Anomalies And Curiosities Of Medicine Part 24

In some instances the p.e.n.i.s is so large as to forbid coitus and even inconvenience its possessor, measuring as much as ten or even more inches in length. Extraordinary cases of large p.e.n.i.s are reported by Albinus (who mentions it as a cause for sterility), Bartholinus, Fabricius Hilda.n.u.s, Paullini, Peyer, Plater, Schurig, Sinibaldus, and Zacchias. Several cases of enormous p.e.n.i.ses in the new-born have been observed by Wolff and others.

The p.e.n.i.s palme, or suture de la verge of the French, is the name given to those examples of single cutaneous envelope for both the t.e.s.t.i.c.l.es and p.e.n.i.s; the p.e.n.i.s is adherent to the s.c.r.o.t.u.m by its inferior face; the glans only is free and erection is impossible. Chretien cites an instance in a man of twenty-five, and Schrumpf of Wesserling describes an example of this rare anomaly. The p.e.n.i.s and testes were inclosed in a common sac, a slight projection not over 1/4 inch long being seen from the upper part of this curious s.c.r.o.t.u.m. When the child was a year old a plastic operation was performed on this anomalous member with a very satisfactory result. Pet.i.t describes an instance in which the p.e.n.i.s was slightly fused with the s.c.r.o.t.u.m.

There are many varieties of torsion of the p.e.n.i.s. The glans itself may be inclined laterally, the curvature may be total, or there may be a veritable rotation, bringing the inferior face above and the superior face below. Gay describes a child with epispadias whose p.e.n.i.s had undergone such torsion on its axis that its inferior surface looked upward to the left, and the child pa.s.sed urine toward the left shoulder. Follin mentions a similar instance in a boy of twelve with complete epispadias, and Verneuil and Guerlin also record cases, both complicated with a.s.sociate maldevelopment. Caddy mentions a youth of eighteen who had congenital torsion of the p.e.n.i.s with out hypospadias or epispadias. There was a complete half-turn to the left, so that the slit-like urinary meatus was reversed and the frenum was above. Among the older writers who describe incurvation or torsion of the p.e.n.i.s are Arantius, the Ephemerides, Haenel, Pet.i.t, Schurig, Tulpius, and Zacchias.

Zacutus Lusitans speaks of torsion of the p.e.n.i.s from freezing.

Paullini mentions a case the result of masturbation, and Hunter speaks of torsion of the p.e.n.i.s a.s.sociated with arthritis.

Ossification of the p.e.n.i.s.--MacClellann speaks of a man of fifty-two whose p.e.n.i.s was curved and distorted in such a manner that urine could not be pa.s.sed without pain and coitus was impossible. A bony ma.s.s was discovered in the septum between the corpora cavernosa; this was dissected out with much hemorrhage and the upward curvature was removed, but there resulted a slight inclination in the opposite direction. The formation of bone and cartilage in the p.e.n.i.s is quite rare. Velpeau, Kauffmann, Lenhoseck, and Duploy are quoted by Jacobson as having seen this anomaly. There is an excellent preparation in Vienna figured by Demarquay, but no description is given. The Ephemerides and Paullini describe osseous p.e.n.i.ses.

The complete absence of the frenum and prepuce has been observed in animals but is very rare in man. The incomplete or irregular development is more frequent, but most common is excessive development of the prepuce, const.i.tuting phimosis, when there is abnormal adherence with the glans. Instances of phimosis, being quite common, will be pa.s.sed without special mention. Deficient or absent prepuce has been observed by Blasius, Marcellus Donatus, and Gilibert. Partial deficiency is described by Pet.i.t Severinus, and others.

There may be imperforation or congenital occlusion of some portion of the urethra, causing enormous acc.u.mulation of urine in the bladder, but fortunately there is generally in such cases some anomalous opening of the urethra giving vent to the excretions. Tulpius mentions a case of deficient urethra. In the Ephemerides there is an account of a man who had a constant flow of s.e.m.e.n from an abnormal opening in the abdomen.

La Peyroma describes a case of impotence due to e.j.a.c.u.l.a.t.i.o.n of the spermatic ducts into the bladder instead of into the urethra, but remarks that there was a cicatrix of a wound of the neighboring parts.

