WILLIAM OSLER ON PENIS CAPTIVUS AND OTHER UROLOGIC TOPICS
 
Urology
October 1973

WILLIAM OSLER ON PENIS CAPTIVUS AND OTHER UROLOGIC TOPICS

EARL F. NATION, M.D.
Pasadena, California

Sir William Osler has related how, in 1884, while visiting Virchow in Leipzig, he received a cabled invitation to come to Philadelphia as professor of medicine at the University of Pennsylvania.1 His reluctance to leave old friends and ties in Montreal was resolved by tossing a four-mark piece into the air. "Heads I go to Philadelphia, tails I stay in Montreal." Thus, the chance turn of a coin influenced thirty-five-year-old Osler to leave his native Canada for Philadelphia.

Here, he was asked to serve as one of four editorial writers for the popular medical journal Medical News. In this capacity he was associated with Theophilus Parvin, an editor primarily responsible for obstetric and gynecologic matters. Osler considered Parvin a pedantic prig, and his opinion seemed vindicated when Parvin delivered himself of a particularly pompous and stilted editorial on "An Uncommon Form of Vaginismus."

Osler, an inveterate prankster, had brought with him from Montreal a nom de plume, a convenience for just such occasions. Thus, Parvin soon was delighted to receive by letter, postmarked Montreal, a case report substantiating his thesis, over the signature of Egerton Y. Davis, Ex. U.S. Army. This letter was published forthwith under correspondence in the issue of the Medical News of December 13, 1884.2 This is one document of interest relative to Osler which Cushing did not reprint in The Life. The letter follows:

Dear Sir:

The reading of an admirably written and instructive editorial in the Philadelphia Medical News of 24th November 24 on forms of vaginismus, has reminded me of a case which bears out, in an extraordinary way, the statements therein contained. When in practice at Pentonville, England, I was sent for, about 11 P.M., by a gentleman whom, on my arriving at his home I found in a state of great perturbation, and the story he told me was briefly as follows:

At bedtime, when going to the back kitchen to see if the house was shut up, a noise in the coachman's room attracted his attention, and, going in, he discovered to his horror that the man was in bed with one of the maids. She screamed, he struggled, and they rolled out of bed together and made frantic efforts to get apart, but without success. He was a big, burly man, over six feet, and she was a small woman, weighing not more than ninety pounds. She was moaning and screaming, and seemed in great agony, so that after several fruitless attempts to get them apart, he sent for me. When I arrived I found the man standing up and supporting the woman in his arms, and it was quite evident that his penis was tightly locked in her vagina, and any attempt to dislodge it was accompanied by much pain on the part of both. It was, indeed, a case "De cohesione in coitu." I applied water, and then ice, but ineffectually, and at last sent for chloroform, a few whiffs of which sent the woman to sleep, relaxed the spasm, and released the captive penis, which was swollen, livid, and in a state of semi-erection, which did not go down for several hours, and for days the organ was extremely sore. The woman recovered rapidly and seemed none the worse.

I am sorry that I did not examine if the sphincter ani was contracted, but I did not think of it. In this case there must have been spasm of the muscle at the orifice, as well as higher up, for the penis seemed nipped low down, and this contraction, I think, kept the blood retained and the organ erect. As an instance of Iago's "beast with two backs," the picture was perfect. I have often wondered how it was, considering with what agility the man can, under certain circumstances, jump up, that Phineas, the son of Eleazar, was able to thrust his javelin through the man and the Midianitish woman (vide Exodus); but the occurrence of such cases as the above may offer a possible explanation.

Yours truly
Egerton Y. Davis
Ex. U.S. Army

Caughnawauga, Quebec,
4th December, 1884.

According to certain notes left by Osler3 concerning his alter ego, "E.Y.D.," he made a belated effort to forestall publication of this letter. Be that as it may, the spurious case report went into the literature and, as Osler later bemoaned, "is often quoted."

