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Of Foetuses & Fibroids: the Accidental Foreign Body

Gemma Angel8 April 2013

Lisa Plotkinby Lisa Plotkin

 

 

 

 

 

As our current exhibition in UCL’s north cloisters demonstrates, “foreign bodies” may take many forms, as well as being continually redefined throughout history. Putting it simply, the term “foreign body” in medicine usually refers to an external object introduced into the body that isn’t supposed to be there. As my colleague Dr. Sarah Chaney notes in her recent blog post, some of the most common foreign objects uncovered from the bodies of 19th and early 20th century patients were coins, safety pins, buttons and needles. These objects could enter the body accidentally or with purpose. Medical instruments or tools, for example, were on occasion accidentally lost inside the patient’s body during an operation. For those Seinfeld fans out there, think back to the “junior mint” episode. However, it was neither pins, mints or instruments which were the subject of a 1939 article in the British Medical Journal devoted entirely to foreign bodies. Rather, Dr. A. H. Charles, obstetric registrar at St. George’s Hospital, zeroed in on one particular foreign body that was with some frequency discovered in the female bladder: slippery elm bark. It may surprise some readers to discover (as it certainly did Dr. Charles), that slippery elm bark was commonly used as an abortifacient. In fact, it is still used by women to induce abortion today.[1] Writing on elm bark as a foreign body inside the bladder, Dr. Charles observed:

Five cases in which a piece of elm bark was used have been reported in detail previously, and in all of these the body has remained undiscovered for some time, until its removal suprapubically after calculus formation had taken place, causing symptoms leading to its discovery. Why the bark of this noble tree should be so popular is difficult to understand.[2]

Called “slippery” elm because when it gets wet it becomes slippery, this type of elm bark has traditionally been used to cause early uterine contractions and induce labor. The bark is inserted into the cervix where it then absorbs water and expands, dilating the cervix and triggering contractions. Needless to say, this procedure was not always successful and could cause life-threatening infections. Occasionally the bark could end up in the bladder by mistake, which is what Dr. Charles had observed. For many of the women who mistakenly inserted the slippery elm into their bladders, there the bark most likely stayed, unless a severe medical problem compelled them to seek medical attention. No doubt for many of the women attempting to self-abort, their experience with slippery elm was less than satisfactory and could have proven fatal.

Slippery Elm Bark, sold as an abortifacient

Slippery Elm Bark, sold as an abortifacient.

Accidental or intentional abortion occurred with a lot greater frequency in the 19th and early 20th centuries than some might imagine, and was inextricably wrapped up with both the idea and concrete reality of “foreign bodies.” For many, the coat hanger is the ultimate symbol of a foreign body inserted into the uterus to cause abortion. Still others may think of obstetric forceps as the foreign body which has caused thousands of fetal deaths during delivery. But what about uterine fibroids? How many abortions have they caused, and can they be regarded as foreign bodies if they are naturally occurring? A uterine fibroid is a benign tumour of the uterus, commonly found in women of reproductive age. Most fibroids are asymptomatic and therefore, most women are never aware that they even have one. However, on occasion these fibroids can cause health complications or interfere with pregnancy. Before the advances of late 19th century abdominal surgery and gynecology, uterine fibroids were not treatable. However, by 1916, obstetric surgeon Sir. John Bland-Sutton was able to boast that “uterine fibroids are common tumours; so common and troublesome that I have removed the uterus in 2,000 women.”[3]

From his experience performing hysterectomy on thousands of women a theme emerges: uterine fibroids closely mimic pregnancy in a variety of ways, and it is difficult – sometimes impossible – to distinguish between the two. Writing of this unfortunate similarity in 1913 Bland-Sutton observed, “A large sub-mucous fibroid produces similar changes in the uterus to those set up by the growth of the fetus […] Women with large sub-mucous fibroids are more or less in a condition resembling chronic pregnancy.”[4] What this similarity meant – and what gynecologists and obstetricians of the time openly acknowledged – was that sometimes a hysterectomy was performed to remove a fibroid that either never existed in the first place, or was also sitting alongside a feotus, masking a pregnancy. Either way, an abortion was performed.

The photograph below demonstrates the reality of such surgeries. This particular specimen belongs to UCL Pathology Collections, and is currently on display in the Foreign Bodies exhibition. The anonymous woman patient underwent a hysterectomy most likely sometime in the early 20th century, in order to remove the sizable uterine fibroid, which can be seen on the right side of the image. However, on closer examination of the image, we see on the left side a preserved feotus, frozen in development, somewhere between 8-11 weeks.  It is unclear whether this woman or her doctor even knew she was pregnant.

Feotus in uterus, with large fibroid tumour. UCL Pathology Collections. Photograph Gemma Angel.

Feotus in utero, with large fibroid tumour.
UCL Pathology Collections. Photograph Gemma Angel.

Such examples abound in medical literature, and Victorian and Edwardian gynaecologists, obstetricians, and surgeons spoke of them with little or no censure. It was all a part of the surgical trial and error that they were practicing. The feotus was sometimes viewed as a necessary casualty in removing a potentially life-threatening fibroid. Either way, be it by slippery elm, by accident, or with purposeful intent, the feotus was removed as a foreign body, like any other. By examining the medical establishment’s attitudes towards fibroid removal we catch a glimpse into one way the feotus, and the experience of pregnancy in general, was understood in the past.


References:

[1] David A Grimes, Janie Benson, Susheela Singh, Mariana Romero, Bela Ganatra, Friday E Okonofua, Iqbal H Shah. “Unsafe abortion: the preventable pandemic.” The Lancet Sexual and Reproductive Health Series, October 2006.

[2] British Medical Journal, 29 July 1939.