There are a number of instances in which the urethra has terminated in the r.e.c.t.u.m. Congenital dilatation of the urethral ca.n.a.l is very rare, and generally accompanied by other malformation.

Duplication of the urethra or the existence of two permeable ca.n.a.ls is not accepted by all the authors, some of whom contend that one of the ca.n.a.ls either terminates in a culdesac or is not separate in itself.

Verneuil has published an article clearly exposing a number of cases, showing that it is possible for the urethra to have two or more ca.n.a.ls which are distinct and have separate functions. Fabricius Hilda.n.u.s speaks of a double aperture to the urethra; Marcellus Donatus describes duplicity of the urethra, one of the apertures being in the t.e.s.t.i.c.l.e; and there is another case on record in which there was a urethral aperture in the groin. A case of double urethra in a man of twenty-five living in Styria who was under treatment for gonorrhea is described, the supernumerary urethra opening above the natural one and receiving a sound to the depth of 17 cm. There was purulent gonorrhea in both urethrae. Vesalius has an account of a double urethral aperture, one of which was supposed to give spermatic fluid and the other urine.

Borellus, Testa, and Cruveilhier have reported similar instances.

Instances of double p.e.n.i.s have been discussed under the head of diphallic terata, page 194.

Hypospadias and epispadias are names given to malformations of the urethra in which the wall of the ca.n.a.l is deficient either above or below. These anomalies are particularly interesting, as they are nearly always found in male hermaphrodites, the fissure giving the appearance of a v.u.l.v.a, as the s.c.r.o.t.u.m is sometimes included, and even the perineum may be fissured in continuity with the other parts, thus exaggerating the deception. There seems to be an element of heredity in this malformation, and this allegation is exemplified by Sedgwick, who quotes a case from Heuremann in which a family of females had for generations given birth to males with hypospadias. Belloc mentions a man whose urethra terminated at the base of the frenum who had four sons with the same deformity. Picardat mentions a father and son, both of whom had double urethral orifices, one above the other, from one of which issued urine and from the other s.e.m.e.n--a fact that shows the possibility of inheritance of this malformation. Patients in whom the urethra opens at the root of the p.e.n.i.s, the meatus being imperforate, are not necessarily impotent; as, for instance, Fournier knew of a man whose urethra opened posteriorly who was the father of four children.

Fournier supposed that the s.e.m.e.n e.j.a.c.u.l.a.t.ed vigorously and followed the fissure on the back of the p.e.n.i.s to the uterus, the membrane of the v.a.g.i.n.a supplanting the deficient wall of the urethra. The p.e.n.i.s was short, but about as thick as ordinary.

Gray mentions a curious case in a man afflicted with hypospadias who, suffering with delusions, was confined in the insane asylum at Utica.

When he determined to get married, fully appreciating his physical defect, he resolved to imitate nature, and being of a very ingenious turn of mind, he busied himself with the construction of an artificial p.e.n.i.s. While so engaged he had seized every opportunity to study the conformation of this organ, and finally prepared a body formed of cotton, six inches in length, and shaped like a p.e.n.i.s, minus a prepuce.

He sheathed it in pig's gut and gave it a slight vermilion hue. To the touch it felt elastic, and its shape was maintained by a piece of gutta-percha tubing, around which the cotton was firmly wound. It was fastened to the waist-band by means of straps, a central and an upper one being so arranged that the p.e.n.i.s could be thrown into an erect position and so maintained. He had constructed a flesh-colored covering which completely concealed the straps. With this artificial member he was enabled to deceive his wife for fifteen months, and was only discovered when; she undressed him while he was in a state of intoxication. To further the deception he had told his wife immediately after their marriage that it was quite indecent for a husband to undress in the presence of his wife, and therefore she had always retired first and turned out the light. Partly from fear that his virile power would be questioned and partly from ignorance, the duration of actual coitus would approach an hour. When the discovery was made, his wife hid the instrument with which he had perpetrated a most successful fraud upon her, and the patient subsequently attempted coitus by contact with unsuccessful results, although both parties had incomplete o.r.g.a.s.ms. Shortly afterward evidences of mental derangement appeared and the man became the subject of exalted delusions. His wife, at the time of report, had filed application for divorce. Haslam reports a case in which loss of the p.e.n.i.s was compensated for by the use of an ivory succedaneum. Parallel instances of this kind have been recorded by Ammann and Jonston.

