Zeynel A. Karcioglu
Charlottesville, Virginia, USA
|A cartoon by the author comparing the tails and depicting the probe in question.|
I read with great interest Dr. Stanley Gutiontov’s article entitled “Pig man: pigs in medicine from Galen to transgenic xenotransplantation” in Hektoen International, and it reminded me of an amusing “pig-related” experience I had years ago.
The twisted tobacco leaves that sailors smoked in the 1700s resembled the curly tail of a pig and were called “pigtails.” Eventually, the term came to be used to describe anything curly, and in particular hair braids that resembled the twisted tobacco leaves. In medical utensil terminology a “pig-tail” device refers to a tightly curled end of a catheter, guide-wire, probe, or any other device that resembles the curly tail of a pig.1,2
In the ophthalmic surgery armamentarium, there is a highly specialized hand-held instrument sometimes used for intubating the lacrimal drainage system (LDS) and designed so as to accurately fit the anatomy of the canaliculi and the lacrimal sac. Because of its shape, this is known as a “pig-tail” probe.2 It has the perfect shape to be used in eyelid trauma and tumor surgery — though not necessarily always successfully, because of either anatomical variations of LDS or lack of experience of the surgeon.3 When it works, however, the result of the canaliculus laceration repair is sound, and the time of anesthesia and surgery is greatly reduced. During my ophthalmology residency in the early 1980s the pig-tail probe was commonly employed in operating rooms all over the world as a simple, low-cost tool. As trainees, we therefore gained ample experience in using this simple instrument, which worked well in many patients though not in every case.
In the early 1990s, I had the opportunity to take a sabbatical leave from my university in the US to work in a big eye specialty hospital in Riyadh, Saudi Arabia. The hospital was large, modern, and well equipped, and its twelve operating rooms were almost always busy with challenging cases.
One day, while operating on a large tumor of the lower eyelid, I had to excise a large part of the canaliculus and establish a by-pass between the remaining stump, the lacrimal sac, and the upper canaliculus by intubating the path with silicone tubing. Instinctively, I asked for a “pig-tail” probe.
There was a moment of silence in the operating room. Then the circulating nurse said rather brusquely, “You won’t find a pig-tail probe in the Kingdom, but we have a camel-tail probe if you want; it would work just the same.” Having been in Saudi Arabia for only a few months, I was intrigued by this name because the tail of a camel is thin and long and has a tufted end that would not possibly fit into the LDS.
But as I had to finish the case, I reluctantly said, “OK, let’s give it a try.” So she handed me the instrument, a typical pig-tail probe if I ever had seen one. Then I realized what was happening: in the zealously religious Kingdom of Saudi Arabia the “pig-tail” probe was renamed “camel-tail,” after the beloved ships of the desert. It did not even occur to me that I could injure religious sensitivities of people by asking for a surgical instrument with a curlicue shape. But the nurse was right. It worked just as well, and I finished the procedure to everyone’s satisfaction.
- Gammie JS, Banks MC, Fuhrman CR et al: The Pigtail Catheter for Pleural Drainage: A Less Invasive Alternative to Tube Thoracostomy. JSLS 1999; 3(1): 57–61.
- Jordan DR, Nerad JA, Tse DT: The Pigtail Probe, revisited Ophthalmology 1990; 97 (4): 512-519
- Yazici B, Yazici Z: Frequency of the Common Canaliculus. Arch Ophthalmol. 2000; 118: 1381-1385
ZEYNEL KARCIOGLU, MD, is a medical/surgical physician, researcher, and a medical educator specializing in ophthalmic oncology and pathology, presently practicing and teaching at the University of Virginia in Charlottesville. He is also a professor emeritus at Tulane University in New Orleans. Dr. Karcioglu has written numerous scientific papers, book chapters, and books and has given many presentations at regional, national, and international meetings. His tangential interest has been the diseases of the artists and the effects of health problems on their work. To this end, he studied in particular instances of writers’ and artists’ diseases, and has produced a variety of works in general medical humanities and medical history.
Achnowledgments: My earnest thanks to Stanley Gutiontov, MD of Northwestern University for bringing up the subject of “pigs in medicine” and reminding everyone how much we owe to this humble animal.
I also thank my dear son Zeynel M. Karcioglu, Esq. who keeps my humor in check and also keeps an eye on my English grammar, who happens to live a few blocks away from Dr. Gutiontov in Evanston, Illinois.