Unhappy meal

Not surprisingly, both these women were bulimics. Bulimics make up the preponderance of stomach rupture deaths recorded in medical literature, second only to dogs and followed closely by the mentally retarded, who have, as one author put it, a "tendency to wolf down large quantities of food." (One such patient was killed by a too-eagerly dispatched serving of beets, some of which he literally inhaled. "Terminal aspiration of beets" was listed as the mechanism of death.) Not included in the ranking is a certain tribe of New Guinea natives whose traditions include the ceremonial ingestion of vast quantities of partly cooked pork, leading to a sometimes fatal condition known as "pig bel."

What is surprising about the two bulimic women is that they survived as long as they did. The shriveled stomachs of people who have been starving tend to rupture more easily. The model, for example, had been interspersing her binges with three- to four-day bouts of complete starvation. The end of World War II saw a disquieting number of former prisoners of war perish from gastrointestinal overload when presented with unlimited quantities of food. It didn't take much. The surgeon commander of the Polish Navy described four such cases in a 1947 issue of the British Medical Journal, with one of the men succumbing from a relatively unnoteworthy two quarts of soup, one quart of coffee, a half pound of bread and some potatoes over the course of a day.

Not all people who eat themselves to death die of a ruptured stomach. The Florida psychologist died of asphyxia, her grossly distended stomach having protruded so far up and out of its customary terrain that the lungs were terminally compromised. Either way, you haven't long for regrets. The ruptured stomach victims in the reports typically died within a matter of hours. Of 31 cases reviewed in one 1941 journal article, only two recovered.

Lest you spend your postprandial hours this holiday season worrying about whether your stomach has quietly ruptured, rest assured that you will know if it happens. Case studies quote patients reporting a sensation of "giving way," a "bursting noise" or "sudden explosion."

A final word of caution. Should you find yourself closing in on the four-quart mark, do not seek relief in a glass of Alka-Seltzer. In 1941, a 51-year-old woman capped a weeklong hyperphagic binge by sitting down to a prodigious meal of macaroni, meat balls, cheese, tomatoes, potatoes, bread, pie, three glasses of grape juice and several shots of whisky -- nearly four quarts of foodstuffs in all. Suffering from "heavy feelings" in her abdomen, she sought to relieve her discomfort with a few teaspoons of sodium bicarbonate in water. Almost immediately, she doubled up with severe stomach pain, the gas from the fizz having apparently stretched the stomach to its breaking point. Within 14 hours, the woman died. The case study, reported in the December 1941 Annals of Surgery, is accompanied by a detailed half-page illustration of her stomach, replete with a gaping five-inch-long rupture, that is enough to put anyone off his supper. Well, almost anyone.

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