Entire absence of the male s.e.xual apparatus is extremely rare, but Blondin and Velpeau have reported cases.

Complete absence of the t.e.s.t.i.c.l.es, or anorchism, is a comparatively rare anomaly, and it is very difficult to distinguish between anorchism and arrest of development, or simple atrophy, which is much more common. Fisher of Boston describes the case of a man of forty-five, who died of pneumonia. From the age of p.u.b.erty to twenty-five, and even to the day of death, his voice had never changed and his manners were decidedly effeminate. He always sang soprano in concert with females.

After the age of twenty-five, however, his voice became more grave and he could not accompany females with such ease. He had no beard, had never shaved, and had never exhibited amorous propensities or desire for female society. When about twenty-one he became a.s.sociated with a gay company of men and was addicted to the cup, but would never visit houses of ill-fame. On dissection no trace of t.e.s.t.i.c.l.es could be found; the s.c.r.o.t.u.m was soft and flabby. The cerebellum was the exact size of that of a female child.

Individuals with one t.e.s.t.i.c.l.e are called monorchids, and may be divided into three varieties:--

(1) A solitary t.e.s.t.i.c.l.e divided in the middle by a deep fissure, the two lobes being each provided with a spermatic cord on the same side as the lobe.

(2) t.e.s.t.i.c.l.es of the same origin, but with coalescence more general.

(3) A single t.e.s.t.i.c.l.e and two cords.

Gruber of St. Petersburg held a postmortem on a man in January, 1867, in whom the right half of the s.c.r.o.t.u.m, the right t.e.s.t.i.c.l.e, epididymis, and the scrotal and inguinal parts of the right vas deferens were absent. Gruber examined the literature for thirty years up to the time of his report, and found 30 recorded postmortem examinations in which there was absence of the t.e.s.t.i.c.l.e, and in eight of these both t.e.s.t.i.c.l.es were missing. As a rule, natural eunuchs have feeble bodies, are mentally dull, and live only a short time. The p.e.n.i.s is ordinarily defective and there is sometimes another a.s.sociate malformation. They are not always disinclined toward the opposite s.e.x.

Polyorchids are persons who have more than two t.e.s.t.i.c.l.es. For a long time the abnormality was not believed to exist, and some of the observers denied the proof by postmortem examination of any of the cases so diagnosed, but there is at present no doubt of the fact,--three, four, and five t.e.s.t.i.c.l.es having been found at autopsies.

Russell, one of the older writers on the t.e.s.t.i.c.l.e, mentions a monk who was a triorchid, and was so salacious that his indomitable pa.s.sion prevented him from keeping his vows of chast.i.ty. The amorous propensities and generative faculties of polyorchids have always been supposed greater than ordinary. Russell reports another case of a man with a similar peculiarity, who was prescribed a concubine as a reasonable allowance to a man thus endowed.

Morgagni and Meckel say that they never discovered a third t.e.s.t.i.c.l.e in dissections of reputed triorchids, and though Haller has collected records of a great number of triorchids, he has never been able to verify the presence of the third t.e.s.t.i.c.l.e on dissection. Some authors, including Haller, have demonstrated heredity in examples of polyorchism. There is an old instance in which two t.e.s.t.i.c.l.es, one above the other, were found on the right side and one on the left. Macann describes a recruit of twenty, whose s.c.r.o.t.u.m seemed to be much larger on the right than on the left side, although it was not pendulous. On dissection a right and left t.e.s.t.i.c.l.e were found in their normal positions, but situated on the right side between the groin and the normal t.e.s.t.i.c.l.e was a supernumerary organ, not in contact, and having a separate and short cord. Prankard also describes a man with three t.e.s.t.i.c.l.es. Three cases of triorchidism were found in recruits in the British Army. Lane reports a supernumerary testis found in the right half of the s.c.r.o.t.u.m of a boy of fifteen. In a necropsy held on a man killed in battle, Hohlberg discovered three fully developed t.e.s.t.i.c.l.es, two on the right side placed one above the other. The London Medical Record of 1884 quotes Jdanoff of St. Petersburg in mentioning a soldier of twenty-one who had a supernumerary t.e.s.t.i.c.l.e erroneously diagnosed as inguinal hernia. Quoted by the same reference, Bulatoff mentions a soldier who had a third t.e.s.t.i.c.l.e, which diagnosis was confirmed by several of his confreres. They recommended dismissal of the man from the service, as the third t.e.s.t.i.c.l.e, usually resting in some portion of the inguinal ca.n.a.l, caused extra exposure to traumatic influence.

