disemboweled girl in pool

Factual Questions
21

[QUOTE=askeptic]

I also pointed out that your cite was a second hand report by a doctor. Who knows what really caused the injuries? I am not saying that it absolutely was not vacuum, just that there is “Some” evidence (Mythbusters) that the story is urban legend. Furthermore even if some injury did occur on the toilet there has been no detailed information provided that it was not some kind of freak malfunction.

This is GQ, I think it is important to point out information which may be urban legend. I am completely willing to have it pointed out that I am incorrect and that there have indeed been cases where a properly functioning toilet created enough vacuum to injur someone. But I hardly think that one cite of an unverified letter to a medical journal 20 years ago is sufficient. The letter itself points out that the information was anecdotal. That means that lay people described what they thought happened.
[/QUOTE]

I assume, first of all, that you are familiar with these vacuum toilets that existed at the time. They had a vicious positive suction that made a horrific sound and slurped down nearly anything fed to them. The ones I recall on one ship were nothing like any I have ever seen in airplanes. This Greek liner from 1987 may have had an older system geared more toward utility than safety with enough suction to serve a large area. I have no difficulty believing it would suck an elderly person’s guts out–these sometimes protrude with straining at stool alone, and there isn’t much holding the rest of the intestines inside.

The report in question is a firsthand account by a physician who was called to the scene and found the patient in distress on her bed next to the toilet with trans-anal prolapse of bowel (the physician thought it was small bowel with omentum). It is not a letter from a physician referring to an anecdote he heard. The first link below contains the original letter. There is no plausible alternative explanation since the patient’s history to the physician, given in her moment of distress with no reason to misinform him, is unlikely to have been deceitful.

I am unfamiliar with Mythbusters. I am familiar with those older vacuum cruise ship toilets and I am, as a physician, familiar with medicine, prolapse and old people with flabby skin. I can assure you that the habitus which has large subcutaneous deposits of soft, fluffy buttock fat can easily hang down and make a seal–not with the lid, but with the relatively small bowel below the seat. Think jello in Saran Wrap and a vacuum cleaner. Neither the buttock nor vaginal creases have enough subcutaneous stromal support in these folk to prevent a suction seal; I have had to have two aides on occasion hold back the flaps to get where I need to go. I might add further that the anus (and vagina) can be very patulent in older people and do not resemble the…ahem…tight sphincters of their youth.

At the time of this report, there was no challenge and no skepticism by anyone that I know of, and those of us old enough to have been tempted to feed toilet paper rolls down those vicious vacuums had no trouble believing it happened. That it passed into urban legend should not diminish its veracity given the sequence of report first and legend second. As Cecil mentions, his research included contacting someone he characterizes as a “folklore guru” for debunking the “legend.” That individual instead confirmed it.

Here is a link from someone trying decide if the legend should be debunked. Unfortunately he is unfamiliar with vacuum toilets and he is wrong that one does not see small bowel with omentum in these types of injuries–that is widely reported in many other cases. This link also contains the original letter:
http://tafkac.org/medical/evisceration/ship_jama.html

Here is a followup link which I believe is the newspaper account of the event, apparently provided by snopes:
http://tafkac.org/medical/evisceration/ship_upi.html

Everything in JAMA is peer-reviewed in the sense that experienced specialists review every case report–even those in letters–and judge their plausibility against their medical expertise.

At some point doesn’t a determined skepticism become an obstruction to learning?

22

[QUOTE=Chief Pedant]
At some point doesn’t a determined skepticism become an obstruction to learning?
[/QUOTE]

Yes, of course. I am not trying to be difficult. However, your first link concludes with this:

“Tentatively I’d say this is a slightly dubious account, but I don’t have strong feelings either way…”

It is important to note that that the letter in question was not in fact peer reviewed and the link you provided is openly skeptical of its authenticity.

ETA:These are the questions that the author in your first link would like to know the answers to:
"When did the UL start? If the story was floating around pre-1986, I’d say this letter is probably copying the story, rather than its source.
Is anybody willing to say definitively that there is absolutely no way any brand of marine toilet could be sealed off this way?
Does anybody know of any followup articles or responses to this letter? I’ll go through the JAMA’s following it for a while, but I’m not going to read every letter for the past ten years. Medline lists no followups, and no other articles or letters by J.B. Wynne.
Philadelphians: Can you find any “J. Brendan Wynne, DO” in the directory? I’m willing to make a fool of myself writing to him for more information, if someone can get me an address. "

So would I.

