An 1868 issue of a French journal, the Bulletin général de thérapeutique médicale et chirurgical, contains this case report contributed by Paul Pamard, chief of surgery at the Hotel Dieu hospital in Avignon. Pamard was unusual among surgeons in combining his medical practice with a successful political career – and at the time of this case he was serving the last of his three terms as mayor of Avignon. After his death a fountain, decorated with a bronze bust of the former mayor, was erected in his memory in central Avignon. It is still there to this day – see the bottom of this page for a photo.
Paul Pamard came from a family of surgeons; indeed, he remarks elsewhere in this article that the operation he performed had been invented by his grandfather. His patient had only himself to blame for his unusual complaint – and so extraordinary was this case that it was later included in several surgical textbooks.
The annals of surgery contain a large number of cases of foreign bodies introduced into the bladder or into the urethra, for the purpose of stimulating organs dulled by the prolonged habit of solitary practices; but I believe the following is unique.
‘Solitary practices’ is of course a euphemism. If you need further enlightenment, read on.
On the 11th of February a 48-year-old man arrived at the hospital, sent there by Dr. Villars. He had a leaden complexion, thinning hair, flabby and puffy of flesh, presenting, in a word, the appearance peculiar to individuals indulged in masturbation.
In the nineteenth century, when masturbation was believed to be a disease (and one with potentially fatal consequences), many doctors thought they could identify one who indulged in the ‘solitary vice’ by their physical appearance.
This individual told us that he had introduced a watch spring into his urethra.
Certainly an original way of opening a conversation.
He was put on a diet and given a long bath. The following day I conducted an examination which gave the following results: the urethra was very dilated, so much so that it easily admitted the end of my little finger. I introduced a large-calibre probe; this met with resistance, giving the sensation of a foreign body, a feeling perceived especially clearly by the patient.
The foreign body was evidently deep inside the urethra: the doctor realised that it would only be possible to extract it surgically.
After administering chloroform to the patient, and placing him on the edge of a bed in the lithotomy position…
The lithotomy position, which is still sometimes used in childbirth, has the patient lying on their back, with the legs raised and slightly flexed. For many years it was also the position of choice for the operation of lithotomy (removal of bladder stones).
…I made an incision of 4 cm on the median line of the perineum.
This was a standard incision for lithotomy: the surgeon was proceeding as if removing a bladder stone. He then inserted a large metal probe into the urethra and widened the incision just enough to ensure that he could make an instrument reach inside the bladder. A thin probe with a ring at its end was then used to retrieve the watch spring.
It consisted of a steel strip 20 cm long, 1.25 mm wide, and 0.1 mm thick; it was folded in two with the end bent into a handle whose curve was lodged in the bladder; both ends showed a clear fracture, which tallied with the explanations given by the patient.
The wound was carefully washed and the patient was taken to bed.
When he woke from the anaesthetic I showed him the watch spring, asking him if he recognised it. He finally decided to make a make a clean breast of it, and told me that there remained in the bladder a clove of garlic.
Not having the necessary instruments to perform the operation, I was obliged to postpone it to the afternoon.
Dr Pamard does not give any indication of his feelings on being asked to operate twice on the same patient in the space of a few hours, but one assumes that he was not best pleased. At three o’clock that afternoon he embarked on Round Two.
I tried in vain to seize the foreign body with forceps: there was no sign of it, and I could not manage to grasp it. Then, pushing my finger into the bladder, which was easy as a result of the enormous dilation of the urethra, I found that I could feel the clove of garlic; it is notable that the patient, who seemed to have become unnaturally sensitive, was perfectly aware of every time that my finger touched the foreign body. I finally introduced a curette into the bladder, and, trapping the clove of garlic, I was able to remove it.
The clove of garlic was on the small side (2.5 cm by 1.5 cm) – but I’d argue that any size clove of garlic is too large to be stuck inside one’s bladder.
The patient remained in hospital for several weeks, his recovery complicated by an infection which caused an abscess. After prompt treatment, however, he healed rapidly.
Since then, the patient steadily improved and was discharged entirely cured on March 28th. From information that I have been able to obtain from the patient and from his family, it appears that he had a long history of masturbation. Married about fifteen years ago, he was never very ardent with his wife; he had a child after a year of marriage, but has not had another.
Dr Pamard learned from the patient that his recreational ‘habit’ dated from long before his marriage, and that he had not been able to give it up after meeting his wife.
Soon it became difficult for him to produce an erection that would allow him to engage in coitus, and when he could do so, ejaculation would be delayed for a long time. Masturbation by ordinary methods no longer satisfied him, and it was then that he resorted to the introduction of foreign bodies.
As it turned out, Dr Pamard had already encountered this man.
He had previously sought my services four years ago, when he imprudently inserted a bean into his urethra; on that occasion he refused surgery and removed it by means of the same watch spring, curved into a handle, which so betrayed him this time.
Quite the catalogue of foreign bodies.
On Sunday, February 9th, after introducing the clove of garlic into the urethra (and this was not the first time that he had done so), he tried to add some variety to his enjoyment by injecting water into the urethral canal; the result was the disappearance of the clove of garlic, which fell into the bladder.
Not entirely surprising.
He then armed himself with his watch spring; but once introduced into the urethra this snapped. Then this man, with extraordinary courage and patience, took a crooked wire and tried that instead. When it reached a certain depth, he could not push it any further, and tried to withdraw it, but its hook penetrated into the mucous membrane, and, in order to withdraw it, he was obliged to tug at it.
The wounds this caused were, the surgeon concluded, the cause of the urinary abscesses that had complicated his recovery from surgery. And thus ends the only case report in the surgical literature involving a watch spring, a bean and a clove of garlic.