A hoax perpetrated in humor by Sir William Osler turned out to be the most cited case of this phenomenon.
The correspondence which follows was published by the Philadelphia Medical News, December 4, 1884, and signed by Egerton Y. Davis, Ex. U.S. Army.
"Through the courtesy of the editor of The Canada Medical And Surgical Journal, we are in receipt of the following note:
"Dear Sir: The reading of an admirably written and instructive editorial in the Philadelphia Medical News for November 24 [actually November 29] on forms of vaginismus, has reminded me of a case in point which bears out, in an extraordinary way, the statements therein contained. When in practice at Pentonville, England, I was sent for, about 11:00 P.M., by a gentleman whom, on my arriving at his house I found in a state of great perturbation, and the story he told me was briefly as follows:
"At bedtime, when going to the back kitchen to see if the house was shut up a noise in the coachman's room attracted his attention, and, going in, he discovered to his horror that the man was in bed with one of the maids. She screamed, he struggled, and they rolled out of bed together and made frantic efforts to get apart, but without success. He was a big, burly man, over six feet, and she was a small woman, weighing not more than ninety pounds. She was moaning and screaming, and seemed in great agony, so that, after several fruitless attempts to get them apart, he sent for me.
"When I arrived I found the man standing up and supporting the woman in his arms, and it was quite evident that his penis was tightly locked in her vagina, and any attempt to dislodge it was accompanied by much pain on the part of both. It was, indeed, a case 'De cohesione in coitu.' I applied water, and then ice, but ineffectively, and at last sent for chloroform, a few whiffs of which sent the woman to sleep, relaxed the spasm, and relieved the captive penis, which was swollen, livid, and in a state of semi-erection, which did not go down for several hours, and for days the organ was extremely sore. The woman recovered rapidly, and seemed none the worse.
"I am sorry that I did not examine if the sphincter ani was contracted, but I did not think of it. In this case there must have been spasm of the muscle at the orifice, as well as higher up, for the penis seemed nipped low down, and this contraction, I think, kept the blood retained and the organ erect. As an instance of Iago's 'beast with two backs," the picture was perfect. I have often wondered how it was, considering with what agility the man can, under certain circumstances, jump up, that Phineas, the son of Eleazar, was able to thrust his javelin through the man and the Midionitish woman (vide Exodus); but the occurrence of such cases as the above may offer a possible explanation.
Egerton Y. Davis,
Ex. U.S. Army"1
The previous case is often noted in articles and textbooks as the authoritative case of penis captivus. Two questions are brought to mind by this interesting case history. What is penis captivus, and who was Egerton Y. Davis?
The condition of penis captivus has been reported in the literature for many years, although descriptions vary somewhat as to predisposing factors, anatomy, and physiologic mechanisms involved. The famous obstetrician Scanzoni2 felt that the vagina contracted and locked the penis in. (Scanzoni is probably most famous for his vitriolic attacks on Semmelweis after Semmelweis suggested that obstetricians wash their hands prior to examining a patient.) It was in 1872 that Hildebrandt3 first suggested that the mechanism consisted of a spasm of the levator ani muscle and spasm of the constrictor cunni muscles (bulbospongiosi). Hildebrandt also gave a case history from his gynecologic practice that was similar, although not an exact duplicate, to the case described by E.Y. Davis. In Hildebrandt's case the female had been suffering from vaginismus (spasm of the bulbospongiosi, preventing entrance of the penis) since her wedding night and was said to be a very nervous and excitable person. However, Hildebrandt stated that the couple freed themselves after their unfortunate experience with penis captivus and he had only the history that the woman had given to him.
