† In a more perfect world, Whitehead would be a dermatologist, just as my gastroenterologist is Dr. Terdiman, and the author of the journal article “Gastrointestinal Gas” is J. Fardy, and the headquarters of the International Academy of Proctology was Flushing, New York.
* Back in 2007, while researching a different book, I came across a journal article with a lengthy list of foreign bodies removed from rectums by emergency room personnel over the years. Most were predictably shaped: bottles, salamis, a plantain, and so on. One “collection”—as multiple holdings were referred to—stood out as uniquely nonsensical: spectacles, magazine, and tobacco pouch. Now I understand! The man had been packing for solitary.
* Biofeedback can help. The anal sphincter can be briefly wired such that tightening and relaxing causes a circle on a computer screen to constrict and widen. The patient is instructed to bear down while keeping the circle wide. The maker of that program has one for children, called the Egg Drop Game, wherein clenching and relaxing causes a basket to move back and forth to catch a falling egg. The website of the American Egg Board has a version of the Egg Drop Game that does not require an anus (or cloaca) to play, just a cursor.
† Especially if the exam entails defecography, which is pretty much what it sounds like. The patient is the star in an X-ray movie viewed by an audience of technicians, interns, and radiologist. “As close to pornography as medicine will come,” says gastroenterologist Mike Jones. Worse, the patient is passing a barium-infused “synthetic stool” crafted from a paste of plasticine (or in simpler days, rolled oats) and introduced wrong-way into the rectum. For the constipated patient, notes Jones, it can be a real ordeal. “It’s like, ‘Dude, if I could do this, I wouldn’t be here now.’”
* Customs officers at Frankfurt Airport have it easier. Suspects are brought to the glass toilet, a specially designed commode with a separate tank for viewing and hands-free rinsing—kind of an amped-up version of the inspecting shelf on some German toilets. P.S.: The common assumption that the “trophy shelf” reflects a uniquely German fascination with excrement is weakened by the fact that older Polish, Dutch, Austrian, and Czech toilets also feature this design. I prefer the explanation that these are the sausage nations, and that prewar pork products caused regular outbreaks of intestinal worms.
* Other red flags for customs agents include the unique breath odor created by gastric acid dissolving latex, and airline passengers who don’t eat. For years, Avianca cabin crew would take note of international passengers who refused meals, and report the names to customs personnel upon landing.
† Occasionally the justice system has no choice but to step right in it. In State of Iowa v. Steven Landis, an inmate was convicted of squirting a correctional officer with a feces-filled toothpaste tube, a violation of Iowa Code section 708.3B, “inmate assault—bodily fluids or secretions.” Landis appealed, contending that without expert testimony or scientific analysis of the officer’s soiled shirt, the court had failed to prove that the substance was in fact feces. The state’s case had been based on eyewitness, or in this case nosewitness, testimony from other correctional officers. When asked how he knew it was feces, one officer had told the jury, “It was a brown substance with a very strong smell of feces.” The appeals judge felt this was sufficient.
My thanks to Judge Colleen Weiland, who drew my attention to the case and did me the favor of forwarding a logistical question to the presiding judge, Judge Mary Ann—may it please the author—Brown. “It appeared,” Brown replied, “that he liquefied the material and then dripped it or sucked it into the tube.”
* Seriously, published by Oxford University Press. But highly readable. So much so that the person who took Inner Hygiene out of the UC Berkeley library before me had read it on New Year’s Eve. I know this because she’d left behind her bookmark—a receipt from a Pinole, California, In-N-Out Burger dated December, 30, 2010—and because every so often as I read, I’d come upon bits of glitter. Had she brought the book along to a party, ducking into a side room to read about rectal dilators and slanted toilets as the party swirled around her? Or had she brought it to bed with her at 2 A.M., glitter falling from her hair as she read? If you know this girl, tell her I like her style.
† Of or relating to the belly or intestines. With crushing disappointment, I learned that Dr. Gregory Alvine is an orthopedist. Staff at the oxymoronic Alvine Foot & Ankle Center did not respond to a request for comment.
‡ You would think the percentage would be higher, but in fact 80 to 90 percent of nondigestible objects that make it down the esophagus pass the rest of their journey without incident. If a man can swallow and pass a partial denture, a drug mule has little to worry about.
