“A Tiny Red Hole”: Horrible Stories of Needles

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.

Mater incerta

In 2002 Lydia Fairchild, a 26-year-old woman living in Washington state, was already a mother of two kids, with a third one on her way, and without a steady job; she had decided to seek public assistance.
The procedure required her children to undergo DNA testing to confirm that their father was indeed Jamie Townsend, Fairchild’s former partner. It should have been a routine check, but some days later the woman received a strange call, asking her to come in the prosecutor’s office at Social Services.
And that is when her world almost fell apart.

Once she went in, the officers closed the door behind her and started drilling her: “Who are you?”, they kept asking her repeatedly, without her understanding what was going on.
The reason behind the relentless questioning was absolutely unpredictable: the DNA tests had proven that Jamie Townsend was actually the children’s father… but Lydia was not their mother.

Although the woman kept repeating that she had carried and delivered them, the results categorically excluded this possibility: the genetic profiles of her children were in fact made up for one half from their father’s chromosomes, and for the other half from the chromosomes of an unknown woman. Lydia Fairchild was facing the risk of having her kids taken away from her.
Before the woman’s despair, Social Services ordered a new test, which gave exactly the same results. Lydia showed no genetic link with her children.

During the following 16 months, things got worse. The officers launched court action to remove her custody rights, as this could turn out to be a case of abduction, and the state even had a court officer witness her third child’s delivery, so that DNA test could be run immediately after birth. Once again, the newborn baby showed no genes in common with Lydia, who then became a suspect of acting as a surrogate for payment (which in Washington state is considered gross misdemeanor).
Lydia Fairchild was living a true nightmare: “I’d sit and have dinner with my kids and just break out crying. They would just look at me like, ‘What’s wrong, Mum.’ They’d come get me a hug, and I couldn’t explain it to them, because I didn’t understand“.

Her lawyer Alan Tindell, though initially perplexed by the case, decided to investigate and one day stumbled upon a similar story that happened in Boston, as described in a paper on the New England Journal of Medicine: a 52-year-old woman, Karen Keegan, had undergone a hystological exam in view of a transplant, and the results had shown no link between her DNA and her children’s.
Quite often the solution for the most intricate mysteries turn out to be disappointing, but in this case the explanation was just as incredible.
The lawyer understood that, just like the mother the scientific paper was about, Lydia too was a chimera.

Tetragametic chimerism happens when two egg cells are fertilized by two different sperm cells and, instead of developing into two fraternal twins, they fuse together at a very early stage. The chimeric individual is equipped with two different genetic makeups, and can develop whole organs having different chromosomes from all the others. Most chimeras do not even know they are, because the existence of two cellular lines is not often noticeable; but they carry inside them for instance the liver, or some other gland, that should have been part of their unborn twin.
In Fairchild’s case, the “foreign” organs were her ovaries. Inside of them were hidden those unknown chromosomes that formed the genetic makeup of Lydias’s children, as was confirmed by the examination of the cells obtained via pap test.

Finally the court dismissed the case. In the court hearing, the judge openly wondered how reliable could DNA tests be, as they are even today held essential in forensic cases — but what if the criminal is a chimera?
Today Lydia Fairchild is back to her normal life, leaving this terrible adventure behind. And some years ago she gave birth to her fourth daughter; or, if you will, the fourth daughter of that sister she never had.

The New England Journal of Medicine paper mentioned in the post can be read here. To discover some less-known istances of chimerism, I suggest this articolo.

La città dell’oscurità

Immaginate una città che si sviluppi senza alcun tipo di controllo urbanistico. Immaginate le strade e i palazzi come un organismo vivente, arterie e cellule di un corpo la cui biologia interna è completamente impazzita. Immaginate appartamenti che crescono di giorno in giorno, uno sopra l’altro, come un tumore che aumenti a dismisura, piano dopo piano, senza che alcuna intelligenza centrale abbia mai messo mano a questo incubo architettonico, totalmente anarchico e sregolato.

