexplicable delay of Western medicine

Needles In The Flesh The bizarre clinical case of the “needle woman”

Needles In The Brain A dreadful legacy

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An interview with a pathologist

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Prehistoric Needles
An invention older than Man himself

Needles Under The Skin
The inexplicable delay of Western medicine

Needles In The Flesh
The bizarre clinical case of the “needle woman”

Needles In The Brain
A dreadful legacy