* Close to but not quite the most egregious indignity bestowed on a corpse by drug dealers. Smugglers have occasionally recruited the mute services of a corpse being repatriated for burial and stuffed the entire length of the dead man’s GI tract. Heroin sausage.
* A term coined by sexologist Thomas Lowry. In his efforts to research fisting, Lowry found himself writing letters to strangers at academic institutions that would begin like this: “Dear Dr. Brender: We spoke on the phone several months ago about ‘fist-fucking.’ At that time you mentioned two surgical articles.” There was no academic term, so eventually Lowry made one up. “I Googled it recently,” he told me, “and found over 2,000 hits. Made me chuckle.”
† Simon refined his technique on cadavers, rupturing a bowel or two along the way, and then began offering training seminars. Cadavers were replaced with live, chloroformed women, thighs flexed on their abdomens. “A large number of professors and physicians” flew all the way to Heidelberg to practice “the forcible entrance.”
12
Inflammable You
FUN WITH HYDROGEN AND METHANE
LONG BEFORE ANYONE put a cautering wand up anyone else’s patoot, the dangers of flammable* bowel gas were well known. If you let manure sit, as any farmer can tell you, bacteria will break it down into more elemental components. Some of these are of value to farmers as fertilizer, which they can pump from their manure pit out onto their crops.† Others—hydrogen, say, and methane—will blow the roof off the hog barn. Here is the Safe Farm Program channeling Beatrix Potter in a methane-safety radio spot: “It has no smell. It has no color. It often lurks about, but fails to leave a trace.”
Methane and hydrogen are explosive in concentrations higher than 4 to 5 percent. The foam on liquid manure in pits is 60 percent methane. Farmers may know this, but their families sometimes don’t. Which explains why the University of Minnesota Extension Service’s farm safety curriculum includes instructions for a children’s classroom Manure Pit Display. (“You will need: . . . toy cow, pig, and bull [1/32 scale], an aquarium, one pound of dry composted manure . . . and chocolate kisses . . . to simulate manure on top of floor [optional].”)
Like a Manure Pit Display, the human colon is a scaled-down version of a biowaste storage tank. It is an anaerobic environment, meaning it provides the oxygen-free living that methane-producing bacteria need to thrive. It is packed with fermentable creature waste. As they do in manure pits, bacteria break down the waste in order to live off it, creating gaseous by-products in the process. Most voluminously, bacteria make hydrogen. Their gas becomes your gas. Up to 80 percent of flatus is hydrogen. About a third of us also harbor bacteria that produce methane—a key component in the “natural gas” supplied by utility companies. (At least two-thirds of us harbor a belief that methane producers’ farts burn blue, like the pilot light on a gas stove. Sadly, a YouTube search unearthed no evidence.)
The flammability of methane and hydrogen is part of the reason for the seeming overkill of protracted bowel-cleansing that precedes a colonoscopy. When gastroenterologists find a polyp during a screening, they will usually remove it while they’re in there, using a snare with an electrocoagulating option to staunch the bleeding. They do not want to worry about igniting a rogue pocket of combustible gas—as happened
in France, in the summer of 1977, to fatal effect.
At a university hospital in Nancy, a sixty-nine-year-old man arrived at the Services des Maladies de l’Appareil Digestif (French for “Gastroenterology Department”). With the current set to 4, the doctor began a simple polypectomy. Eight seconds into it, an explosion was heard. “The patient jerked upwards off the endoscopy table,” reads the case report, and the colonoscope was “completely ejected” (French for “launched from the rectum like a torpedo”).
What was strange was that the Frenchman had followed his colonoscopy prep instructions to the letter. The culprit, in this case, had been the laxative. The staff had prescribed a solution of mannitol, a sugar alcohol similar to sorbitol, the likely laxative agent in prunes. Though the man’s colon contained no fecal matter, it still contained bacteria, hungry bacteria that feasted on the mannitol and produced enough hydrogen to set the stage for an internal Hindenburg scenario. A study done five years later found potentially explosive concentrations of hydrogen or methane, or both, in six out of ten patients prepped with mannitol.
