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-?berg 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-?berg was a professor of medicine at the local university and a very thorough man. I had hired a translator named Ingeborg to read Key-?berg’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-?berg’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-?berg 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-?berg’s lab and maneuvered into chairs in a “half-seated position.” Here one longs for some of that Key-?berg 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-?berg 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.