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Thursday, September 11, 2014

The Woman Who Claimed She Urinated a Bullet

While urinating a worm is physically possible as described in a recent blog post, there is an early medical report from 1668 of a woman urinating something even more incredible…a bullet. The story goes like this.

A large, pale, woman by the name of G. Eliot in Suffolk, England was tormented with intestinal problems for many years. She was persuaded by a neighbor who had similar problems to swallow two bullets.  It is not stated what the logic was behind how swallowing bullets would supposedly help. The woman claimed that she felt better initially after swallowing the bullets but that the pains returned and increased.

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After 15 years of continued symptoms, she presented to Dr. Nathan Fairfax’s pharmacy.  He prescribed her something called Lady Hollands powder that was mixed into a hot drink. She vomited over night.  When using the bathroom the next morning (which was referred to as the chamber pot), she urinated when a thwang was heard on the side of the vessel.  This reportedly surprised her and led her to wonder what it could be. So she poured the urine and saw a heavy gravelly stone that was yellow-red in color and as big as the end of a thumb. However, this is based solely on self-report.  She reportedly took a hammer, knocked off the outer crust, and found a bullet enclosed in it. She then reportedly cut it a little with a knife and found lead within it.

Dr. Fairfax asked her if she had ever urinated bullets before and she said no, including the other bullet. Recollecting back to when she swallowed the two bullets, she stated that she checked her feces slightly for days afterwards and never found the bullets and so she gave up. She stated that the bullet was smaller compared to when she originally swallowed it.  Before and since that time, she stated that she urinated an abundance of red gravel.

Ms. Eliot stated that when she voided the bullet that it felt like a kidney stone but that it lasted longer (i.e., weeks),  caused her to bow forwards, and led to vomiting.  She claimed to feel it move lower from the kidney to the bladder.  Dr. Fairfax asked her if she was sure that the bullet came from the urine and she assured him that it was and that she was not mistaken. Dr. Fairfax stated that the bullet did have a gravelly coat. Since she passed the bullet, she stated that she still had kidney stone pains but not as bad as before.

Dr. Fairfax stated the tale strengthened his belief that there must have been a passage from the stomach to the bladder but in reality, there is no such passage.  He believed that nature had found a way to finally rid the body of something it found offensive. Basically, his argument was that the body works in mysterious ways.

This story is a good lesson that highlights the problem that arises when health care professionals rely on self-report , despite claims that the self-report is definitely not mistaken. What this woman described is actually anatomically impossible. There is no known mechanism by which someone can swallow a bullet or any other foreign object and have it passed from the stomach to the kidneys. When solid objects and liquid enters the stomach from the esophagus it goes directly to the small intestines. The blood picks up excess fluid and is filtered by the kidneys but there is no way for the blood to transfer a solid object from the small intestine to the blood and into the kidneys.

Thus, either Ms. Eliot made the story up and showed the doctor a bullet that was not the one she swallowed or she or Dr. Fairfax misperceived the middle of a kidney stone as a bullet. Incidentally, there is no report in the modern medical literature of a foreign object being passed out of the body through the urine.

Fairfax, N. (1668). An Extract of a Letter, Written by Dr. Nathan. Fairfax to the Publisher, about a Bullet Voided by Urine, Philosophical Transactions, 40, 803-805.

How a Flower Can Kill a Rattlesnake: The Medical Dangers of Pennyroyal Oil

While doing some historical medical research from the 1600s, I recently came across a fascinating account of how people in Virginia used a common flower to kill rattlesnakes. The story was relayed by Captain Silas Taylor to members of the Royal Society in England, who were always interested in hearing new discoveries from places overseas.

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Captain Taylor spoke about how colonists in Virginia used a plant known as pennyroyal (pictured below) to kill rattle snakes. He noted that the leaves of this plant produced a very hot sensation when placed on the tongue.  So the colonists took some of the pennyroyal leaves, tied them to the end of a long stick, and held them by the nose of the rattlesnake.