Venette gives an instance of four t.e.s.t.i.c.l.es, and Scharff, in the Ephemerides, mentions five; Blasius mentions more than three t.e.s.t.i.c.l.es, and, without citing proof, Buffon admits the possibility of such occurrence and adds that such men are generally more vigorous.

Russell mentions four, five, and even six t.e.s.t.i.c.l.es in one individual; all were not verified on dissection. He cites an instance of six t.e.s.t.i.c.l.es four of which were of usual size and two smaller than ordinary.

Baillie, the Ephemerides, and Schurig mention fusion of the t.e.s.t.i.c.l.es, or synorchidism, somewhat after the manner of the normal disposition of the batrachians and also the kangaroos, in the former of which the fusion is abdominal and in the latter scrotal. Kerckring has a description of an individual in whom the s.c.r.o.t.u.m was absent.

In those cases in which the t.e.s.t.i.c.l.es are still in the abdominal cavity the individuals are termed cryptorchids. Johnson has collected the results of postmortem examinations of 89 supposed cryptorchids. In eight of this number no t.e.s.t.i.c.l.es were found postmortem, the number found in the abdomen was uncertain, but in 18 instances both t.e.s.t.i.c.l.es were found in the inguinal ca.n.a.l, and in eight only one was found in the inguinal ca.n.a.l, the other not appearing. The number in which the s.e.m.e.n was examined microscopically was 16, and in three spermatozoa were found in the s.e.m.e.n; one case was dubious, spermatozoa being found two weeks afterward on a boy's s.h.i.+rt. The number having children was ten. In one case a monorchid generated a cryptorchid child. Some of the cryptorchids were effeminate, although others were manly with good evidences of a beard. The morbid, hypochondriac, the voluptuous, and the imbecile all found a place in Johnson's statistics; and although there are evidences of the possession of the generative function, still, we are compelled to say that the chances are against fecundity of human cryptorchids. In this connection might be quoted the curious case mentioned by Geoffroy-Saint-Hilaire, of a soldier who was hung for rape. It was alleged that no traces of t.e.s.t.i.c.l.es were found externally or internally yet s.e.m.e.n containing spermatozoa was found in the seminal vesicles. Spermatozoa have been found days and weeks after castration, and the individuals during this period were capable of impregnation, but in these cases the reservoirs were not empty, although the spring had ceased to flow. Beigel, in Virchow's Archives, mentions a cryptorchid of twenty-two who had nocturnal emissions containing spermatozoa and who indulged in s.e.xual congress. Partridge describes a man of twenty-four who, notwithstanding his condition, gave evidences of virile seminal flow.

In some cases there is anomalous position of the t.e.s.t.i.c.l.e. Hough mentions an instance in which, from the great pain and sudden appearance, a small tumor lying against the right pubic bone was supposed to be a strangulated hernia. There were two well-developed t.e.s.t.i.c.l.es in the s.c.r.o.t.u.m, and the hernia proved to be a third. McElmail describes a soldier of twenty-nine, who two or three months before examination felt a p.r.i.c.king and slight burning pain near the internal aperture of the internal inguinal ca.n.a.l, succeeded by a swelling until the tumor pa.s.sed into the s.c.r.o.t.u.m. It was found in the upper part of the s.c.r.o.t.u.m above the original t.e.s.t.i.c.l.e, but not in contact, and was about half the size of the normal t.e.s.t.i.c.l.e; its cord and epididymis could be distinctly felt and caused the same sensation as pressure on the other t.e.s.t.i.c.l.e did.

