The Evil Monkey has a Ph.D. in Neuroscience from a southeastern U.S. university. After a postdoctoral nightmare of Inquisitorial proportions, he is currently working in a laboratory and an adjunct assistant professor at a nearby state university.
Scicurious is a graduate student wrestling with a PhD in Physiology at a southern institution. She is a nerd, a geek, and also a dork. And yes, that really is her brain.
NotoriousLTP is an MD-PhD student in New York City. After finishing (hopefully soon) his PhD in behavioral neuroscience, he will re-enter the fun vortex that is medical education.
Weird Science is going up late this week, sorry guys. But it's weird science AND historical science, which makes it double cool.
Also, NEW site from Zooillogix, and it's the CUTEST THING EVER. Called zooborns, you just want to cuddle everything on the site. It will definitely cheer you up after a bad day.
So I like this paper partially because it reminds me of a guy I knew in college. He was telling me one time of the funny exploits he had in high school. Apparently there was a period where he would walk down the hall with his friend and spontaneously say, loudly "YEAH, THE DOCTOR SAYS IT'S ELEPHANTITIS OF THE LEFT TESTICLE." I thought this was hilarious. Were I a guy I would totally have done this. Unfortunately, walking along the hall and yelling out "yeah, it's elephantitis of the left OVARY" probably wouldn't get as good a response.
With that preamble, here it goes.
Perkins, GW. "Double consecutive castration for primary tuberculosis of testicles." Annals of surgery, 1889.
I suppose this paper continues my current fascination with all things TB. Most people think of tuberculosis as infecting only the lungs, but in fact it infects almost every part of the body (when paleomicrobiologists look for evidence of TB in skeletons, they actually look for characteristic bone lesions, which make your bones look like swiss cheese). Of course pulmonary TB is most common, accounting for about 70% of cases. Sometimes, people will get pulmonary TB and then it will spread or move to other parts of the body, though this usually only happens in immunosuppressed patients and young children.
This paper covers a 32 year old freight conductor who came to see the doctor in 1887. He apparently was entirely healthy and had no venereal disease or anything, but for about two years he had noticed that his left ball was swelling. A lot. He finally went to the doctor about it because he could no longer walk well enough to do his job. The author described the testicle as being about 5-6 times its normal size, and lessee, normal testicle size is what...about 18 square 18, and 5-6 times that is 90-108 square cm, which is about 16 inches square, which is one HUGE testicle. How big is 16 inches sq? I think it's about the average size of a little decorative sofa pillow. Or a small footstool. And he had that thing hanging off him for MONTHS.
The doctor recommended castration. The man said no way. The doctor tapped the testicle and got some fluid out, and sent him home. But the man came back a few months later, completely unable to work, and with no libido whatsoever. He finally agreed to get the testicle removed. The operation went well (the doctor referred to antiseptic dressing), and when dissected, the author found that the testicle was full of little "cheesey masses" which were anywhere from 1/4 inch to 3/4 inch, and the larger ones breaking down in the center. He confirmed it as TB, but didn't do a search for bacteria. The patient made a full recovery, and the doctor notes that he didn't notice any symptoms in the right testicle.
But a few months later he was back. Now the RIGHT testicle was swelling, and fast enough that he could actually see it. This time the patient himself demanded castration, because he was practically sterile, and unable to support his family because he couldn't work. So they had to take out the right testicle, and sure enough, it was also filled with "cheesy masses", though not nearly so bad as the left one had been. The man made a full recovery and by 1889 apparently was just fine.
The doctor diagnosed this as two independant instances of testicular TB. I disagree, but then I'm not a doctor. He thought that there had been no transmission from the left to the right testicle, because he didn't notice symptoms in the right testicle when the left was removed. But I think he would have seen something very different if he had done a biopsy (not that he could). I imagine the TB (if it was TB) was already starting to work on the right when the left was removed.
And I'm not so sure it was TB. Since TB rarely spreads from the lungs unless you're immunocompromised, I think it's more likely that this guy had testicular cancer, especially since the testicles were full of small masses, which could have been tumors. Additionally, when some tumor masses get large and are unable to recruit adequate blood flow, they can start to die in the center, like the doctor saw in the left ball. But then again, I am NOT a doctor. And I don't know a lot about testicles. Neither do I know a lot about the prevalence of testicular TB.
So next time you're walking down the hall of your high school, make sure you yell out "YES, THE DOCTOR SAYS IT'S TB OF THE LEFT TESTICLE"
G. W. Perkins (1889). Double consecutive castration for primary tuberculosis of testicles Annals of Surgery, 10 (3), 169-170
Medicine & Health
Comments
Wasn't "tubercle" originally understood as any "small, wormy mass" in the body? So, in 19th c. medical parlance, "a tuberculosis" is an infestation of tubercles.
What we call tuberculosis today was originally "tuberculosis of the lungs."
I would say that "tuberculosis of the testicle" was an accurate description of what he observed, that would have been understood by his peers to be an accurate description of the condition, and not necessarily connected to the disease we call tuberculosis.
After all, in the 1880s, you could diagnose someone with "dropsy" or "catarrh." Today, we would consider those descriptive of the symptoms, but not a diagnosis of the underlying disease. I don't think 19th c. medicine was up to the distinctions we take for granted now.
I agree with you that the cancer diagnosis is most likely in retrospect, but I think you're having a bit too much fun at the expense of a doctor who was doing the best he could with the information he had.
(NB: I am not a doctor, or a medical historian. I am, however, particularly fond of 19th c. prose. Oh, hey, speaking of which, as a pharmacology student, maybe you give me some insight into the pharmacology of "bromides," taken as sedatives up until the introduction of modern barbiturates, and frequently appearing in 19th c. fiction.)
Posted by: HP | October 17, 2008 8:37 PM
Ewwwwww....
Posted by: who's yer daddy | October 17, 2008 9:01 PM
HP: Please don't think I was mocking the doctor! I wasn't having fun at HIS expense, I was having fun at the expense of the patient's testicles. :)
Of course, back then they didn't even know what cancer really WAS. And you are very correct, 'tubercule' does mean 'wormy mass', however, what we refer to as tuberculosis nowadays refers to the infection of the bacterium, rather than a specific tuberculosis of the lungs, though that is the most common infection.
I in fact think it was brilliant of him to castrate, honestly, he probably saved that man's life. Additionally, aseptic surgery was relatively uncommon at that time, and he mentions using aseptic dressing, which was probably a big influence in the patient's recovery. If he had just kept siphoning off fluid or something, the man probably would have died. I admire his willingness to recommend something so drastic. And he definitely did the best with the tools he had and the diagnoses that he knew.
The testicles themselves, however, were entirely at fault.
Posted by: scicurious | October 17, 2008 9:31 PM
PS: Bromides would be an excellent idea for a history post! Thanks for thinking of the idea! I will have to do something.
And I am also a fan of 19th century prose. We should discuss. :)
Posted by: scicurious | October 17, 2008 9:37 PM
Re. Bromides (and I realize we're getting away from the nut of the original post), one of my favorite old short stories is "The Horla," by Guy de Maupassant. I used to read it as a supernatural horror story, but the last time I read it, I was interested in the narrator's growing dependence on bromides, and wondered if that couldn't account for the character's paranoia and hallucinations.
Posted by: HP | October 17, 2008 9:53 PM