The fistulated—or “holey,” as the students like to say—cow has been an ag-school standard for decades. My husband Ed recalls, as a child, hearing from his dad about the cow at Rutgers with “a window in its side.” The operation is simple. The bottom of a coffee can is traced with chalk on the cow, a topical anesthetic applied, and the circle cut from the hide, along with a matching opening in the rumen. The two holes are stitched together and the hole is outfitted with a plastic stopper. It is little more barbaric than the earlobe plugs of my local Peet’s barista or Ariel’s facial adornments. “The animal rights people come out here expecting a glass window with a sash and sill,” said DePeters. He handed me a protective plastic veterinary sleeve that extended to my shoulder and directed me to position myself to the side of the opening. When a fistulated cow coughs, if it has been eating, wet plant matter sometimes blows out of the hole.
DePeters took some photographs of me with my right arm in 101.5. The cow appears unmoved. I look like I’ve seen God. I was in all the way to my armpit and still could not reach the bottom of the rumen. I could feel strong, steady squeezes and movements, almost more industrial than biological. I felt like I’d stuck my arm into a fermentation vat with an automated mixing paddle at the bottom, and I basically had.
Ancient man was omnivorous—a scavenger as much as a predator. Often enough, his steak dinner was shared with millions of potentially harmful bacteria. Thus the human stomach, unlike the ruminant’s, concerns itself with disinfection more than holding capacity. But even scavenged meals were sporadic, and some degree of storage was needed. How compliant is the human stomach? That depends on what you use it for.
10. Stuffed
THE SCIENCE OF EATING YOURSELF TO DEATH
ON APRIL 22, 1891, a fifty-two-year-old carriage driver in the city of Stockholm swallowed the contents of a bottle of prescription opium pills. Mr. L., as he became known, was found by his landlord and taken to a hospital, where the staff got busy with the tools of overdose: a funnel, a length of tubing, and lukewarm water to flush out and dilute the drug. The technique is known today as pumping the stomach, but in the case report it was referred to as gastric rinsing. The term gives a deceptive air of daintiness to the proceedings, as though Mr. L.’s stomach were a camisole in need of a little freshening. Hardly. The patient was slumped in a chair, thinly attached to his wits, while the medics loaded his stomach, multiple times in fast succession. With each filling, the organ appeared to hold more, which should have been a clue. Mr. L. had sprung a leak.
If you define eating as the mechanical act of putting something in your mouth and swallowing it, you could say that Mr. L., in consuming the pills, had eaten himself to death. Generally that is the only way to do it, to eat oneself to death. Bursting a stomach by overfilling is a nearly impossible feat, owing to a series of protective reflexes. When the stomach stretches past a certain point—to accommodate a holiday dinner or chugged beer or the efforts of Swedish medical personnel—stretch receptors in the stomach wall cue the brain. The brain, in turn, issues a statement that you are full and it is time to stop. It will also, around the same time, undertake a transient lower esophageal sphincter relaxation, or TLESR, or burp. The sphincter at the top of the stomach briefly relaxes, venting gas and restoring a measure of safety and relief.
Sterner measures may be needed. “A lot of people, myself included from time to time, eat way the hell past that point,” says dyspepsia expert Mike Jones, a gastroenterologist and professor of medicine at Virginia Commonwealth University. “Maybe they’re stress-eating. Or it’s just: ‘You know what, that’s some damn fine key lime pie.’” The caution signs grow more obvious: pain, nausea, and the final I-warned-you-buster—regurgitation. A healthy stomach will up and empty itself well before it reaches the breaking point.
Unless for some reason it can’t. In the case of Mr. L., the opium had interfered. The patient had “shown strong urges to vomit,” wrote Algot Key-Åberg in a case report published in a German medical journal after Mr. L.’s autopsy was completed, but he had been unable to manage it. Key-Åberg was a professor of medicine at the local university and a very thorough man. I had hired a translator named Ingeborg to read Key-Åberg’s paper aloud to me. The description of Mr. L.’s stomach and the ten parallel rupture wounds ran to two and a half pages. At some point Ingeborg looked up from the page. “So I guess the rinsing did not work out.”
Mr. L.’s was the first stomach in Key-Åberg’s experience to have ruptured by overfilling. The case, he wrote, “stands on its own in the literature.” Medicine needed to know about this so that future rinsers and pumpers could be alerted to the danger. Was it the volume of water or the force of its flow that mattered more? “In order to gain more clarity,” Key-Åberg continued, “I needed to experiment with the stomach of a cadaver.” Ingeborg made a small noise. “These experiments I conducted in large numbers.” For much of the spring, unclaimed Stockholm corpses, thirty in all, were delivered to Key-Åberg’s lab and maneuvered into chairs in a “half-seated position.” Here one longs for some of that Key-Åberg zeal for detail. Was the position designed to mimic Mr. L.’s posture during the treatment, or did it simply reflect the difficulty of persuading a corpse to assume the upright profile of a dinner guest?
Key-Åberg found that if the stomach’s emergency venting and emptying systems are out of commission—because the person is in a narcotic stupor, say, or dead—the organ will typically rupture at three to four liters, around a gallon. If you pour slowly, with less force, it may hold out for six or seven liters.
Very, very occasionally, the stomach of a live, fully conscious individual will give way. In 1929, Annals of Surgery published a review of cases of spontaneous rupture—stomachs that surrendered without forceful impact or underlying weakness. Here were fourteen people who managed, despite the body’s emergency ditching system, to eat themselves to death. The riskiest item in these people’s stomachs was often the last to go in: bicarbonate of soda (aka, baking soda, and the key ingredient in Alka-Seltzer). Bicarbonate of soda brings relief two ways: by neutralizing stomach acid and by creating gas, which forces the TLESR. (Less often, the stomach-inflating gas comes from actively fermenting food or drink. The Annals roundup includes a man killed by “much young beer full of yeast,” and two deaths by sauerkraut.)
More recently, a pair of Miami-Dade County medical examiners reported the case of a thirty-one-year-old bulimic psychologist found seminude and fully dead on her kitchen floor, her abdomen greatly distended by two-plus gallons of poorly chewed hot dogs, broccoli, and breakfast cereal. The MEs found the body slumped against a cabinet, “surrounded by an abundance of various foodstuffs, broken soft drink bottles, a can opener and an empty grocery bag” and—“the coup de grace”—a partially empty box of baking soda, the poor man’s Alka-Seltzer. In this case, the greatly ballooned stomach had not burst; rather, it killed her by shoving her diaphragm up into her lungs and asphyxiating her. The pair theorized that the gas could have forced one of the poorly chewed hotdogs up against the esophageal sphincter, at the top of the stomach, and held it there, preventing the woman from burping or vomiting.
By way of underscoring the impressive pressure produced by the chemical reaction of sodium bicarbonate and acid, I direct you to any of the myriad websites devoted to Alka-Seltzer rockets. Or, less playfully, the works of P. Murdfield, who, in 1926, ruptured the stomachs of fresh cadavers by pouring in a half gallon of weak hydrochloric acid and then adding a little sodium bicarbonate.