Marshall mentions a boy of sixteen in whom the right half of the s.c.r.o.t.u.m was empty, although the left was of normal size and contained a t.e.s.t.i.c.l.e. On close examination another t.e.s.t.i.c.l.e was found in the perineum; the boy said that while running he fell down, four years before, and on getting up suffered great pain in the groin, and this pain recurred after exertion. This t.e.s.t.i.c.l.e was removed successfully to the s.c.r.o.t.u.m. Horsley collected 20 instances of operators who made a similar attempt, Annandale being the first one; his success was likely due to antisepsis, as previously the t.e.s.t.i.c.l.es had always sloughed.

There is a record of a dog remarkable for its salacity who had two t.e.s.t.i.c.l.es in the s.c.r.o.t.u.m and one in the abdomen; some of the older authors often indulged in playful humor on this subject.

Brown describes a child with a swelling in the perineum both painful and elastic to the touch. The child cried if pressure was applied to the tumor and there was every evidence that the tumor was a t.e.s.t.i.c.l.e.

Hutcheson, quoted by Russell, has given a curious case in an English seaman who, as was the custom at that time, was impressed into service by H.M.S. Druid in 1807 from a trading s.h.i.+p off the coast of Africa.

The man said he had been examined by dozens of s.h.i.+p-surgeons, but was invariably rejected on account of rupture in both groins. The s.c.r.o.t.u.m was found to be an empty bag, and close examination showed that the t.e.s.t.i.c.l.es occupied the seats of the supposed rupture. As soon as the discovery was made the man became unnerved and agitated, and on re-examining the parts the t.e.s.t.i.c.l.es were found in the s.c.r.o.t.u.m. When he found that there was no chance for escape he acknowledged that he was an impostor and gave an exhibition in which, with incredible facility, he pulled both testes up from the bottom of the s.c.r.o.t.u.m to the external abdominal ring. At the word of command he could pull up one t.e.s.t.i.c.l.e, then another, and let them drop simultaneously; he performed other like feats so rapidly that the movements could not be distinguished.

In this connection Russell speaks of a man whose t.e.s.t.i.c.l.e was elevated every time the east wind blew, which caused him a sense of languor and relaxation; the same author describes a man whose t.e.s.t.i.c.l.es ascended into the inguinal ca.n.a.l every time he was in the company of women.

Inversion of the t.e.s.t.i.c.l.e is of several varieties and quite rare, it has been recognized by Sir Astley Cooper, Boyer, Maisonneuve, Royet, and other writers.

The anomalies of the vas deferens and seminal vesicles are of little interest and will be pa.s.sed with mention of the case of Weber, who found the seminal vesicles double; a similar conformation has been seen in hermaphrodites.

CHAPTER VII.

ANOMALIES OF STATURE, SIZE, AND DEVELOPMENT.

Giants.--The fables of mythology contain accounts of horrible monsters, terrible in ferocity, whose mission was the destruction of the life of the individuals unfortunate enough to come into their domains. The ogres known as the Cyclops, and the fierce anthropophages, called Lestrygons, of Sicily, who were neighbors of the Cyclops, are pictured in detail in the "Odyssey" of Homer. Nearly all the nations of the earth have their fairy tales or superst.i.tions of monstrous beings inhabiting some forest, mountain, or cave; and pages have been written in the heroic poems of all languages describing battles between these monsters and men with superhuman courage, in which the giant finally succ.u.mbs.

The word giant is derived indirectly from the old English word "geant,"

which in its turn came from the French of the conquering Normans. It is of Greek derivation, "gigas", or the Latin, "gigas." The Hebrew parallel is "nophel," or plural, "nephilim."

Ancient Giants.--We are told in the Bible a that the bedstead of Og, King of Basham, was 9 cubits long, which in English measure is 16 1/2 feet. Goliath of Gath, who was slain by David, stood 6 cubits and a span tall--about 11 feet. The body of Orestes, according to the Greeks, was 11 1/2 feet long. The mythical t.i.tans, 45 in number, were a race of Giants who warred against the G.o.ds, and their descendants were the Gigantes. The height attributed to these creatures was fabulous, and they were supposed to heap up mountains to scale the sky and to help them to wage their battles. Hercules, a man of incredible strength, but who is said to have been not over 7 feet high, was dispatched against the Gigantes.