There are numerous references to the case in the medical literature of the last seventy-five years. Kirsch,4 in his book on The Sexual Life of Woman, translated into English in 1910, details the case as proof of the existence of such a condition. In 1926 Hühner,5 stated:

In particularly severe cases (of vaginismus) it has been necessary to chloroform the female in order to release the penis from the vaginal spasm. A case of such undue severity is reported by Davis.

More recently, Oliven6 described such a condition. He even suggests an implied "tried and true" treatment, namely, "the insertion of a well-lubricated thumb into the woman's rectum" to help relax the vaginal spasm. He fails to mention whose thumb should be used.

How often have hoaxes been perpetrated in the medical literature? How careful must one be in reading? Does the following case report by Sims, quoted in books by Hühner and by Kelly,7 sound any less apocryphal than Osler's?

A particularly severe case (of vaginismus) is recorded by Sims as follows: A family physician anesthetized the wife for first coitus, which then offer end no difficulty; he continued to do this at biweekly intervals for a year, when she became pregnant and bore a child at term. The old pain returned, however, and it became necessary to resume the "ethereal relations."

The concept of penis captivus in the human being has a good and ancient background.8 Brief allusions to the condition are found in Homer and Lucretius. The first detailed accounts appear in medieval literature of the twelfth through fourteenth centuries. All of these have religious connotations, and the condition, when it occurred, was considered a miracle. Separation was usually effected by prayers of the monks.

Accounts by medical writers began to appear during the seventeenth century.9 Diembroeck, the well-known seventeenth century anatomist, gives the following account of a case:

When I was a Student at Leyden I remember there was a young Bridegroom in that Town that being overwanton with the Bride had so hamper'd himself in her Privities, that he could not draw his Yard forth, till Delmehorst the Physician unty'd the Knot by casting cold Water on the Part.

A true case of de cohesione in coitu or penis captivus, such as that discussed by Parvin and lampooned by Osler, has not been found in the modern literature. Can time thus have changed things? Perhaps, one day, we shall "rediscover" this condition. We are inclined, with Jacobsen,10 to doubt the occurrence of such a catastrophe. He expresses his convictions as follows:

Has the human penis ever really been in captivity? We doubt it. We jealously proclaim its complete freedom in a world of compromises, inhibitions and frustrations. If the penis is not free, then all privilege is a fiction. As Britons never shall be slaves, so the penis never shall be captured. Failure to include such a declaration in the Atlantic Charter was a serious omission.

Other Urologic Topics

Osler's writing on urologic topics does not end with the whimsical contribution. He also wrote on polycystic renal disease and on nephroptosis. A single quotation from Osler on the latter subject is his best urologic aphorism: "it is more often the mental kidney than the abdominal one that floats."

His devilish streak was again evoked by another urologic subject. On this occasion he reported in the Boston Medical and Surgical Journal (1903)11 a true case of Peyronie's disease. However, not content with giving the report a Rabelaisian twist he concluded by signing it with the initials of a well-known Philadelphia urologist, J.W. White, Jr. The latter, recognizing the true author, countered a short time later in the same journal with a charge of "plagiarism" detailing the tell-tale evidence of the identity of the true author; and all of this over the initials of Osler's nom de plume (with a misprinted T for the middle initial).

Peyronie's Disease - Strabisme du penis

Pittsburg, Feb. 14, 1903

    Mr. Editor: An old codger of about 65 years came in one day, and, casting a furtive glance about the room, shut the door with great deliberation. To my question, "What is the matter?" he replied, "Squint of the cock." As I did not take genito-urinary cases, I advised him to consult my friend Dr. Ricord, upon which he handed me a letter, saying that his doctor had told him that I would be most interested in his case. He then told me his story. A widower for some years, he was anxious to marry again, but was afraid to do so on account of a most remarkable change in his yard. When erect it curved to one side in such a way as to form a semicircle, hopeless and useless for any practical purpose. I call it, he said, squint of the cock. Examination showed at one side at the root of the penis a firm induration about the size of a cherry, so placed as to completely fill a part of one corpus cavernosum. Of course, on erection blood filled the other corpus only, and in consequence the penis curved towards the affected side, producing the squint of which he spoke. In the works at my disposal, including one well-known manual of genito-urinary surgery, I could find no account of this singular affection, but have learned when in doubt to consult Hutchinson's Archives of Surgery, I there found a very full account of these fibrous plaques in the corpora cavernosa, which if unilateral produce all sorts of distortions of the penis, if bilateral, impotence. Turning to another storehouse, the Dictionnaire Encylcopedique, under the article "Pénis," I there found a very good description, but in addition, what was most interesting, the statement that in about 1765, Peyronie, a French surgeon, had described the disease as strabisme du pénis, the very term used by my old patient. There are very good illustrations of the condition in Taylor's Manual, but in these eponymic days old Peyronie should have the credit of describing in a happy phrase a very unfortunate defect.