This is no excuse for putting off your colonoscopy. Mannitol is no longer used, and doctors routinely blow air or nonflammable carbon dioxide into the colon as they work, which dilutes any pockets of hydrogen or methane. (Inflating the colon also helps them see what they’re doing. And creates the magnificent, billowing flatulence that rings through the colonoscopy recovery room.)
Outside the body, intestinal hydrogen and methane pose no danger. The act of passing flatus dilutes the gases, mixing them with the air in the room and lowering the concentration to levels well below combustibility. As anyone who has typed pyroflatulence into YouTube is aware, the match would have to contact the gas the second it’s blown from the body.
In the early days of the space program, NASA fretted about flammable astronaut flatus building up inside the tiny, hermetically sealed space capsules. A researcher presenting at the 1960s conference “Nutrition in Space and Related Waste Problems” was concerned enough to suggest that astronauts be selected from “that part of our population producing little or no methane or hydrogen.” NASA used to keep flatus expert Michael Levitt—whom you’ll meet shortly—on retainer as a consultant. Levitt assured them the capsules were large enough and the air inside sufficiently well circulated that intestinal contributions of hydrogen and methane were unlikely to reach a dangerous concentration. NASA was understandably wary. An earlier decision to circulate 100 percent oxygen in the capsules led to the deaths of all three Apollo 1 astronauts when a spark ignited a fierce fire during a launch-pad test.
EARLY ONE MORNING in the winter of 1890, a young British factory worker leaned from his bed to check the time. It was not yet dawn, the streets of Manchester still dark and shuttered. As he struck a match to see the hands of his timepiece, he happened to emit a belch. “To his consternation,” wrote Dr. James McNaught in the British Medical Journal, “the gas took fire, burned his face and lips considerably, and set fire to his moustache.”
Cases of “inflammable eructation”—McNaught cites eight other cases—are perplexing. The gas in a typical belch is either carbon dioxide (from carbonated drinks) or air swallowed while eating or drinking, both nonflammable. The healthy human stomach, unlike the colon, does not produce hydrogen or methane. Gastric acid’s job is to kill microorganisms; without them there can be no hydrogen- or methane-producing fermentation. Even if a relative few bacteria survive in a stomach—and some species can, we now know—the chymified food is passed on to the small intestine too quickly for fermentation to make much headway.
McNaught reached for his stomach tube. It had been five hours since the factory worker ate, a time lag normally sufficient for the stomach to finish its duties and pass the chyme along to the small intestine. Yet up came a pint and a half of a sour-smelling, soupy matter with a sediment of “grumous* remains of food.” And gas, lots of it, visible as a head of frothy bubbles, foaming and bursting like the contents of a mad scientist’s beaker.
To identify the gas and confirm its flammability, McNaught had only to collect some from the headspace of the beaker and set it alight. But that’s no fun. Instead, on a different day, McNaught had the man yet again visit his office. Through a tube, he poured water into the misbehaving stomach, to displace the gas. As he did so, he held a flame to the invisible plume issuing from the man’s mouth. “The result . . . was to produce a flame of dimensions alarming to both the patient and myself.” Maybe I’m projecting, but a poorly suppressed schoolboy glee occasionally surfaces in McNaught’s writing, setting it off from the typical Hippocratic benevolence of British Medical Journal prose. If I had a medical license, I fear I’d be a Dr. McNaught.
It turned out that owing to strictures of the pylorus, the stomach’s lower sphincter,* the food in the young man’s stomach was held back an uncommonly long time. Plus, McNaught claimed to have cultivated strains of acid-resistant, gas-producing bacteria. Carbohydrates plus bacteria plus time and body heat equals fermentation.
The story made me curious about cows. As we learned earlier, the rumen is a vast fermentation pit, a massive bacterial slum. A grazing cow can produce a hundred gallons of methane a day, vented, as stomach gases typically are, through the mouth. You would think that cow-belch-lighting would rival cow-tipping as a late-night diversion for bored rural youth. How is it that growing up in New Hampshire I never heard a cow belch? My ag pal Ed DePeters had the answer. When a ruminant is feeling bloated and needs to make room in her rumen, she pushes out some methane, but instead of belching it up, she can shift her internal tubing to reroute the gas down into the lungs and then quietly exhale it. To, say, a pronghorn out on the savannah, quiet can be key to survival. “Ungulates in the wild tend to go off and hide someplace while they ruminate,” DePeters explained. “If a lion walks by and hears a loud urrp . . .” Sayonara, antelope.
