“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.

Collectible tattoos

For some days now I have been receiving suggestions about Dr. Masaichi Fukushi‘s tattoo collection, belonging to Tokyo University Pathology Department. I am willing to write about it, because the topic is more multifaceted than it looks.

Said collection is both well-known and somewhat obscure.
Born in 1878, Dr. Fukushi was studying the formation of nevi on the skin around 1907, when his research led him to examine the correlation between the movement of melanine through vascularized epidermis and the injection of pigments under the skin in tattoos. His interest was further fueled by a peculiar discovery: the presence of a tattoo seemed to prevent the signs of syphilis from appearing in that area of the body.

In 1920 Dr. Fukushi entered the Mitsui Memorial Hospital, a charity structure where treatment was offered to the most disadvantaged social classes. In this environment, he came in contact with many tattooed persons and, after a short period in Germany, he continued his research on the formation of congenital moles at Nippon Medical University. Here, often carrying out autopsies, he developed an original method of preserving tattooed epidermis he took from corpses; he therefore began collecting various samples, managing to stretch the skin so that it could be exhibited inside a glass frame.

It seems Dr. Fukushi did not have an exclusively scientific interest in tattoos, but was also quite compassionate. Tattooed people, in fact, often came from the poorest and most problematic bracket of japanese society, and Fukushi’s sympathy for the less fortunate even pushed him, in some instances, to take over the expenses for those who could not afford to complete an unfinished tattoo. In return, the doctor asked for permission to remove their skin post mortem. But his passion for tattoos also took the form of photographic records: he collected more than 3.000 pictures, which were destroyed during the bombing of Tokyo in WWII.
This was not the only loss, for a good number of tattooed skins were stolen in Chicago as the doctor was touring the States giving a series of academic lectures between 1927 and 1928.
Fukushi’s work gained international attention in the 40s and the 50s, when several articles appeared on the newspapers, such as the one above published on Life magazine.

Life

As we said earlier, the collection endured heavy losses during the 1945 bombings. However some skin samples, which had been secured elsewhere, were saved and — after being handed down to Fukushi’s son, Kalsunari — they could be today inside the Pathology Department, even if not available to the public. It is said that among the specimens there are some nearly complete skin suits, showing tattoos over the whole body surface. All this is hard to verify, as the Department is not open to the public and no official information seems to be found online.

Then again, if in the Western world tattoo is by now such a widespread trend that it hardly sparks any controversy, it still remains quite taboo in Japan.
Some time ago, the great Italian tattoo artist Pietro Sedda (author of the marvelous Black Novel For Lovers) told me about his last trip to Japan, and how in that country tattooers still operate almost in secret, in small, anonymous parlors with no store signs, often hidden inside common apartment buildings. The fact that tattoos are normally seen in a negative way could be related to the traditional association of this art form with yakuza members, even though in some juvenile contexts fashion tattoos are quite common nowadays.

A tattoo stygma existed in Western countries up to half a century ago, ratified by explicit prohibitions in papal bulls. One famous exception were the tattoos made by “marker friars” of the Loreto Sanctuary, who painted christian, propitiatory or widowhood symbols on the hands of the faithful. But in general the only ones who decorated their bodies were traditionally the outcast, marginalized members of the community: pirates, mercenaries, deserters, outlaws. In his most famous essay, Criminal Man (1876), Cesare Lombroso classified every tattoo variation he had encountered in prisoners, interpreting them through his (now outdated) theory of atavism: criminals were, in his view, Darwinianly unevolved individuals who tattooed themselves as if responding to an innate primitiveness, typical of savage peoples — who not surprisingly practiced tribal tattooing.

Coming back to the human hides preserved by Dr. Fukushi, this is not the only, nor the largest, collection of its kind. The record goes to London’s Wellcome Collection, which houses around 300 individual pieces of tattoed skin (as opposed to the 105 specimens allegedly stored in Tokyo), dating back to the end of XIX Century.

enhanced-buzz-wide-23927-1435850033-7

enhanced-buzz-wide-23751-1435850156-21

enhanced-buzz-wide-19498-1435849839-13

enhanced-buzz-wide-18573-1435849882-14

Human_skin_tattooed_with_the_words_République_Française_F_Wellcome_L0057040

The edges of these specimens show a typical arched pattern due to being pinned while drying. And the world opened up by these traces from the past is quite touching, as are the motivations that can be guessed behind an indelible inscription on the skin. Today a tattoo is often little more than a basic decoration, a tribal motif (the meaning of which is often ignored) around an ankle, an embellishment that turns the body into a sort of narcissistic canvas; in a time when a tattoo was instead a symbol of rebellion against the establishment, and in itself could cause many troubles, the choice of the subject was of paramount relevance. Every love tattoo likely implied a dangerous or “forbidden” relationship; every sentence injected under the skin by the needle became the ultimate statement, a philosophy of life.

enhanced-buzz-wide-18325-1435849786-17

enhanced-buzz-wide-22871-1435849601-14

enhanced-buzz-wide-25187-1435849704-8

enhanced-buzz-wide-26586-1435849809-15

enhanced-buzz-wide-27691-1435849758-7

These collections, however macabre they may seem, open a window on a non-aligned sensibility. They are, so to speak, an illustrated atlas of that part of society which is normally not contemplated nor sung by official history: rejects, losers, outsiders.
Collected in a time when they were meant as a taxonomy of symbols allowing identification and prevention of specific “perverse” psychologies, they now speak of a humanity who let their freak flag fly.

enhanced-buzz-wide-16612-1435849486-7

enhanced-buzz-wide-32243-1435849426-7

enhanced-buzz-wide-31525-1435849449-17

enhanced-buzz-wide-16819-1435849507-7

(Thanks to all those who submitted the Fukushi collection.)

