Medical mystery solved: The case of the ‘Balloon Man’

Imagine walking around with a 40-pound bag of manure in your abdomen. That’s probably what life was like for the young man pictured here, who suffered from chronic constipation for most of his life. When he died in 1892 at the age of 29, an autopsy revealed that his colon was 8 feet long, with a circumference of 28 inches at its widest point, and contained 40 pounds of feces.

Identified only as J.W., his problems began before 2 years of age. Along with an enlarged abdomen, the child had irregular bowel movements and constipation. As J.W. grew older, the size of his abdomen increased along with the severity of his constipation. By age 16, he could go for up to a month without any bowel movement.

At age 20, he was employed as a human exhibit—the “Balloon Man”—at a Philadelphia freak show. J.W. died less than a decade later, found in a bathroom attempting a bowel movement.

To this day, J.W. remains on display in Philadelphia—or at least his giant megacolon does. The 8-foot colon, dried and stuffed with straw and fabric, is on exhibit at the Mütter Museum. The museum is owned by the College of Physicians of Philadelphia, one of the oldest professional medical organizations in the United States. (The Mütter Museum, which takes a certain morbid pride in its unusual collection, has a plush megacolon for sale on its website.)

Although J.W.’s condition was a medical mystery at the time, it is now known to have been caused by congenital aganglionic megacolon, also known as Hirschsprung’s disease. In this abnormality, nerve fibers (autonomic ganglia) fail to develop in the smooth muscle wall of the distal part of the colon. This absence weakens or altogether stops peristalsis in the colon, resulting in severe bowel obstruction and chronic constipation.

Hirschsprung’s disease occurs in 1 in every 5,000 live births and is about four times more common in males than females. Danish pediatrician Harald Hirschsprung first described the condition in 1886—during the same time that J.W. was employed as an anatomical curiosity.

Today, the condition is typically identified in infancy. Surgical repair in early childhood (resection of the aganglionic portion of the bowel) is usually successful, and prognosis afterward is very good overall. If only J.W. had been born today, the “Balloon Man” and his 8-foot megacolon would never have happened.