La cittadella in questione era Caolun (Kowloon, in inglese), e quest’anno ricorre il ventennale della sua demolizione; dopo la difficile opera di evacuazione, con il crollo degli ultimi mattoni, finiva nel 1993 la storia stupefacente dell’unica città al mondo senza legge né regole.

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Sorta prima dell’anno 1000, la città fortificata di Caolun, in Cina, era stata abbandonata e poi ricostruita a metà dell’800 dagli inglesi che controllavano Hong Kong. Abbandonata nuovamente, cominciò a ripopolarsi e divenne ben presto una zona autonoma, sviluppandosi velocemente grazie a un inspiegabile “buco” amministrativo e politico.
Le Triadi mafiose locali presero il potere proprio quando la cittadella, abitata da profughi della Seconda Guerra Mondiale e da dissidenti del regime Maoista, si stava ingrandendo; ma per fortuna nel 1974 una task force di 3.000 poliziotti sgominò le bande criminali, “liberando” Caolun dal giogo della mafia. Fu allora che la popolazione cominciò davvero a crescere.

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Nel giro di dieci anni, il numero degli abitanti era aumentato vertiginosamente: 33.000 accertati, quasi 50.000 quelli stimati, in una “cittadella” che in realtà potrebbe benissimo essere definita un quartiere, viste le sue dimensioni ridotte (soltato 26.000 metri quadrati). Con un rapido calcolo vi accorgerete che la densità della popolazione a Caolun era davvero impensabile: quasi due milioni di esseri umani per km2.

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Le case venivano costruite a velocità folle, senza ingegneri o architetti, sopraelevando, occupando qualsiasi spazio libero: la mattina avreste potuto svegliarvi e scoprire che la vostra finestra non dava più sul consueto panorama, ma su un nuovo muro dell’edificio vicino. I cortili si chiudevano progressivamente, fino a diventare dei piccoli pozzi di aerazione, i vicoli si restringevano di giorno in giorno, e la luce del sole si allontanava sempre di più, sottile linea a malapena visibile fra le case che arrivavano a più di dieci piani. Caolun cominciò ad essere chiamata HakNam, la città delle tenebre, perché nei suoi vicoli era notte anche a mezzogiorno. Vennero istallati dei tubi fluorescenti lungo le claustrofobiche stradine, tenuti accesi costantemente.
Le case che continuavano a salire in verticale, accatastate le une sulle altre, fermarono la loro folle crescita per un solo motivo: evitare le rotte di atterraggio degli aerei del vicino aeroporto Kai Tak.

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Eppure, al contrario di quanto si potrebbe pensare, la vita all’interno di questo caos architettonico era sorprendentemente tranquilla, e l’integrazione fra le diverse etnie presenti piuttosto pacifica. Sui tetti più alti erano stati piantati alberi e piccoli giardini dove i bambini potevano giocare; una settantina di pozzi garantivano l’acqua agli abitanti, finché il governo di Hong Kong non decise di portare acqua pulita e corrente elettrica fino ai margini della cittadella. La criminalità non era poi eccessivamente elevata, nonostante case da gioco, bordelli e droga fossero comuni, e lungo i vicoli nacquero negozi, piccole fabbriche, ristoranti e persino asili, scuole, anche una specie di tribunale.  Proliferavano gli studi medici senza autorizzazione, che però talvolta avevano un discreto livello di professionalità; ma, in generale, l’aspetto più disastroso era senz’altro la terribile condizione igienico-sanitaria.

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Alla fine degli anni ’80 i due governi di Hong Kong, quello inglese e quello cinese, si accordarono per mettere fine alla situazione ormai insostenibile, ed evacuarono la zona autonoma per demolirla infine nel marzo del 1993. I lavori terminarono nel 1994, con alcuni scavi archeologici che riportarono alla luce le antiche strutture preesistenti; oggi il sole finalmente splende nel parco cittadino ubicato proprio dove sorgeva l’oscuro e labirintico alveare di case.

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(Grazie, Michele!)