BOTH THESE patients were natives of North China, and presented themselves for treatment at the Union Medical College, Peking.

The Chinese conjuror’s tale

THE FIRST was a middle-aged man and a conjuror by profession. On arrival he stated that some three weeks previously, while giving a performance, he had swallowed a dollar which, contrary to the usual course of events, he had not been able to reproduce when required.

He volunteered the information that members of his profession when they “swallowed” coins, iron balls, etc., really only packed them away down behind the tongue somewhere in the region of the epiglottis, but that this particular dollar, instead of remaining vertical, had become horizontal, and in some way caught so that he was not able to return it or dislodge it.

The remarkable thing was that, although the dollar is a large heavy silver coin of 1½ inches diameter, he said he had suffered very little inconvenience, and was able to eat his food practically as before.

He was only anxious to get the coin back because the Chinese New Year was at hand, which is the great holiday time when all debts have to be paid off, so that he was in need of the money!

What he confidently affirmed to be the dollar lying horizontally was evidently the cornua of the hyoid bone. He had drawn a picture to demonstrate the exact position of the coin, and said that when he took solid food he experienced a slightly awkward sensation at the place indicated; he also said it was no use trying to get it up through the mouth as many such attempts had failed, but some method must be found whereby the coin could be grasped from the outside and twisted up into the vertical position, and then, he said, it could be got from the mouth.

X-rays revealed nothing abnormal in the hyoid region, but the current was not sufficiently strong at the time to allow of thorough examination of his stomach.

The man was so persistent that the dollar was still there that it was suggested that an oesophageal bougie should be passed, and the stomach sounded in this way. He readily agreed to this, and said he could easily swallow the bougie himself, which he did and got it down about 9 or 10 inches, when it was pushed on for another 6 or 7 inches without any difficulty, but nothing was found.

On attempting to withdraw the instrument, it caught at once, but was easily freed by a slight jerk and came up, followed immediately by a blackened Hong Kong dollar, which rattled out into the pail to the astonishment of the medical man much more than of the patient.

Examination of the bougie found it to be distinctly scratched and roughened at a place measuring 11 inches from the teeth. Evidently, the man had swallowed the dollar, and it has passed down the oesophagus, past the natural stricture at the back of the cricoid, but had not been able to get through the second stricture situated at the point where the oesophagus passes through the diaphragm. It had remained in a vertical position and had practically caused no obstruction to food, nor to the passage of the bougie, but fortunately, on attempting to withdraw the instrument it had caught sufficiently to dislodge the coin.

After it was all over, the patient admitted that it had been down for over two months, but he had not dared to say so because he feared that, in that case, no attempt would be made to recover it.

The Chinese soldier and his loot

THE SECOND was a Chinese soldier, who had evidently taken his share in the looting of Peking, and for this reason considered that his head was not safe. He determined to take no risks, and, therefore, sought to put an end to himself, the method adopted being to swallow 36 copper coins, called tung-tzus, in six doses of six; but he stated that he vomited up five of the coins.

As the coins did not have the desired effect, he began to feel sorry for what he had done, and, therefore, started to cut them out, but had not the courage to continue the operation. He came to the hospital on the third day after swallowing the coins, complaining of pain and a heavy feeling in the stomach; he had also a skin wound about 2½ inches long to the left of the middle line just over the stomach area where he had started to operate upon himself.

On examination with X-rays, a dark mass was seen in the abdomen to the right of the vertebral column, which could easily be made to shift to the left side by turning the patient

An ordinary operation for gastrotomy was performed, and 29 of these coins were recovered; the operation was rendered rather more difficult than usual by the fact that the weight of the coins dragged the stomach right down into the fossa at the side of the vertebral column, and a pair of long forceps had to be used to recover all the coins. The patient made an uninterrupted recovery. Each of the coins measures 1⅛ inches in diameter, the whole pile of 29 was 2 inches high, and weighed 7¾ oz. There should have been 31 coins, according to the patient’s statement, but no trace of two coins could be found. It was concluded that he had vomited up more than five, or had not swallowed so many as intended.