Pliny describes Gabbaras, who was brought to Rome by Claudius Caesar from Arabia and was between 9 and 10 feet in height, and adds that the remains of Posio and Secundilla, found in the reign of Augustus Caesar in the Sall.u.s.tian Gardens, of which they were supposed to be the guardians, measured 10 feet 3 inches each. In common with Augustine, Pliny believed that the stature of man has degenerated, but from the remains of the ancients so far discovered it would appear that the modern stature is about the same as the ancient. The beautiful alabaster sarcophagus discovered near Thebes in 1817 and now in Sir John Soane's Museum in Lincoln's Inn Fields in London measures 9 feet 4 inches long. This unique example, the finest extant, is well worth inspection by visitors in London.

Herodotus says the shoes of Perseus measured an equivalent of about 3 feet, English standard. Josephus tells of Eleazar, a Jew, among the hostages sent by the King of Persia to Rome, who was nearly 11 feet high. Saxo, the grammarian, mentions a giant 13 1/2 feet high and says he had 12 companions who were double his height. Ferragus, the monster supposed to have been slain by Roland, the nephew of Charlemagne, was said to have been nearly 11 feet high. It was said that there was a giant living in the twelfth century under the rule of King Eugene II of Scotland who was 11 1/2 feet high.

There are fabulous stories told of the Emperor Maximilian. Some accounts say that he was between 8 1/2 and 9 feet high, and used his wife's bracelet for a finger-ring, and that he ate 40 pounds of flesh a day and drank six gallons of wine. He was also accredited with being a great runner, and in his earlier days was said to have conquered single-handed eight soldiers. The Emperors Charlemagne and Jovia.n.u.s were also accredited with great height and strength.

In the olden times there were extraordinary stories of the giants who lived in Patagonia. Some say that Magellan gave the name to this country because its inhabitants measured 5 cubits. The naturalist Turner says that on the river Plata near the Brazilian coast he saw naked savages 12 feet high; and in his description of America, Thevenot confirms this by saying that on the coast of Africa he saw on a boat the skeleton of an American giant who had died in 1559, and who was 11 feet 5 inches in height. He claims to have measured the bones himself.

He says that the bones of the leg measured 3 feet 4 inches, and the skull was 3 feet and 1 inch, just about the size of the skull of Borghini, who, however, was only of ordinary height. In his account of a voyage to the Straits of Magellan, Jacob Lemaire says that on December 17, 1615, he found at Port Desire several graves covered with stones, and beneath the stones were skeletons of men which measured between 10 and 11 feet. The ancient idea of the Spaniards was that the men of Patagonia were so tall that the Spanish soldiers could pa.s.s under their arms held out straight; yet we know that the Patagonians exhibit no exaggeration of height--in fact, some of the inhabitants about Terra del Fuego are rather diminutive. This superst.i.tion of the voyagers was not limited to America; there were accounts of men in the neighborhood of the Peak of Teneriffe who had 80 teeth in their head and bodies 15 feet in height.

Discoveries of "Giants' Bones."--Riolan, the celebrated anatomist, says that there was to be seen at one time in the suburbs of Saint Germain the tomb of the giant Isoret, who was reputed to be 20 feet tall; and that in 1509, in digging ditches at Rouen, near the Dominicans, they found a stone tomb containing a monstrous skeleton, the skull of which would hold a bushel of corn; the s.h.i.+n-bone measured about 4 feet, which, taken as a guide, would make his height over 17 feet. On the tomb was a copper plate which said that the tomb contained the remains of "the n.o.ble and puissant lord, the Chevalier Ricon de Vallemont."

Plater, the famous physician, declares that he saw at Lucerne the true human bones of a subject that must have been at least 19 feet high.

Valence in Dauphine boasted of possessing the bones of the giant Bucart, the tyrant of the Vivarias, who was slain by his va.s.sal, Count de Cabillon. The Dominicans had the s.h.i.+n-bone and part of the knee-articulation, which, substantiated by the frescoes and inscriptions in their possession, showed him to be 22 1/2 feet high.

They claimed to have an os frontis in the medical school of Leyden measuring 9.1 X 12.2 X .5 inches, which they deduce must have belonged to a man 11 or 12 feet high.