Difficulty getting it down

priapism caseHere’s a painful tale from The Journal of Foreign Medical Science and Literature, published in 1823: not for children or the squeamish – and likely to make men in particular wince.

On March 17th 1822 Thomas Calloway, a London surgeon, was asked to visit a ‘healthy, muscular’ man aged 44:

On Saturday night, the 8th of March, he came home inebriated, and had connexion with his wife three times during the night, without its producing the consequent collapse of the penis, although emission each time ensued; the penis remaining firmly erect during the following day, Monday, and Tuesday.  On the Wednesday, when I was called to him, the organ was then erect, and without pain (except on very firm pressure: twelve leeches were applied, fomentations of hot water directed, and brisk cathartics used.  

The doctor also prescribed a hip bath and bleedings, but these also had no effect.  When Mr Calloway examined him, the patient had been living with this ‘condition’ continuously for nine days.  Finding that these local treatments were unsuccessful, he tried emetics and a large range of drugs:

The whole class of narcotics, as conium, hyoscyamus, opium, &c., were ineffectually had recourse to; the tobacco enema was also administered, which, although it produced its full influence in lowering the vital powers, pulse, &c., had not the slightest effect on the penis: the mercurial ointment, with camphor, was rubbed in twice a day for several days, until ptyalism [excessive production of saliva] was induced.  Still the penis remained as firm and turgid as before.

Mr Calloway decided that drastic measures were called for.  As the epic erection entered its third week, he opted to use the knife:

An opening, with a lancet, was made into the left crus of the penis, below the scrotum, and a large quantity of dark grumous blood, with numerous small coagula, escaped.  By pressing the penis, the corpora cavernosa were immediately emptied, and each side became flaccid, the communication by the pecten allowing of the discharge of the contents of both corpora, by the incision into the left crus, without there being a necessity for an opening into each of the crura.  

The incision was left open for several days; Mr Calloway’s description of this phase of recovery is probably best left unreported.  But the operation was – partially, at least – a success:

I have seen him within the last month: he has remained quite well, but informs me that he is impotent, the organ continuing collapsed, and no erection having been since produced, nor has it been acted on by venereal excitement: consequently it is not subservient to the purposes of procreation; this is most probably occasioned by a deposition of coagulable lymph in the cells of the corpora cavernosa preventing the admission of blood, and consequent distension of the organ.

Mr Calloway concludes with an observation which was no doubt of clinical interest, but was probably scant consolation to his patient.

It may be remarked, that at no time during the existence, of the priapism was there any difficulty in passing the urine.

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