Body piercing
BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7225.1627 (Published 18 December 1999) Cite this as: BMJ 1999;319:1627All rapid responses
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The Times of the 22nd of March quoting the Turkish daily Hurriyet
reports that Alison McKinnon, the British woman charged in Istanbul with
trying to smuggle 3.1 kilogrammes of heroin out of Turkey, came to the
attention of the police when her "intimate" pierced jewellery triggered a
metal detector.
Clearly, this is going to be another source of irritation at airports when
body piercers set off alarms.
Competing interests: No competing interests
In reply - The article "Body Piercing" (1) was an interesting paper
that examined prejudices against patients who choose to pierce their
bodies. Some medical professionals, however, have well-founded concerns
about piercing.
While the article provided information about many types of piercing, it
failed to mention tongue piercing, a practice which has become
increasingly popular in recent years. A recent letter in Anaesthesia (2)
draws attention to the problems tongue piercing can cause for
anaesthetists. It gave details of a patient who became hypoxic following
a procedure for which she had been intubated. The cause of hypoxia was
bleeding from a tear adjacent to a tongue stud that had not been removed
prior to intubation.
This is not the first concern to be raised about tongue piercing and
intubation and the American literature has also addressed the issue (3-5).
Tongue jewellery is a foreign object within the oral cavity and if it
remains there during operative procedures there are risks of aspiration,
injury to the tongue, dental trauma and difficulty in securing the airway
(3-5).
In response to these publications, the department of anaesthesia at Dr
Gray's Hospital, Elgin has elected not to perform anaesthesia for
operative procedures in patients who refuse to remove tongue jewellery and
patients are advised of this pre-operatively.
While medical professionals are not in a position to judge patients who
choose have piercings; patients should appreciate that not all requests to
remove jewellery are due to prejudice. On some occasions the removal of
jewellery is essential for their own safety.
Angela Finlay
Final year medical student, University of Aberdeen.
References
1. Ferguson, Henry. Body Piercing. BMJ 1999;319:1627-9
2. Wise, H. Hypoxia caused by body piercing. Anaesthesia
1999;54:1129
3. Mandabach, Mark G.; McCann, Diedre A.; Thompson, Gale E. Body Art:
Another concern for the Anesthesiologist. Anesthesiology 1998;88(1):279-
280
4. Rosenberg, Andrew D.; Young, Marjorie.; Bernstein, Ralph L.;
Albert, David B. Tongue rings: just say no. Anesthesiology 1998; 89(5):
1279
5. Mandabach, Mark G.; McCann, Diedre A.; Thompson, Gale E. Tongue
rings: just say no. Anesthesiology 1998; 89(5): 1279-80
Competing interests: No competing interests
While we accept Ferguson’s contention that wearing body jewellery is
essentially a personal experience [1], it does have certain highly
relevant clinical implications which we have recently outlined [2]. Maybe
the author would not feel so astonished at being asked to remove his
ornaments if he appreciated that X-rays cannot penetrate steel and that
they may have been creating diagnostic difficulties. This would have been
especially true if a CT Scan was being performed which given the
description of his injuries seems probable. Certainly requests to remove
body jewellery maybe clinically necessary and should be seen as part of
the process of ‘saving a life.’
In this era of evidence based medicine with doctors being urged to
reduce antibiotic usage we were surprised to read a recommendation for the
blind treatment of body piercing related infections with flucloxacillin on
the grounds that they are likely to be caused by S. aureus, without any
supporting evidence. The microbiology of body piercing related infections
has not yet been determined however the bacteria associated with surgical
sutures and staples have been investigated. These have been shown to be a
mixed flora with S epidermidis the commonest organism, the bacteria being
shown to be enveloped in a complex biofilm which is thought to protect the
organism from host defense factors and account for their persistence on
suture surfaces till removed with the sutures [3]. Genital piercing are
however more likely to be infected with a bacteria from the periurethral
microflora. E coli is the commonest bacterium to cause urinary tract
infections [4] but it cannot be assumed that in the presence of a foreign
body this will remain the infecting pathogen. Intra oral piercings are
likely to be infected with oral commensals. Unless proof to the contrary
is demonstrated we believe that body jewellery associated with infection
should be removed and antibiotic usage decided on after examining for
signs of local and systemic dissemination.
References:
1.Ferguson H. Body piercing. BMJ 1999;319:1627-29.
