The AFU and Urban Legend Archive
Medical
Evisceration
 ship jama




Date: Wed, 1 May 1996 11:18:46 -0400 (EDT)
From: "Ian A. York" <iayork@panix.com>
Subject: Re: Article <49ggok$h0s@panix.com>, This is your Life! (well probably)

(Originally posted to AFU November, 1995)

In article <48u0kk$iqc@shellx.best.com>, JVG <jimbo@xoxo.com> wrote: >
>The FAQ:
>F. Fat person on ship/airline toilet has intestines sucked out due to
>vacuum.
>
>The article:
>
>From UPI in San Francisco Chronicle Friday, March 6, 1987.
>=======================================================
>Tourist's Strange Intestinal Attack

Thanks to JVG, I found the original article to which the newspaper account refers. It was a letter to the Journal of the American Medical Association (JAMA): JAMA March 6, 1987 257(9):1177 ...

Vacuum Toilet Evisceration 

        To the Editor: --I would like to alert your readers to the
        potential for serious injury that exists in the use of vacuum
        toilets such as those found on cruise ships.
                Recently, while on a Greek-registered cruise ship moored near
        Vancouver, British Columbia, to accomodate the hotel overflow from
        Expo 86, I responded to an emergency call over the ship's
        loudspeaker and was asked to administer first aid to a woman who
        had sustained a serious pelvic injury.
                A 70-year-old, slightly obese woman was in her cabin lying 
        on the bunk in the right lateral recumbent position.  She was
        alert and responding verbally but in obvious distress, moaning in
        pain, diaphoretic, and apprehensive.  Protruding behind her on the
        bed were several feet of small intestine with omentum attached. 
                The woman stated that she had flushed the toilet while still
        seated and the suction had "pulled everything out."  Apparently,
        her buttocks and thighs had occluded the opening of the toilet
        seat, causing the full force of the vacuum to be applied to the
        perineal area.  She kept repeating, "Why didn't they warn me?"
                Indeed, the only warning associated with the use of the 
        toilet was a multilingual sign posted nearby stating in English:
        "This toilet operates on vacuum system.  Please do not throw any
        object except toilet paper."
                An ambulance crew responded with a few moments and 
        transported the woman to a local hospital.  I left Canada within
        the hour and am unaware of the final outcome of the incident.
                Whether this occurrence represents a malfunction of this
        particular vacuum system, or if this could occur with any vacuum
        toilet, I do not know, but it certainly bears further
        investigation. 

                                        J. Brendan Wynne, DO
                                        Philadelphia

Now then. Altering the FAQ is a serious business, and we have to be sure that this letter is reliable; so let's deconstruct it carefully. (I understand that there was a discussion of this letter before my time, but nobody seems to remember what the decision was.) (Also note that I don't really know what 'deconstruct' means, and only used it in the hope that I did so incorrectly, thereby inducing diaphoresis in Ian and Michele.)

Considerations:

(1) Does the letter as a whole seem believable? (2) Is it conceivable that a vacuum toilet could be occluded at all? (3) If so, could there be enough vacuum to suck out intestines? (4) Is the description of the damage plausible?

(1) At first glance the letter looks pretty believable; there's a fair amount of detail. However, it looks to me as if there isn't actually enough detail to follow this up. We know the ship is Greek-registered, but not its name or owners; we know roughly the time (1986) but no more than that. The author gives his name, but the only address is 'Philadelphia'.

On the other hand, the author may have been concerned about lawsuits or harrassment from the shipping firm; not unreasonably so. He also, presumably, didn't have permission from the subject to publicize details about her. A cautious person might well leave things a little vague. The address thing is the standard form for JAMA, although I presume they require a full address before they'll print a letter.

(2) I've never seen a vacuum toilet, as far as I know; but they're standard toilets as far as having a seat and so forth is concerned. I have a hard time picturing how you could get a seal around a toilet seat. Could it be done? Remember, we're talking about a woman who was 'slightly obese'. I suppose it might depend on the design of the particular toilet. People who have led a less sheltered life than I have should speak right up.

(3) I think there probably could be enough vacuum to suck out intestines. I don't have a really good reason for thinking this, but eversion of the intestine is not terribly difficult. We may add to the vacuum any, ahem, straining performed by the victim.

(4) Here I have a slight problem. The author describes "several feet of small intestine with omentum attached". First, as others have noted, if you're dealing with eversion of the intestine you'd see large rather than small intestine; but more importantly, you wouldn't see omentum. The omentum is attached to the outside of the intestine, and if the intestine is everted you'll only see the inside. (I'll pause a moment so the topologists among you can draw some diagrams.)

These objections could both be overcome if, instead of eversion, the problem was a rupture of the perineal area followed by evisceration [Afternote: I find that the cases of children having their intestines pulled out by swimming pool drains can, in fact, have rupture of the perineal region rather than true eversion.] However, for this to occur, it seem to me the force would have to be considerably higher; skin, even the perineal skin of an elderly and obese lady, is pretty tough stuff and doesn't rupture at the drop of an atmosphere.

I see three possible explanations for the 'omentum' bit. The author could have been wrong about the omentum. (Not, perhaps, surprising; this would be a disconcerting experience for all but the most blase.) The event could have been perineal rupture rather than eversion. Or the author could have been making this up.

For the purpose of comparison, there are several articles on children who have had unpleasant experiences after sitting on swimming pool pump intakes. This should be a fairly similar event, although the suction will be more localized. In each of these cases, the child experienced eversion of the intestines rather than rupture through the perineum. [Reading these more carefully, as I say, I find that the word 'eversion' is used sloppily and some did have ruptured perineum.] Hardly definitive, but suggestive.

Tentatively I'd say this is a slightly dubious account, but I don't have strong feelings either way. Here are some approaches to try to settle it:

That's about all that leaps to mind. Anyone else see any leads?

Ian "flushed with success" York


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