J. W. W., Jr.

The reply of J.W. White, Jr.,12 alleged author of the first letter, took the following form:

"Peyronie's Disease - Strabisme du pénis"
Philadelphia, April 24, 1903

    Mr. Editor: I fear J. W. W., Jr. of Pittsburg, Pa., has been listening to many valuable "over the Scotch and soda" clinics of one of the distinguished members of our profession, and has unconsciously become guilty of plagiarism, palming off another's erudition for his own (see Journal, Feb. 26, 1903, p. 245). The earmarks of plagiarism are: (I) the title (I have heard "S and S" Lectures with such title), (II) "Codger," (III) "Yard," (IV) Hutchinson's Archives (see a visit to the Hutchinson's Country Home by etc., etc.), (V) Dictionnaire Encyclopédique (none such in Pittsburg). Is it possible, like everything else that is good from Pittsburg, it is a "steal"?
    Moreover, no one in Pittsburg would ever think of writing a sentimental letter of such character on Valentine's Day. There is too much iron in his soul.
    Finally, I find by Polk's that Dr. Ricord lives in Baltimore. Regretting this further, "gold from salt water" attempts to "take in" the Yankees,
        I am,
        E. T. D., Jr.

Lest it be concluded that the Boston Medical and Surgical Journal was given over to such levity, let us note that the two articles following Osler's contribution are by George Crile and Harvey Cushing on erudite researches into means of controlling the blood pressure and determining arterial tension in the operating room, respectively. In the same volume there also appears one of Osler's fine essays, "On the Educational Value of the Medical Society."

The foregoing depicts a little realized side of the character of "The Beloved Physician." Far from demeaning that character, it is hoped that it may be broadened and enlivened by this glimpse of Osler's sense of humor.

112 North Madison Avenue
Pasadena, California 91101


References

1. DAVISON, W.C.:   Quotations by Osler before the American Clue, Oxford, February 12, 1916, Sir William Osler: Reminiscences. The Pharos of Alpha Omega, 13: 13 (1949). Cushing, H. S.: Life of Sir William Osler, vol. 1, p. 220.
2. Medical News 45: 673 (1884).
3. Prefatory notes to certain documents relating to a "MS. of Egerton Yorrick Davis, M.D., late U.S. Army, Caughnawauga, P.Q.," Osler Library. Cushing,1 pg. 241.
4. KISCH, E. H.:   The Sexual LIfe of Women in its Physiological, Pathological, and Hygienic Aspects, New York, Rebman, Co., 1910.
5. HÜHNER, M.: Disorders of the Sexual Function, Philadelphia, F. A. Davis Co., 1926.
6. OLIVEN, J. S.:   Sexual Hygiene and Pathology, Philadelphia, J. B. Lippincott Co., 1955, p. 209.
7. KELLY, H.:   Medical Gynecology, New York, P. Appleton and Co., 1918.
8. ROLLESTON, J. D.:   Penis captivus: A historical note, Janus 35: 196 (1935).
9. SCHURIGIUS, D. M.:   Spermatologia, 1737, p. 314.
10. JACOBSEN, A. C.:   Medical Times 73: 52 (1945).
11. Correspondence, Peyronie's Disease - Strabisme du pénis, Boston Med. Surg. J. 148: 245 (1903).
12. E. T. D., Jr.: Peyronie's Disease - Strabisme du pénis, ibid. 148: 485 (1903).