2.Khanna R, Kumar SS, Raju BS, Kumar AV. Body piercing in the accident and
emergency department. J Accid Emerg Med 1999;16:418-21.
3.Gristina AG, Price JL, Hobgood CD et al. Bacterial colonization of
percutaneous sutures.Surgery 1985;98:12-19.
4.Faro S, Fenner DE. Urinary tract infections.Clin Obstet Gynecol
1998;41:744-54.
Competing interests: No competing interests
Body art: Marks of Identity by Janice Hopkins Tanne is well written
but not wholesomely accounting [see
http://www.bmj.com/cgi/content/full/320/7226/64]. The author's view
concerned with
essentially artistic perspective. It is not all that goes into why people
artistify the body or pierce. Other conditions far deeper than accounted
embed the practice. The following piece makes the point.
Body piercing is one of the recurrent phenomena today. It consists in
inflicting oneself a good amount of pain right on the naked skin. The
reason for this is far too enigmatic that little do we know about its
meaning as a pattern of behaviour. Explanations range from being aesthetic
to eccentric. For some conventional minds body piercing stands in response
to untoward circumstances and appears for that matter to be an answer to
specific worries. What good answers are provided remains something of a
debate. Some strongly-minded agree that body piercing is one of the many
ways society gets to revisit and trace its roots. For others it is a way
of inserting identity and solidarity with the self and others.
While some degree of sympathy can be granted to such views, it is
important to explore afresh what we really gain from this 'masochist
experience'. This entails casting our minds back to its historical
meaning.
This we know. Body piercing means to perforate the body in response
to such needs as beautification and cure. No region of our body can be
spared from it. From head to tail, piercing affects ear, nose, nostril
and, unabashedly, our private parts. The decision to pierce rests with a
personal attitude to life or with the society demands for identity and
healing.
On personal grounds, piercing is said to make one feel good and
relieved from some hidden and sometimes painful past; a past with which
one is desperately seeking to come to terms. But to feel good means to be
different from others or to imitate a pierced figure in history like Jesus
and other ancestors. The idea behind is that one is the master of one's
body. One can use it or abuse it.
On social grounds, piercing as a form of mutilation comes down to
integrating an individual into a group. The group takes the form of secret
club. On a personal plane it is suggested, an individual is free to choose
which part of his body needs to be pierced. Such a decision in society
lies with cultural institutions, agencies and processes. They prescribe
how the body is to look like to be accepted for, say pubic duties and
civil service. In many societies, rites such as circumcision and entry
into a secret society back the practice of body piercing. The aim is to
obtain the bloodletting, which in many regards serve to bond beliefs,
thwart suicide and traumatic experiences. Traumatic because the subject is
said to be divided into two and the rite of piercing and as a result of
blood practice serves the purpose of reconstitution of his personhood.
This aspect has been the cutting edge of psychiatrists. The divided self
is a result of trauma stirred by hauntingly inhospitable forces. This
sometimes calls several names like demonic spirits.
Mutilation of the body takes different meanings all standing aloof
from clear-cut understanding. It is nothing short of complicated matter.
And attempts to pigeonhole its meaning would cloud the many layered-
messages it seeks to convey. The body clearly is a web of social
interpretations (it is associated with guilt, antisocial acts, as well as
other self-negative images). A pierced body stands as a symptom of a
hidden trauma or episodic pathological condition. It embodies the desire
to be beautiful which means that one feels ugly and the yearning for
membership suggesting that one does not yet belong or is on the road to
experience a unique moment in dealing with one's own body. Concertedly,
rituals recognising gender and identity add to the force.
Body piercing also takes the form of tattooing. The word 'tattoo' is
thought to have stemmed from Polynesia and become synonymous with knocking
or striking on the skin. As Charles Darwin noted, "no aborigines ever
lived without tattooing themselves." To tattoo a body, a design is carved
into the skin and a colourful pigment rubbed into the cuts. And in some
societies like the Igbo of Nigeria, this corresponds to ichi facial marks
carried by the Oke Nze or those associated with sacredness in the running
and management of land. Tattooing assumes in this society various names
according to the role one is called upon to perform among his group. In
Egypt, tattooed were mummies found to be a mark of noble birth. Some
societies may use tattooing to represent their social group whether gangs
or prisoners. At times tattooing aims to identify these rather unwanted
category of people.