Because my readers, perhaps more than anyone else’s, might be inspired to head out to the pasture with a lighter in their pocket and bovine malfeasance in their heart, let me add this: lighting a cow’s breath will not produce a McNaughtian geyser of flame. Because of the afore-described methane rerouting system, the gas is diluted by nonflammable gases in the breath. For ignition, you would need the sort of concentrated blast that is a belch. And cows don’t belch.
Snakes don’t either, but they can, under certain circumstances, create an inflammable eructation of literally mythical proportions. For this story, we leave Ed DePeters in his muck boots and feed cap and turn to our snake digestion man in Alabama, Stephen Secor. First, a little background: Many plant-eating animals lack rumens, so some fermenting takes place in the cecum, an anatomical pouch at the junction of the small intestine and the colon. These same plant-eaters—horses, rabbits, koalas, to name three—tend to have a larger-than-average cecum. Pythons and boas do too, which struck Secor as odd, because they’re carnivores. Why, he wondered, would a meat-eater need a vegetation digestion unit? Secor theorized that perhaps these snakes had evolved ceca as a way to digest and take advantage of plant matter inside the stomachs of their prey.
To test his theory, Secor fed rats* to some of the pythons in his lab at the University of Alabama and hooked them up to a gas chromatograph. He tracked the hydrogen level in their exhalations as they digested whole rats over the course of four days. He did see a spike, but it appeared long before the rat arrived at the python’s cecum. Instead, Secor suspected, the hydrogen spikes were the result of the decomposing, gas-bloated rat bursting inside the python. “One thing led to another.” (Secor’s way of saying he popped a bloated rat corpse and measured the hydrogen that came off it.) Suspicion confirmed. The hydrogen level was “through the roof.” Secor had stumbled onto a biological explanation for the myth of the fire-breathing dragon. Stay with me. This is very cool.
Roll the calendar back a few millennia and picture yourself in a hairy outfit, dragging home a python you have hunted. Hunted is maybe the wrong word. The python was digesting a whole gazel
le and was in no condition to fight or flee. You rounded a bend and there it was, Neanderthal turducken. Gazython. The fact that the gazelle is partially decomposed does not bother you. Early man was a scavenger as well as a hunter. He was used to stinking meat. And those decomp gases are key to our story. Which I now turn over to Secor.
“So this python is full of gas. You set it down by the campfire because you’re going to eat it. Somebody kicks it or steps on it, and all this hydrogen shoots out of its mouth.” Hydrogen, as the you and I of today know but the you and I of the Pleistocene did not know, starts to be flammable at a concentration of 4 percent. And hydrogen, as Stephen Secor showed, comes out of a decomposing animal at a concentration of about 10 percent. Secor made a flamethrowery vhooosh sound. “There’s your fire-breathing serpent. Imagine the stories that would generate. Over a couple thousand years, you’ve got yourself a legend.” He did some digging. The oldest stories of fire-breathing dragons come from Africa and south China: where the giant snakes are.
* * *
* Flammable is a safety-conscious version of inflammable. In the 1920s, the National Fire Protection Association urged the change out of concern that people were interpreting the prefix in to mean “not”—as it does in insane. Though surely those same people must have wondered why it was necessary to warn of the presence of gas that will not burst into flame.
† “Work with your neighbors,” urges the Southeast Iowa Snouts & Tails Newsletter. “Inquire about any outdoor events in the neighborhood such as weddings, cookouts and such to avoid manure application prior to those events.” Unless your neighbors are also swine farmers, who apparently don’t mind that sort of thing. The next item in the newsletter is a Manure Injection Field Demonstration “followed by a free lunch.”
* Meaning “clotted or lumpy.” Grumous is one of many evocative words that deserve to break free from medical dictionaries and join the ranks of day-to-day vocabulary. Likewise, glabrous (“smooth and hairless”), periblepsis (“the wild look of delirium”), and maculate (“spotted”).