When exposed to the pennyroyal leaves, the rattlesnakes would turn and wiggle and do whatever they could to avoid it. But the colonists were persistent and eventually the rattlesnake died in less than 30 minutes from the scent of these leaves.

How is this possible? Medical science has the answer. As it turns out, the essential oil in pennyroyal is very high (up to 90%) in pulegone. This oil is highly toxic, particularly to the liver, even at very low levels. (e.g., one ounce). The rest of the oil is made up of similar toxins. Human consumption of just a half a teaspoon of the oil can result in death.

The high toxicity of pulegone is mainly due to methofuran, an organic chemical that the body converts the oil into. Pennyroyal oil can cause seizures, fainting, failure of multiple organs, acute (sudden) kidney and/or liver failure, brain damage, hallucinations, paralysis of respiratory muscles, failure of the heart and lungs, coma, and as mentioned, death. In humans, the toxicity usually occurs a few hours after ingestion, but if one held the flower over the rattlesnake for 30 minutes, the constant exposure to the oils in the flower could explain why death occurred during that time frame.

Pennyroyal oil causes damage to organs by depleting levels of glutathione, a natural chemical in the body that prevents damage to cells. Thus, when not enough glutathione is present, cellular damage occurs quickly.
Humans need to make sure not to ingest pennyroyal oil. For example, in 1996, two infants died because they drank a tea that was made with pennyroyal.  Dogs have died after licking this oil off of their fur. A college student who drank two teaspoons of pennyroyal oil in teas died two days later in 1994. Thousands of years ago, pennyroyal oil was actually used to terminate unwanted pregnancies. It is also used as a powerful insect repellent.

Reference: 1665 (author unknown). Of A Way of Killing Rattle-Snakes. Philosophical Transactions, 3, 43.

Tuesday, September 09, 2014

Worms in the Urine: Strange Facts

Many people have heard of parasitic worm infections in their animals and even in humans. In those cases, people generally are familiar with worms being found in the fecal matter. However, many people are unaware that people can actually urinate worms. The reason is because some types of worms can infect the urinary tract.

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One type of worm infection is trichomoniasis, but these worms are microscopic. Another worm infection is schistosomiasis, which is caused by a worm called a fluke. This can cause severe kidney failure, blood in the urine, blockage of urine flow, and can eventually result in bladder cancer. In cases of fluke infection, worm eggs are released in the urine from the worms that live in blood vessels around the urinary bladder.

 Another parasitic worm infection is filariasis, which is threadworm infection. This can cause lymph fluid to enter the urine and a severe enlargement of tissues (elephantitis).  Yet another parasitic worm infection that can rarely present in the urine is strongyloidiasis which is caused by a type of roundworm.  Sometimes, the worms are living and swimming freely in the urine.  Identification of worms such as these in urine samples can sometimes prevent fatal health outcomes as these conditions are often treatable and reversible with medication.

Another type of roundworm infection that can rarely present in the urine is Ascaris lumbricoides (see picture above, image copyrighted by the Journal of Postgraduate Medicine).  These worms can live in the body for 12 to 18 months and can produce 240,000 eggs.

One of the earliest accounts of a worm present in the urine occurred in 1677 by a man named Matthew Milford. Mr. Milford noted that worm he passed was snake-headed and alive. He noted that it was small at the tail. He noted being very ill before hand and that since that time he had blood in the urine. He reportedly probably had urinary retention for some time. The worm presented on the second urine, leading the writer of the article to hypothesize that it descended from the kidney to the bladder initially and then out into the urine stream. The worm was then noted to be dead, dry, and a dull red color, with a thickness of 1/12th of an inch. It is unclear exactly what type of worm this was.

Reference : Ent and Milford (1677). A Relation of a Worm Voided by Urine; Communicated by Mr. Ent: to Whom It Was Sent by Mr. Matthew Milford. Philosophical Transactions, 140, 1009.