Unfortunate predicaments A regular feature of any hospital emergency department is the patient who turns up with an embarrassing and entirely self-inflicted complaint. When questioned about the nature of their ailment and how it came about, they may fall silent or offer a less than plausible explanation. In 1953, a man was admitted to a hospital in Barnsley with severe abdominal pain that he said had been plaguing him for almost a fortnight. Surgeons discovered severe tearing in the wall of his rectum, evidently inflicted just a few hours earlier, which they were able to repair. Asked how he had sustained this injury, the patient claimed that he was standing too near a firework "while in a stooping position," and it had gone off unexpectedly. Pressed for the truth, he admitted that he had become frustrated in his personal life and had "decided to explode a firework up his seat." That''s one way of dealing with it, I suppose. The medical literature is brimming with misguided individuals, the forebears of this proctological pyrotechnician, who inserted strange objects in places where they weren''t meant to go.

One of the earliest stories concerns a monk who tried to ease his colic by coaxing a bottle of perfume inside his gut; another relates how a surgeon rescued the dignity of a farmer who had somehow ended up with a goblet wedged inside his rectum. But these are prosaic achievements compared with some of the bravura feats recorded in the following pages. What is so impressive about many of these tales of mishap is the sheer ingenuity that had gone into creating a highly regrettable situation-often matched by the imaginative manner in which a physician or surgeon went about treating the unfortunate patient. Medicine has improved almost beyond recognition in the past few centuries, but some things never change. The human capacity for mischief, misadventure and downright idiocy is apparently a trait that progress cannot eradicate. A fork up the anus Modern medical journals aren''t exactly famous for their snappy headlines. The professional terminology doesn''t help: It''s not easy to write a zinger of a heading if the subject of your article has a name like bestrophinopathy, idiopathic thrombocytopenic purpura or necrotizing fasciitis. But recent years have seen a fightback against such sterile jargon, with a few researchers trying to grab their readers'' attention by means of literary allusions, pop culture references and bad puns.

One recent article in The New England Journal of Medicine made a desperate pitch to George R. R. Martin fans with the headline "Game of TOR: The Target of Rapamycin Rules Four Kingdoms." Another, about foreign bodies in the bladder, was headed "From Urethra with Shove." And for sheer chutzpah, it''s difficult to beat "Super-mesenteric-vein-expia-thrombosis, the Clinical Sequelae Can Be Quite Atrocious"-the improbable title of an article about a serious complication of appendicitis. But my favorite medical headline of all was written almost three hundred years ago. In 1724, the Philosophical Transactions, the journal of the Royal Society, published a letter from Mr. Robert Payne, a surgeon from Lowestoft in Suffolk.

The title is unimprovable: James Bishop, an apprentice to a ship-carpenter in Great Yarmouth, about nineteen years of age, had violent pains in the lower part of the abdomen for six or seven months. It did not appear to be any species of the colic; he sometimes made bloody urine, which induced Mr P. to believe it might be a stone in the bladder. He was very little relieved by physic; at length a hard tumour appeared in the left buttock, on or near the glutaeus maximus, two or three inches from the verge of the anus, a little sloping upwards. A short time after, he voided purulent matter by the anus, every day for some time. This is the old sense of the word tumor: not necessarily indicating abnormal tissue growth, but a swelling of any description. This example was, as it turned out, some sort of cyst, and eventually its surface broke. The surgeon suspected it was an anal fistula-an anomalous channel between the end of the bowel and the skin.

But events soon proved him wrong: Shortly after the prongs of a fork appeared through the orifice of the sore, above half an inch beyond the skin. As soon as the prongs appeared, his violent pains ceased; I divided the flesh between the prongs, according to the best of my judgment; and after that made a circular incision about the prongs and so with a strong pair of pincers extracted it, not without great difficulty, handle and all entire. The end of the handle was besmeared with the excrement, when drawn out. Naturally. This was a surprisingly large item of cutlery: It is six inches and a half long, a large pocket-fork; the handle is ivory, but is dyed of a very dark brown colour; the iron part is very black and smooth, but not rusty. The young man was reluctant to explain how he had managed to get himself in this predicament; at least, not until he was threatened with the withdrawal of his allowance. A relation of his, a Gentleman in this neighbourhood, who sent him to be under my care, the Reverend Mr Gregory Clark, Rector of Blundeston, on whom, in a great measure, his dependence is, threatened never to look upon him more, unless he would give him an account how it came; and he told him, that, being costive, he put the fork up his fundament, thinking by that means to help himself, but unfortunately it slipped up so far, that he could not recover it again. Mr.

Payne adds a postscript: PS: He says he had no trouble or pain till a month, or more, after it was put up. A fact that does not alter the moral of this cautionary tale: If you''re constipated, it''s better not to stick a fork up your fundament. Swallowing knives is bad for you Compulsive swallowers have always featured heavily in medical literature. There are numerous cases in nineteenth-century journals-but most of the individuals concerned were obviously suffering from some kind of mental illness. This, from the Medico-Chirurgical Transactions for 1823, is the first I''ve come across in which the patient was swallowing knives for a laugh. In the month of June 1799, John Cummings, an American sailor, about twenty-three years of age, being with his ship on the coast of France, and having gone on shore with some of his shipmates about two miles from the town of Havre de Grace, he and his party directed their course towards a tent which they saw in a field, with a crowd of people round it. Being told that a play was acting there, they entered, and found in the tent a mountebank, who was entertaining the audience by pretending to swallow clasp-knives. Having returned on board, and one of the party having related to the ship''s company the story of the knives, Cummings, after drinking freely, boasted that he could swallow knives as well as the Frenchman.

Not a particularly wise boast, and his comrades lost no time in challenging him to prove it. Eager not to disappoint them, he put his penknife in his mouth and swallowed it, washing it down with yet more booze. The spectators, however, were not satisfied with one experiment, and asked the operator "whether he could swallow more?"; his answer was, "all the knives on board the ship", upon which three knives were immediately produced, which were swallowed in the same way as the former; and "by this bold attempt of a drunken man", (to use his own expressions) "the company was well entertained for that night." Actions have consequences, as every sailor should know, and when foreign objects are ingested, the "consequences" usually come within twelve hours. And lo, it came to pass. The next morning he had a motion, which presented nothing extraordinary; and in the afternoon he had another, with which he passed one knife, which however was not the one that he had swallowed the first. The next day he passed two knives at once, one of which was the first, which he had missed the day before. The fourth never came away, to his knowledge, and he never felt any inconvenience from it.

So no problem, right? After this great performance, he thought no more of swallowing knives for the space of six years. In the month of March 1805, being then at Boston, in America, he was one day tempted, while drinking with a party of sailors, to boast of his former exploits, adding that he was the same man still, and ready to repeat his performance; upon which a small knife was produced, which he instantly swallowed. In the course of that evening he swallowed five more. The next morning crowds of visitors came to see him; and in the course of that day he was induced to swallow eight knives more, making in all fourteen. It seems safe to assume at this point that Mr. Cummings was not-ahem-the sharpest knife in the drawer. This time, however, he paid dearly for his frolic; for he was seized the next morning with constant vomiting and pain at his stomach, which made it necessary to carry him to Charleston hospital, where, as he expresses it, "betwixt that period and the 28th of the following month, he was safely delivered of his cargo." No doubt this was a common naval euphemism of the time rather than an original bon mot; but it made me laugh.

Having "emptied the hold," Cummings boarded a vessel traveling to France. But on the return journey, his ship was interc.