Egerton Yorrick Davis and Penis Captivus

The term penis captivus describes a relatively rare medical condition in which a woman's vaginal muscles uncontrollably spasm during intercourse, trapping her partner's penis inside her vagina. The only solution to such a problem is to administer muscle relaxants to the female in question, thereby alleviating the spasms and effecting a penile escape. Case studies of penis captivus have been documented in reputable medical literature. Really.

However, this condition does not actually exist.

In reality, penis captivus started out as an elaborate hoax perpetrated by a playful physician in the late 19th century. During this time period, sexology and the study of sexual dysfunction was just beginning to come into vogue with the work of pioneers like Richard von Krafft-Ebing and later, Havelock Ellis. Of particular interest was the condition known as vaginismus, in which the muscles of the vaginal wall uncontrollably contract, making sexual penetration either very painful or physically impossible. On December 4, 1884, the Philadelphia Medical News published a letter from an ex-Army physician named "Egerton Y. Davis" which purported to describe an actual case study of a rare form of vaginismus called penis captivus (or alternatively, de cohesione in coitu). Until this point, the condition had existed as a purely hypothetical situation.

Dr. Davis recounts an unusual house call he made late one night to the home of a well-to-do patient. When Davis arrived, the gentleman explained that his coachman required the doctor's services. Allegedly, the master of the house, whilst investigating strange noises coming from the servants' quarters, had inadvertently stumbled upon the coachman and the downstairs maid mid-coitus. The maid was so surprised at the interruption that her entire body, including her vagina, just locked up. As she was apparently a very small woman, these muscular contractions held the coachman's penis in place, and no amount of pushing or pulling could disengage the couple. After several abortive attempts to use ice and lubricant to solve the problem, the good doctor dosed the woman with chloroform to relax her muscles and free the hapless coachman.

Davis goes on to describe the coachman's penis as semi-erect and extremely swollen near the top of the shaft and the glans. He admits that he did not examine the maid's genitals or anus before attempting the extraction, but suggests that sudden contraction of both her anal sphincter and the muscles in her vaginal wall had constricted the flow of blood to and from her partner's member, causing his penis to become abnormally engorged near the top and creating a "lock and key" situation. The letter concludes by quoting the infamously raunchy line from Shakespeare's Othello, along with theorizing that the biblical story of Phinehas could be explained through the penis captivus phenomenon (With a single javelin thrust, Phinehas simultaneously killed a man and a woman who had engaged in the sinful act of whoredom).

A week before receiving the letter, the Philadelphia Medical News had published an article detailing several different forms of vaginismus and suggesting that penis captivus might be physiologically possible. Thus, the journal was eager to print Dr. Davis' case study as a followup to the previous article, and did not check the veracity of the letter before publication. This oversight is understandable, as it probably would have taken a week or two to confirm the case study (at the time, communication by telegraph was limited, and the telephone was still a new invention). However, the journal never bothered to check out Davis' story even after the letter was published (one would think that someone would have requested more information).

There are several aspects of the letter that make the case study rather questionable. By today's standards, it is anecdotal at best. There are few specific details about the patients, other than a brief mention that the maid probably weighed less than 90 pounds. Dr. Davis seems more concerned with making witty literary allusions than relaying pertinent medical information. Finally, the geography of the letter doesn't quite match up. When signing the letter, Egerton Y. Davis wrote "Ex U.S. Army" after his name, states in the body of the letter that his practice is located in England, and originally sent the piece to The Canada Medical and Surgical Journal, which then forwarded it to Philadelphia Medical News. Despite these inconsistencies, Dr. Davis' informal case study was held as incontrovertible proof of the existence of penis captivus for nearly a century. It was referenced in numerous urology and sexology textbooks and medical articles.

As it turns out, there was no such person as Egerton Y. Davis. The name was a pseudonym for Sir William Osler, who served on the editorial board for the Philadelphia Medical News. Generally speaking, Osler was a staunch believer in scientific research, which ironically led him to submit the fallacious case study. The article on vaginismus that had been published the previous week was written anonymously by fellow board member Theophilius Parvin. Osler felt that Parvin had inserted too much editorial commentary and neglected medical facts when writing the article. Therefore, he devised a little prank to play on his colleague. Osler wrote the letter from Davis, forged an accompanying letter from the editor of The Canada Medical and Surgical Journal, and had a friend mail both documents from Montreal in order to obtain a legitimate Canadian postmark. Osler figured that, after the false case study was published, surely someone would recognize it for what it was, greatly embarrassing Parvin (as he was the one who decided to publish the letter as a followup to his own article) and eliciting a hearty round of laughter from the rest of the journal's staff. Much to Osler's chagrin, the medical community bought into the idea of penis captivus hook, line and sinker.

Egerton Yorrick Davis was a known pseudonym (and somewhat of an alter ego) that Osler used on multiple occasions, a fact that is well documented in his biography The Life of Sir William Osler, written by Harvey Cushing and first published in 1925. Osler carried the secret of the penis captivus debacle to his grave (he passed away in 1919), and Cushing either didn't make the connection or chose to allow Osler's hoax to continue. It wasn't until the early 1970s that physicians, curious as to why there are no documented cases of penis captivus after the 1884 letter, dug into the matter and discovered the prank.

Nowadays, most members of the medical community discount the theory of penis captivus as implausible, if not impossible. Vaginismus is a physical manifestation of a psychological condition (usually because a woman has been sexually abused in her past), and invariably occurs before penetration, not during intercourse. A few physicians (who are in a distinct minority) believe that penis captivus may be possible, but if so, the condition would certainly cease to be a problem after the man loses his erection. To this day, Osler's prank continues to live on in the form of urban legend.

