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Urology pearls: The Christmas ‘guillotine letter box’

Shahar Madjar, MD

A week before Christmas, a 59-year-old housewife lost the tip of her middle finger. The finger belonged to her left, dominant hand. The accident happened while she was posting a Christmas card through a neighbor’s mailbox. The mailbox had a spring-loaded flap that snapped down on the finger as she pushed the envelope through the opening. She instinctively, quickly withdrew her trapped digit. The sharp edge of the mailbox acted as a blade and the finger-tip was amputated. She underwent surgery and was discharged home in time to celebrate Christmas. This incident happened in Nottingham, England, where a mailbox is referred to as ‘letterbox.’ It was later described in the British Journal of Plastic Surgery as the ‘Guillotine Letter Box.’

I would like you to hold the image of the severed finger in your mind for a bit longer while I tell you another story — a story that takes place in the USA rather than in England, and involves a bridge, not a mailbox.

The bridge — Norfolk Southern-Gregson Street overpass — is a railroad bridge in Durham, North Carolina. It was designed in the 1920s and built in 1940. I learned about the bridge through several clips I saw on YouTube. In one clip, I saw a long-shot of the bridge with cars passing underneath the way cars usually pass under bridges. Several seconds into the clip, a truck entered the scene. The truck moved innocently and at a normal speed, but then, it hit the bridge forcefully in a rather surprising manner — its roof opened like a sardine can where the top of the truck violently peeled back from its frame. Watching this video clip on YouTube caused me to improperly burst into a laughter so vivid that I almost fell off the sofa.

And I thought about the driver and how careless he was, or perhaps unfortunate, to ignore, or just miss the big sign and the blinking hazard lights that were so clearly posted, warning that the bridge is too low (11-foot-8 inches, to be exact). And he tried, nevertheless, to pass underneath, and miserably failed.

After watching several more clips featuring the bridge, I changed my mind about this truck driver and many others like him. He was no longer playing the role of a careless driver, but that of a victim of poor design. In one of the videos, a compilation of many other clips, the bridge is seen, time after time, truck after truck, and in all instances the same sequence appears. An innocent driver hits the bridge, and the truck’s roof folds.

The videos were taken by Jurgen Henn who works in an office near the bridge. Jurgen mounted the camera in April 2008 and has recoded more than 150 crashes. The bridge has been featured in an article in the Wall Street Journal, and on an episode of a Comedy Central TV show called Tosh.O. The bridge was raised by 8 inches in 2019. It is still lower than the typical bridge clearance and collisions still happen.

Do you still remember the unfortunate case of the “Guillotine Letter Box?’ Do you still hold in your mind the image of the housewife’s severed finger? In the same letter to the editor, published in the British Journal of Plastic Surgery, Yvette Godwin, a specialist in plastic surgery, reported on two other cases of similar nature and with similar fate. One person, an anesthetist, lost a third of his right index finger; and another person, a plumber, lost the tip of his dominant middle finger to a vicious mailbox. A local postman admitted that second to angry dogs with unsympathetic owners, spring-loaded letter boxes were the next greatest occupational hazard.

Accidents sometimes just happen. But often, a common cause can be identified in the form of bad design. Our brain isn’t quick enough to process the multiple hazards we face in our daily lives. We are a distracted species overwhelmed by our complex environment. Given enough time, and paying proper attention, drivers could have avoided the bridge, and the victims of the ‘Guillotine Letter Box’ might have been spared. But the recurrent nature of these and other accidents point at a larger challenge–that of effective, yet safe, design. The way to prevent accidents isn’t always to rely on the end-user and their ultimate caution, but to design tools, processes, and systems with safety in mind.

Editor’s note: Dr. Shahar Madjar is a urologist at Aspirus and the author of “Is Life Too Long? Essays about Life, Death and Other Trivial Matters.” Contact him at smadjar@yahoo.com.

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