[3] Sir John Bland-Sutton, “A Clinical Lecture on 200 Consecutive Hysterectomies for Fibroids Attended With Recovery” reprinted British Medical Journal, 4 July 1916.

[4] Sir John Bland-Sutton, “The Visceral Complications Met With Hysterectomy for Fibroids and the Best Methods for Dealing With Them” British Medical Journal, 1 November 1913.

Foreign Bodies: Attack of the Clones

Gemma Angel18 February 2013

Profile  by Felicity Winkley

 

 

 

 

 

One of the most controversial specimens amongst the Grant Museum’s encyclopaedic collection is a preserved domestic cat; in fact, on one occasion, I was standing quite close to this object at the exact moment when a small child laid eyes upon it and promptly burst into tears. The fact that the sight of preserved animals, particularly domesticated or fluffy ones, provokes such a response would be ample topic for a debate in its own right, however in this instance I am more interested in the way the Grant have developed the subject in their museum signage. Beside the exhibit, they point out that in 2004 the first domesticated cat was cloned for $50,000 – a kitten called ‘Little Nicky’, commissioned by a Texan woman called Julie after the original cat ‘Nicky’ had died [1] – and ask whether or not this was a good thing to do? nickyAt the time of the cloning in 2004, the response from the scientific community was negative: it was thought a fatuous use of the technology to reproduce a domestic pet, as well as inhumane given the animal’s short life-expectancy (roughly a third of cloned cats did not survive beyond 60 days).[2] Today, expanding the subject beyond the cloning of domestic animals, as part of the successful QRator scheme (in which visitors are invited to record their responses to topical questions relating to the collections), the Grant Museum asks the public to contribute to a wider debate: Should we clone extinct animals?

The argument is a complex one. For one thing, extinct animals may have died out because of their own comparative weaknesses, and therefore any attempts to reintroduce them may prove futile. The journalist Chris Packham, for example, has famously lambasted attempts to conserve the Giant Panda, criticising the huge amounts of money spent on attempting to breed an animal which is so reluctant to reproduce itself. He suggests that the Giant Panda is “a species that of its own accord has gone down an evolutionary cul-de-sac” and therefore should be allowed to die out, not least because any attempts to reintroduce it into the wild will be limited by the increasingly diminishing area of its potential habitat anyway.[3] Where cloning animals and reintroducing them is concerned, habitat is also an issue in terms of preempting any potential environmental changes that might have occurred since the species was last present in the wild. The repercussions of reintroducing clones despite drastic ecosystem change are fairly clearly (if not necessarily realistically!) laid out for us to see in Jurassic Park. Although the author accepts this is an extreme example, it is nevertheless an effective visualisation of what can occur when we tamper with complicated systems of which we have limited understanding.

Jurassic Park III

 

But what of those species made extinct by human influence, and through no fault of their own? The quagga, hunted to extinction in 1883, and the thylacine, in 1936, are both on display in exhibition cases at the Grant Museum. If we accept, then, the fault of human oversight, perhaps these two could justifiably be cloned and reintroduced into the wild – but given the cost of the procedure and the potentially limited life-span of the animal subjects, wouldn’t the enormous investment be better applied to conserving those species still alive today but in dire need of assistance? The Amur leopard population, for example, is currently at a critical low, with just 7-12 thought to remain in the wild in China and 20-25 in Russia.[4]

Taking into account all of these conflicting arguments where cloning is concerned, it was with some interest, therefore, that I read a few weeks ago about a Harvard professor’s hopes for recruiting a female volunteer willing to surrogate a baby created with Neanderthal DNA.[5] Geneticist Professor George Church has recently completed enough Neanderthal bone-sample analysis to accurately isolate the genetic code that would enable him to create artificial Neanderthal DNA, according to his publication Regenesis: How Synthetic Biology Will Reinvent Nature and Ourselves.[6] Having previously been involved in the Human Genome Project, which successfully mapped human DNA, Professor Church would insert artificial Neanderthal DNA into stem cells and inject these into a human embryo in the earliest stages, allowing this to develop in the laboratory before implanting it into the womb of a potential surrogate mother. He believes that Neanderthals, whose population flourished in Europe and extended throughout the Middle East and into China between 70,000 and 30,000 years ago, were highly intelligent. This impression is certainly supported by archaeological evidence: the skulls of Neanderthals held large brains, “in the range of and exceeding the cranial capacity of modern humans” state Lewin and Foley.[7] As such, Professor Church proposes that a cloning and reintroduction of Neanderthals could be useful to increase diversity, and introduce an alternative way of thinking into society:

When the time comes to deal with an epidemic or getting off the planet or whatever, it’s conceivable that their way of thinking could be beneficial. They could maybe even create a new neo-Neanderthal culture and become a political force. The main goal is to increase diversity. The one thing that is bad for society is low diversity.[8]

Aside from the obvious concerns about the potential risks to the surrogate mother of a baby created via this method, critics have also challenged the ethics of the proposed experiment. Whilst the Charter of Fundamental Rights of the European Union prohibits reproductive human cloning in member states of the EU, and it is likewise illegal in the UK under the Human Fertilisation and Embryology Act 2008 – because the project proposes the cloning of a Neanderthal rather than a Homo Sapiens, there are fears that current legislation may not apply. In any case, there is no uniform guideline agreed for the United States of America on human cloning, whether reproductive or therapeutic. But were Professor Church to have his way, how would a new Neanderthal cope in modern-day society? Physically, could their immune system withstand it? Emotionally, would they successfully integrate, or be outcast as a monster? Whatever the answer – and luckily at the moment our concerns are purely speculative – there is no denying that a neo-Neanderthal person would be the ultimate foreign body.