23

[QUOTE=Rick]
I just want to say after reading the first couple of links, I think my asshole slammed so shut, I will be able to use the toilet for a week or so.
[/QUOTE]

And then what? You’ll go back to not being able to use it? What do you use instead? Or is that something I’m better off not knowing?

24

[QUOTE=askeptic]
Yes, of course. I am not trying to be difficult. However, your first link concludes with this:

“Tentatively I’d say this is a slightly dubious account, but I don’t have strong feelings either way…”

It is important to note that that the letter in question was not in fact peer reviewed and the link you provided is openly skeptical of its authenticity.

ETA:These are the questions that the author in your first link would like to know the answers to:
"When did the UL start? If the story was floating around pre-1986, I’d say this letter is probably copying the story, rather than its source.
Is anybody willing to say definitively that there is absolutely no way any brand of marine toilet could be sealed off this way?
Does anybody know of any followup articles or responses to this letter? I’ll go through the JAMA’s following it for a while, but I’m not going to read every letter for the past ten years. Medline lists no followups, and no other articles or letters by J.B. Wynne.
Philadelphians: Can you find any “J. Brendan Wynne, DO” in the directory? I’m willing to make a fool of myself writing to him for more information, if someone can get me an address. "

So would I.
[/QUOTE]

I agree that the first link is someone struggling with the same issues you are.
I posted it for that reason; I consider the veracity of Dr. Wymme’s account obvious and the skepticism in that link ill-informed for the reasons I stated above, but of course you are welcome to your own analysis.

25

Years ago I saw a patient in the ER who was evaluated by the ER docs as having a ‘possible rectal prolapse’. In fact, she had herniated multiple loops of small bowel, with mesentery attached, through a perforation in her rectum that was caused by a stercoral ulcer. She was in her 90’s and had a history of severe constipation. Once she got a tear in the rectosigmoid wall, intraabdominal pressure alone was enough to push out the loops of small bowel. There was no external hole or wound; the tear was an internal one. So loops of small bowel with attached mesentery protruding from the anus is quite possible, and does not lessen the believability of the JAMA letter.

As far as debunking the JAMA letter goes, I’m not quite sure why that’s in doubt- is it your claim that Wynne was lying, or that the patient was lying about the mechanism of injury, or what? The second cite seems to indicate that the UPI tracked down and confirmed at least some of the information - although to be fair I can’t locate any reference to it on the Snopes site. Wynne was a DO in Pennsylvania at the time - in fact he was the program director of the orthopedic residency at the Philadelphia College of Osteopathic Medicine.

26

[QUOTE=brossa]
Years ago I saw a patient in the ER who was evaluated by the ER docs as having a ‘possible rectal prolapse’. In fact, she had herniated multiple loops of small bowel, with mesentery attached, through a perforation in her rectum that was caused by a stercoral ulcer. She was in her 90’s and had a history of severe constipation. Once she got a tear in the rectosigmoid wall, intraabdominal pressure alone was enough to push out the loops of small bowel. There was no external hole or wound; the tear was an internal one. So loops of small bowel with attached mesentery protruding from the anus is quite possible, and does not lessen the believability of the JAMA letter.

[/QUOTE]

Bolding mine.

You have just described alternative method for how the injury, described in the JAMA letter, could have occured.

27

>I only refered to Mythbusters because they actually did some on air expirements. Not that they are necesarily good science, but they made some good points. Mainly that the seat between the bowl and a persons ass would prohibit a good seal to create vacuum.

Mythbusters is certainly popular entertainment, but as you observe they are not necessarily doing good science. The problem with them doing poor science is that you can’t be very confident in the points they make. They generally consider some plausible scenario and conduct an experiment to test it, but that isn’t enough. They don’t learn the relevant art or survey much of the literature or consult with many experts or construct very meaningful quantitative theories or do many experiments. I didn’t see the episode you refer to but have seen perhaps 20 others and am every time bothered by all the missing pieces, sloppy work, obviously weak or incorrect assumptions, and generally insubstantial methods. They are often clever and always entertaining, but they’re not practicing as scientists and people who are would probably agree their results aren’t to be trusted.

28

A reporter on TV said that the girl would have to be fed intravenously for the rest of her life. Is it possible to live a semi-normal life without a functioning digestive system?

29

[QUOTE=Napier]
Mainly that the seat between the bowl and a persons ass would prohibit a good seal to create vacuum.