Ariana Page Russell

Ariana è un’artista newyorkese affetta da una patologia della cute chiamata dermografismo: si tratta di una reazione abnorme agli stimoli e agli urti violenti. Se Ariana sbatte accidentalmente contro un tavolo, sulla sua cute si forma immediatamente un ponfo di colore rosso o rosa acceso che non se ne va prima di mezz’ora. Se si passa sulla pelle un oggetto acuminato, come ad esempio la punta di una matita, laddove alla maggior parte di noi resterebbe una sottile linea bianca che presto scompare, a lei rimane una striatura in rilievo per venti minuti buoni.

Questo tipo di affezione, che non è grave di per sé (a meno che non sia un sintomo di patologie più serie) e si può curare con antistaminici, non provoca né dolore né prurito ad Ariana – l’unico effetto negativo sono questi segni antiestetici che solcano periodicamente la sua pelle. Così la giovane artista ha deciso di trasformarli nel loro contrario, in un esercizio estetico puro.

Nella sua serie di fotografie intitolata Skin, la Russell ha trasformato il suo corpo in una vera e propria tela d’artista, in un laboratorio aperto in cui provare nuove forme e inedite decorazioni. Grazie alla sua peculiare anomalia, Ariana ha la possibilità di testare diversi materiali e diverse “fantasie” su di sé: la reazione cutanea dura più o meno mezz’ora, dandole così tutto il tempo per scattare delle foto e, se necessario, replicare il suo “quadro di pelle” per ottenere migliori risultati.

Le fotografie di Ariana Page Russell, che ricordano una versione ben più innocua delle scarificazioni, si iscrivono così nel più vasto filone della body art, ma con un elemento assolutamente personale; tutto questo, infatti, sarebbe impensabile se non fosse per la sua “malattia”, trasformata dall’artista in un tratto unico e inequivocabile della propria identità e del proprio stile.

A volte, sembrano dire questi temporanei “abbellimenti” decorativi sul corpo dell’artista, sta soltanto a noi decidere se una cosa è venuta per nuocere o meno; cosa è bene o cosa è male per noi; e ciò che per una persona è un problema, un fastidio o peggio ancora un handicap, per un’altra può rivelarsi uno stimolo positivo e carico di frutti.

Ecco il sito ufficiale di Ariana Page Russell.

La donna arlecchino

La più rara e grave forma di genodermatosi (alterazione genetica della pelle) ha un nome che sembra innocuo: è la cosiddetta “ittiosi Arlecchino”. Eppure, dietro questo nome, si cela una patologia quasi invariabilmente fatale per il bambino.

L’ispessimento degli strati cheratinici della pelle porta alla formazione incontrollata di squame dure, dalla forma di diamante, e a un colorito generalmente rosso. Inoltre la bocca, le orecchie e gli occhi così come gli arti possono risultare contratti o permanentemente invalidati. Le scaglie di cheratina impediscono i movimenti del bambino, e poiché la sua pelle si spacca là dove dovrebbe piegarsi, le ferite sono spesso a rischio di infezione.

Con un simile quadro clinico, non stupisce sapere che i neonati affetti da ittiosi Arlecchino non sopravvivono normalmente più di qualche giorno.

Ma è qui che arriva la parte sorprendente. Nusrit Shaheen, Nelly per gli amici, è affetta da questa sindrome. Oggi, ha ben 26 anni.

Ogni mattina e ogni sera Nelly si adagia in una vasca da bagno riempita di paraffina liquida. E questo è solo un passo della rigida prassi terapeutica che deve seguire per impedire che le scaglie si formino sul suo corpo. Creme, scrubbing, medicinali sono la sua quotidianità, per mantenere le giunture della pelle flessibili e scongiurare il rischio che il derma si secchi. Colliri, addirittura, perché le scaglie potrebbero formarsi sul retro delle sue palpebre. Ma a parte questa routine inflessibile, Nelly scoppia di salute.

Nelly ha convissuto con la sua malattia per tutta la sua vita. Ogni volta che sbatteva contro qualcosa, la pelle tendeva a rompersi, e lei doveva fasciarsi per evitare infezioni. Per gran parte della sua giovinezza, la ragazza si è nascosta in vestiti abbondanti, cappellini con visiere per nascondere il volto, e via dicendo. Ma oggi ha imparato a reagire. Riesce a controllare il suo problema medico talmente bene che non viene quasi più seguita dai medici. Non ha più paura di apparire, anzi: ha deciso di diventare una sorta di testimonial per la fondazione britannica per le malattie della pelle (British Skin Foundation). Da sportiva qual è, ha partecipato alla maratona in Sutton Park organizzata a fini benefici, è stata intervistata in televisione, e ormai non sembra fermarla più nessuno. Dopotutto, è la persona affetta da ittiosi Arlecchino più longeva del mondo.

“I medici non si azzardano a fare una prognosi nel mio caso. Nessuno dice niente. La mia respirazione è ottima, e finché sto attenta e mi prendo cura di me, dovrei rimanere in salute”.