Medicine: Needle

In Webster, Mass., last week a five-month-old infant was wailing with a concatenation of cries which clutched the mother’s heart, sent her running to her baby’s crib. She snatched up the child and hurriedly felt for open diaperpins. Then she undressed it to hunt for chafes. The body was pink and dry. Gently she pressed the abdomen, even though the cries were not those of colic. The flesh dimpled under her probing finger. It was firm yet not rigid. Puzzled and worried she dandled her baby a moment and gave it to nurse. The wailing had subsided to choking, interrupted whimpers. Tears mottled the baby face like dew on roses. The mother kissed them away.

As she kissed, her eyes grew great with fright. On the child’s head was a lump, a lump she had never seen before, and she knew every tiny spot on her baby’s body. Something horrible must have happened. She telephoned Dr. Strochavi. Would he please, please rush over at once!

Dr. Strochavi examined the lump. Was the lump present at birth? No, her baby had been a “clean” baby. He felt the lump. The infant screamed. Contusion? There was no sign of bruising. Caput succedaneum, the deep bruising of the scalp layer immediately next to the bony skull? Probably not. Inflammation or abscess of the scalp? No. There were no signs of erysipelas, wounds, boils, suppurating sweat glands, and very little likelihood of any decay of a bone in the skull. Encephalocele, a tumor formed by the sticking out through the soft infantile skull of the membranes of the brain, with brain matter and cerebrospinal fluid? No. This bump was too firm. Meningocele, a tumor containing the meninges of the brain and spinal fluid? Probably not, because a meningocele usually protrudes through an unossified part of the skull, usually at the back, sometimes at the root of the nose.

Well, the best thing would be to open up this bump very carefully and learn the hidden cause directly. So with a sterilized lancet the doctor, emergency surgeon now, pricked the baby’s pink scalp. He pricked again. He heard a minute clink; he felt something hard against his lancet blade. He looked, and there gleaming up at him like a reptilian eye glittered in his incision the end of a steel darning needle.

Gravely he turned to the father, who had come up, to the mother, who stood by trembling. There is a needle in your child’s brain! When could that have happened? Perhaps when she was cradling her baby in her lap as she darned away. She could not tell. For the needle to puncture the infantile skull was easy. At five months the bones of the skull are comparatively soft. They have not yet closed completely, are joined together by tough membrane which in the embryo was the sole case of the brain (TIME, March 22).

To leave the needle in the child’s brain meant eventual death, most probably a horrible death in convulsions. To pull the needle out probably would kill the child. Yet there was the slightest of chances that it would survive the operation. Because it was only five months old, perhaps the brain of its own accord would repair the damage the needle had already done. Perhaps the child would live and grow up normally. But the doctor would not operate without the parents’ consent. They consented.

So this family doctor had to perform, on the spot and without the elaborate accessories a specialist would have at his command, a monstrously delicate operation. His humble confrères everywhere must in emergencies do deeds comparably as difficult. They go their long ways night and day unapplauded otherwise than by the devotion of their patients.

The doctor took a pair of forceps in his hand. That hand must not tremble. It must pull the needle straight out in one swift motion. The forceps must not grope for its grip on the needle end. The screech of slipping steel would sound the tiny patient’s death. He must not jiggle the needle, else its embedded tip would tear the thin cells of the brain and kill the patient. With micrometer precision he gripped with the forceps the needle end. With ramrod straightness he pulled. The needle came out. Except for a little clot of blood it was clean. Little possibility of infection. The child probably would live.