[/QUOTE]

If this is the sticking point for Mythbusters, they erred badly.
The body habitus that can do this is not an enormous fat person–they would be too big, and their tissue might not hang down properly to create a seal.
The habitus at risk is an older person with loss of subcutaneous stroma (supporting connective tissue) so that the excess fat that they do have flops around–think bags of jello in Saran Wrap as I mentioned above.
When you see this folks you can take those loose fatty buttock folds and hold them in your hand like a jellyfish.
The toilets are fairly small and the lid sits flat on the pan. It is very easy for me to visualize the folds of loose floppy skin and fat draping down into the bowl and creating a seal against the pan of this type of bowl circumferentially. Nor does the suction have to be perfect; the amount of pressure required to prolapse bowel in an older person with aging connective tissue is not large, and their sphincters are not that good anymore.
That it was a tramatic injury and not a spontaneous prolapse is also clear to me as a physician from the description in the letter–as it was clear to the editors of JAMA who published it.

I suspect a certain amount of “I can debunk that” pride on the part of TV show hosts who have a show to produce. From a medical perspective the event is not that incredible, and it is the combination of circumstances–elderly; vacuum toilet; extensive herniation of bowel; cruise ship–that makes it a delightful gee-whiz sort of an event. It isn’t the sort of thing where the reaction of an experienced medical professional is “That probably wouldn’t happen” anymore than the girl in the pool story is particularly surprising to those of us with experience and knowledge of other similar reports.

30

[QUOTE=mks57]
A reporter on TV said that the girl would have to be fed intravenously for the rest of her life. Is it possible to live a semi-normal life without a functioning digestive system?
[/QUOTE]

Well, in the sense she’ll be able to get up and walk around (probably with an IV in tow - she’ll need it not just for food but also fluids), talk, go to school, interact with people, enjoy many things in life like movies and books and music and TV… yes, you can live a “semi-normal life”.

However, the human body isn’t set up to work that way. That sort of long-term intravenous feeding results in liver and other organ damage over the long haul.

A more normal existance (although one still involving much medical stuff) would result from an intestine transplant, but those are rare, tricky, and apparently the success rate is not wonderful.

In other words, the girl is facing significant disability and very likely a drastically shortened lifespan.

(Docs, please correct me if I got any of that wrong)

31

Wikipedia gave a hint (no substantial info) that a small intestine transplant may be possible.

32

[QUOTE=askeptic]
This is GQ, I think it is important to point out information which may be urban legend. I am completely willing to have it pointed out that I am incorrect and that there have indeed been cases where a properly functioning toilet created enough vacuum to injur someone. But I hardly think that one cite of an unverified letter to a medical journal 20 years ago is sufficient. The letter itself points out that the information was anecdotal. That means that lay people described what they thought happened.
[/QUOTE]
Just for the record it’s worth noting that in 1994 there was another report of a (freak) injury occurring in a rather health-compromised passenger who had been seated on a vacuum toilet, this time on an airplane. No evisceration, but still not a particularly pleasant experience.

S. Meldon, S. Hargarten. Airplane Vacuum Toilets: An Uncommon Travel Hazard. *J. Travel Med. * 1(2): 104-105, 1994. (PDF available here.)

The authors conclude that

It would be interesting to know what the researchers at Mythbusters made of this report when they crafted their, well, debunking.

– Tammi Terrell

33

[QUOTE=Chief Pedant]

I am unfamiliar with Mythbusters.

I can assure you that the habitus which has large subcutaneous deposits of soft, fluffy buttock fat can easily hang down and make a seal–not with the lid, but with the relatively small bowel below the seat. Think jello in Saran Wrap and a vacuum cleaner. Neither the buttock nor vaginal creases have enough subcutaneous stromal support in these folk to prevent a suction seal; I have had to have two aides on occasion hold back the flaps to get where I need to go. I might add further that the anus (and vagina) can be very patulent in older people and do not resemble the…ahem…tight sphincters of their youth.

[/QUOTE]

Ok 1) you should check out that show, it’s pretty entertaining even though the science can be a bit suspect 2) you should send an application for a similar Discovery Channel show called “Dirty Jobs” and 3) they haven’t printed enough money in the world

34

[QUOTE=KneadToKnow]
Okay, it’s official. Anything Chuck Palahniuk writes about could actually happen. The intestines out through the back door thing was my last holdout.
[/QUOTE]

I wanted to make a joke about Jack’s small intestine, but since this happened to a little girl, that would be in pretty bad taste.

35

I recall seeing a very similar case involving a small boy and the extreme suction of a pool drain. I saw it years ago on TV–one of those nightly news magazine shows, I believe.