Pricked it all over with a fine needle

I recently came across the online archives of the Bristol Medico-Chirurgical Journal, the in-house publication of the Bristol Medico-Chirurgical Society. The society was founded in Bristol around 1874 and is still very much in existence – as is its journal, albeit in electronic form. In the very first volume of the BMCJ, published in 1883, can be found this arresting headline:

case of priapismA.H. Boys was a physician at the St Albans General Dispensary in Hertfordshire. Like most of his contemporaries he seems to have been a true generalist: his publications are scanty, but deal with subjects as varied as dermatology and tuberculosis. For a decade he was also the superintendent of a private lunatic asylum for women.

W.S., aged 65, gardener, came to see me on the 12th May, 1883, complaining of an erection of the penis which had already lasted a week.

This is the condition known as priapism. Generally speaking, there are two varieties: ischaemic and non-ischaemic. In ischaemic priapism, blood is trapped inside the penis and cannot escape. This is the more dangerous and painful form of the condition, since the tissues of the penis rapidly become starved of oxygen (ischaemic) and – without prompt medical intervention – may become necrotic and die. In non-ischaemic priapism, the problem is caused by a malfunction of the mechanism causing an erection in the first place: blood continues to flow through the erectile tissue, so necrosis is much less likely to occur.

The history was that while riding a horse it ran away with him, and the unusual exertion had rubbed the skin off the nates, there was also considerable bruising of the gluteal region generally. The next morning he had an erection (a rarity with him) which had lasted ever since.

Both ‘nates’ and ‘gluteal region’ are medical terms for the buttocks. It may sound unlikely that riding a frisky horse could have anything to do with a persistent erection, but it’s actually quite plausible. Injury to the perineum (the area between genitals and anus) is a common cause of priapism – and this patient’s riding injury was evidently quite a nasty one, given that he had skinned his buttocks.

He had had sexual intercourse in the hopes it would disappear, but that seemed to make it worse; he also suffered a good deal of pain.

There aren’t many medical conditions for which ‘having sex’ seems a reasonable shot at a cure, but this is certainly one of them.

On examination I found the whole penis swollen, red and oedematous, and it looked at first sight as if he had a paraphimosis…

Oedema is fluid retention, often manifesting as swelling. Paraphimosis is a painful condition when the foreskin becomes trapped around the base of the glans.

…this was in consequence of the foreskin (which was naturally retracted) at the base of the glans being so puffy and oedematous. I at first ordered a cold lead lotion to be constantly applied, and gave him a mixture containing ten grains of bromide of potassium every three hours.

Potassium bromide, known colloquially as bromide, was the first effective drug for epilepsy. It is a sedative and was also administered to suppress sexual urges (although reports of the British Army adding it to tea for the same purpose are probably apocryphal). So it’s easy to see why Dr Boys tried it in this case. True priapism, however, is a physiological condition usually caused by a malfunction of the blood vessels or nerves involved with the mechanism of erection – so is not likely to be affected by a sedative.

In five days there was no improvement. I then pricked the penis all over with a fine needle…


…Serum flowed abundantly, so I ordered hot bathing, poultices, &c., hoping to encourage the flow of serum, and so reduce the tension on the whole organ.

This had no effect, so the doctor ‘thoroughly cleared out’ the patient’s bowels with doses of powerful laxatives including calomel, a compound of mercury which was truly unpleasant in its effects.

The man is temperate; rather prematurely aged. He had a slight attack of bronchitis, also slight hemiplegia about six months before, but there are no signs of paralysis now, and with the exception of the persistent erection of the penis, together with the pain in that organ, and consequent irritability of temper, he is quite well.

The ‘slight hemiplegia’ is intriguing and suggests a minor stroke.

The hot treatment failing to produce relief, I again applied cold, in the shape of ice, to the penis and scrotum, a mustard plaster to the spine, giving him internally ten minims of tincture of belladonna every three hours.

The mustard plaster was a measure from the once-fashionable (but by the 1880s rather antiquated) medical doctrine of counter-irritation – the idea being, essentially, to combat inflammation in one part of the body by provoking it in another.

On the 22nd May, ten days after he came to me, Dr. Shingleton Smith saw him with me. He suggested belladonna suppositories, each containing half a grain of that drug. One was ordered to be inserted every four hours.

Belladonna is deadly nightshade, which was commonly used in medicine for centuries. It is also notable for being highly toxic. Suppositories are usually inserted into the anus; however, in this case there appears to have been a failure of communication:

I visited him on the 24th, when he assured me he could not use the suppositories as they caused so much pain, but on more minute enquiry I discovered to my horror he had been vainly struggling to push a large suppository down his penis!

Ow, ow, and more ow. This sounds a mighty uncomfortable thing to attempt.

From this date, however, they were used properly and persistently, in conjunction with a pill containing two grains of iodoform and a grain and a half of extract of conium.

Iodoform was used as an antiseptic and is relatively innocuous; conium, however, is an extract of the notoriously toxic plant hemlock. Its active ingredient is coniine, which can act on the nerves and muscles to cause a condition known as flaccid paralysis. And flaccid is what the patient’s member gradually became:

In about three days there was a decided improvement, the penis gradually recovered its normal condition, till at the end of three weeks there was no trace of its recent turbulence.

The doctor clearly thought that the combination of medications was what had cured his patient. It seems more likely that he simply experienced a spontaneous remission of symptoms as the riding injury healed. Whatever the truth of the matter, deadly nightshade and hemlock should be considered as DEADLY POISONS rather than plausible treatments for sexual dysfunction.

Veins of the penis, from Gray’s Anatomy (1918)

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