Interestingly, a phenomenon similar to penis captivus does occur in other species, namely canids (such as dogs and wolves). The males of these species have a penis with a particularly bulbous head compared to human males. Due to this bulbous structure, a mating male and female may remain locked together in the copulatory position for as long as 10-20 minutes after ejaculation. This is probably an evolutionary mechanism to prevent the female from immediately running off and mating with another male.

Read more at http://everything2.com/title/penis+captivus

Occam's razor vs Hickam's dictum

Pluralitas non est ponenda sine necessitate.

— William of Occam, 14th century

In the 14th century, William of Occam stated,“Plurality must not be posited without necessity.”

Hickam's dictum is a counterargument to the use of Occam's razor in the medical profession. The principle is commonly stated: "Patients can have as many diseases as they damn well please". The principle is attributed to John Hickam, MD. Hickam was a faculty member at Duke University in the 1950s, and was later chairman of medicine at Indiana University.

When discussing Occam's razor in contemporary medicine, doctors and philosophers of medicine speak of diagnostic parsimony. Diagnostic parsimony advocates that when diagnosing a given injury, ailment, illness, or disease a doctor should strive to look for the fewest possible causes that will account for all the symptoms. However, this principle has very important limits in medical practice. The actual process that occurs when diagnosing a patient is a continuous flow of hypothesis and testing of that hypothesis, then modifying the hypothesis, and so on. In the context of this method, the principle of Hickam's dictum asserts that at no stage should a particular diagnosis be excluded solely because it doesn't appear to fit the principle of Occam's razor. The principle of Occam's razor, or parsimony, does not demand that the diagnostician necessarily opt for the simplest explanation, but instead guides the medical practitioner to seek explanations, without unnecessary additional assumptions, which are capable of accounting for all relevant evidence.

A key reason for using Hickam's dictum as a limiting principle to that of Occam's razor is, it is often statistically more likely that a patient has several common diseases, rather than having a single rarer disease which explains their myriad symptoms. Another key reason is that, independently of statistical likelihood, some patients do in fact turn out to have multiple diseases. In such cases multiple categories of diagnosis may indeed have independent causes rather than a single source; i.e. may be due to separate events or combinations of events to which the patient may have been subjected or exposed. Thus Hickam's dictum provides physicians with a counterbalancing principle to the unfettered use of Occam's razor in diagnosis.

An example of the utility of Hickam's dictum is Saint's triad of hiatus hernia, gallbladder disease, and diverticulosis. C. F. M. Saint was a British surgeon. His triad has no known pathophysiological relationship, nullifying the usefulness of Occam's razor. Hickam's dictum is similar in principle to William of Chatham's anti razor

The Discovery of Insulin

The story of the discovery of insulin has been well chronicled beginning with a young physician, Frederick Banting, in London, Ontario, imagining that it might be possible to isolate the internal secretions of the pancreas by ligating the pancreatic ducts to induce atrophy of the acinar cells and thereby minimize contamination of the tissue extract with digestive enzymes. Banting presented his suggestion to J. J. R. Macleod, a distinguished physiologist at the University of Toronto who provided Banting with a laboratory for the summer and some dogs for the experiments. Macleod was initially skeptical, but eventually agreed to let Banting use his lab space while he was on vacation for the summer. He also supplied Banting with ten dogs to experiment on, and two medical students, Best and Clark Noble, to use as lab assistants, before leaving for Scotland. Since Banting only required one lab assistant, Best and Noble flipped a coin to see which would assist Banting for the first half of the summer. Best won the coin toss, and took the first shift as Banting's assistant. Loss of the coin toss may have proved unfortunate for Noble, given that Banting decided to keep Best for the entire summer (and eventually shared half his Nobel Prize money and a large part of the credit for the discovery of insulin with the winner of the toss)

During the summer of 1921, Banting and Best made remarkable progress, and by fall they had isolated material from pancreas extracts that dramatically prolonged the lives of dogs made diabetic by removal of the pancreas. In the winter of 1922, Banting and Best treated their first human patient, a young boy, who's life was saved by the treatment. This was a stunning accomplishment. Consider that from the start of the research in the summer of 1921 to treating a human patient successfully in the winter of 1922, the pace, especially by current standards for clinical treatments, was remarkable.

With that achievement, Macleod, who had been initially unenthusiastic about the work, assigned his entire laboratory to the insulin project. He also enlisted the Eli Lilly Company to aid in the large scale, commercial preparation of insulin although the University of Toronto received the patent for insulin production. By 1923, insulin was available in quantities adequate for relatively widespread treatment of diabetes. Although the success of the insulin project was remarkable, the rewards for the research workers were, it seems, quite controversial. The 1923 Noble Prize in Physiology or Medicine was awarded to Banting and Macleod. Apparently, Banting was annoyed at the omission of Best and gave him half of his share of the prize. There was also, perhaps, the feeling that Macleod had done little in the initial stages of the work and was an undeserving recipient. Macleod split his share of the Prize with J. B. Collip who had made contributions to the later stages of the work on insulin purification.

After the spectacular events of 1921–1923, the University of Toronto established the Banting and Best Department of Medical Research separate from the University. Banting accomplished little during the rest of his career and died in a plane crash in 1940. Best, however, had a long successful tenure at the University of Toronto working on insulin and subsequently other important topics including the importance of dietary choline and the development of heparin as an anticoagulant.

Read more at The Discovery of Insulin: the Work of Frederick Banting and Charles Best Robert D. Simoni, Robert L. Hill and Martha Vaughan /The Journal of Biological Chemistry,