The least one can say of this tattooing today is that it is a
function of global fashion. Those who provide seekers with the service to
bore the body are body artists. They engage in a high manifestation of
body mutation within a society that enforces conformity to marginal
groups. Body tattooing may turn out to be perverse, erotica and sado-
masochistic. Prostitutes, nonetheless, indulge in tattooing to enhance
their sense of self-pity. On some accounts by informants, one may believe
that male homosexuals are tattooed as a strategy of accepting and lauding
their belief and impairment. Their bodies are tattooed with surprising
inscriptions such as "Giant missile" on their penis in the sense that it
will harmonise seduction. Some tattoos are noted to ward off violence and
dangers in many societies. Tattoo shops owned by body artists can in our
day be seen in many places. The youth, students, etc. clamour for one
tattooic intention or the other. One Leuven student who pierced noted that
he did so to "feel good". Aesthetic reasons as well as sickness and
cultural grace surround why people pierce, bore and tattoo. The burdening
of body parts in terms of tattooing and piercing should be commonly
regarded as a social device. A device I would call a didactic ritual frame
that transforms claims of its seekers. Thus, piercing and tattooing in
someway serve to anchor time and social space to ensure the continuity of
life, identity and group vision.
The practice of sticking either needles, piercing the body, or some
forms of bodily pain such as within drug sub-culture, masculine cultural
events, seem to derive pleasure. The interpretation of these experiences
is multi-faceted. Regardless of what psychological and psychiatric process
took place in piercing and tattooing, seekers conclude to articulate a
sense of gratification, bonding, rejection, and marginality or inclusion
in the frame of their being and psycho-identity choice and healing of the
selfhood. Psychosomaticists deserve to worry about the trendy of this
phenomenon in abnormal condition of personhood and society.
From the ongoing exposé, the experience of body art seems more rooted to
conditions of health than it has been reported in Janice's museum
perspective. The author has only succeeded in giving us only a tip of the
complex factors surrounding why individuals and societies engage in
artistic body play.
Competing interests: No competing interests
Shocked and amazed
I would first like to declare that I am a second year medical student
of the University of Glasgow. I also have a total of 15 body piercings
(mostly on my ears, two facial, two body and my tongue) and a tattoo.
Although I was aware of the prejudice present in the medical community
regarding body piercing, I was honestly shocked and amazed to read of the
treatment of Mr Ferguson when brought into A&E after a serious
accident. I can understand the medical practitioners' concerns about the
accuracy and effectiveness of any scans performed while the patient is
wearing metal body jewellery, as well as any complications due to the
presence of this jewellery. These problems can easily and quickly be
overcome by simply informing the medical professionals how to remove this
jewellery. It is not a hard process, made easier by the wearing of latex
gloves, and can remove all of the problems associated with metal body
jewellery in emergency medicine. However, to withhold treatment from a
severely injured man purely because of a fear of infection, with the only
indication of this being the practitioners prejudices about the man's
appearance is completely disgusting, and in my mind unacceptable. When I
started studying to become a doctor we were told that it is our duty to
treat those in need, with no personal prejudices influencing our
decisions. It appals me that it is so acceptable for these medical
"professionals" to make such damaging and uninformed decisions without
reprimand.
Another aspect of this article (or rather the responses to it) that
shocked me was the very biased and rather patronising report written by
Patrick Iroegbu. His view that body modification is purely masochistic,
or the external proof of some inner torment is laughable at best. Yes, it
is true that some of those who enjoy adorning their bodies with body
jewellery do it because of inner insecurities, in attempt to control an
otherwise out of control situation, or just because they enjoy the pain.
However in most situations the reasoning behind body modification can be
much more interesting and varied. Many do it to feel individual in a
world of sheep; some do it because they wish to feel more at home with
their culture (for example nostril piercing in Asian women); and some do
it simply because they think it looks nice. It is offensive and wrong to
assume that all those who "indulge" in body adornment are emotionally
scarred or in need of psychological help. In fact, many view their
introduction to the body modification community as a profoundly positive
turning point in their lives. Iroegbu noticeably only mentioned
delinquent members of society; for example prisoners, prostitutes and
sadomasochists; which just goes to show his complete lack of understanding
about the body modification community. I would ask him to research
further than those who go to see medical professionals about either
physical or psychological problems, and happen to also indulge in body
modification. As any idiot can see, this would show an extremely
inaccurate and skewed image of the community as a whole.
Competing interests:
None declared
Competing interests: No competing interests