The anatomy involved is well described by Lachman,4 who in a recent letter to JAMA appeared to accept the documentation of cases of penis captivus. He states that the pubococcygeus part of the levator ani is the most important muscle in this condition, although the bulbospongiosus and the urogenital diaphragm also contribute. Lachman feels that the contraction of the muscle tissue in the vagina contributes little to the condition. The mechanism is described5 as being a dilation of the inner two thirds of the vagina (caused by the elevation of the uterus into the false pelvis6) and a constriction of the lower third by the muscles mentioned above. This then causes venous engorgement of the penis and the formation of a "lock and turned key" situation with the engorged penis being inside a dilated cavity yet being pulled against a narrowed orifice in the attempt to remove the organ from the vagina. The fact there is generalized muscle spasm during sexual intercourse has been well documented by Masters and Johnson.7 The theory that the perineal muscle spasm was the result of spread from other muscle spasms was probably first postulated by Hildebrandt in his article.8
Most authors agree that the condition of penis captivus is found only in cases where the female has a prolonged history of vaginismus. When penis captivus occurs it is necessary for the spasm of vaginismus to begin after the act of penetration has been successfully completed. Supposedly the vaginismus has a psychologic etiology. It is this point of time relationship and the male reaction to the spasm that causes the authors' doubts as to the validity of penis captivus as a true entity. Vaginismus is, indeed, a well-known clinical entity, but in the original article9 that gave the name "vaginismus" to this condition of perineal muscle spasm the type of vaginismus described by Davis and Hildebrandt was not mentioned. The original cases of vaginismus all happened in women who had muscle spasm of severe degree at the first attempt at sexual intercourse. It is the senior author's personal opinion that it is highly improbable for spasm of the pubococcygeus and bulbospongiosus to be severe enough after penetration to cause penis captivus. We also feel that the normal male response to a contraction of this type would be relaxation of the penis, allowing withdrawal.
|Question||RESPONSES||FACULTY||RESIDENTS & INTERNS|
|If you saw this case history in a journal, would you believe it?||YES||4||3|
|Have you ever heard of penis captivus before?||YES||8||6|
|Have you ever seen a case yourself?||YES||0||1*|
|Do you believe such a condition is possible? (i.e., can the ovator ani spasm with such strength and duration to physically lock the penis and vagina?)||YES||4||4|
To return to the second of our original questions, we ask, "Who was Egerton Y. Davis?" The answer is supplied by Sir Harvey Cushing in his famous work, The Life Of Sir William Osler.10 Cushing states that Egerton Y. Davis was Osler's "fanciful half, who first and last got him into a good deal of trouble." Osler was on the editorial board of Medical News with Theophilus Parvin, an obstetrician who had a tremendous interest in spasm of the perineal muscles. Parvin had written an editorial11 on the subject and published it anonymously in the magazine. Osler was a pioneer among those who felt that research and scholarly thought were essential in medicine, but he should be studied with equal diligence. This feeling was evident in the content of most of the publications printed in Medical News. The magazine had reports and lectures on diagnosis and therapeutics that would be practical for the physician of the times. Evidently Parvin was more ascetic in his view of medicine and used his position on the editorial board (a board that never published the names of its members) to insert an editorial on his favorite minuscule aspect of medicine. No one knows what Osler's exact thoughts were when he read the editorial, but we can surmise that he considered it of little value to the physicians who read the journal. Osler then planned to embarrass the pompous Parvin so he wrote the fictitious case history, signed it "Egerton Y. Davis," and had it mailed to Medical News from Montreal. Soon after the letter had been received by Parvin the following conversation took place between Osler and Minis Hays, the editor:
"By the way, do you know Egerton Y. Davis who lives somewhere near Montreal? Parvin is delighted as he has sent the report of a case just as he thought possible."
"Hays, for Heaven's sake, don't print anything from that man Davis: I know he is not a reputable character..."
"Too late now. The journal is printed off."12 The "authoritative case history" of penis captivus was nothing more than a hoax designed to embarrass a pompous obstetrician and perpetrated by none other than Sir William Osler.
To get an idea of how far entrenched as fact in the minds of physicians Osler's hoax has become, a copy of the original case history was mailed to a random sample of faculty and house staff members at Vanderbilt University Hospital. Eleven faculty members and thirty house staff members received this history. We received replied from ten faculty and seven house staff (Table 1). Egerton Y. Davis would be pleased!
1. Correspondence, Med. News 45:673, Philadelphia, Dec. 4, 1884.
2. Scanzoni, F.W.: Beitrage zur Geburtskunde und Gynakologie 7:1,
3. Hildebrandt: Archiv fur Gynakologie 3:221, 1872.
4. Lachman, E.: Anatomy as applied to clinical medicine. The New Physician 16:301, Nov. 1967.
5. Hildebrandt, op. cit.
6. Masters, W.H. and Johnson, V.E.: Human Sexual Response (London: Churchill Ltd, 1966), pp. 71-73.
7. Masters, W.H. and Johnson, V.E., ibid., pp. 7, 27.
8. Hildebrandt, op. cit.
9. Sims, J.M.: Trans. Obstet. Soc. London 3:356, 1861.
10. Cushing, H.: The Life of Sir William Osler (London, Oxford U.P. 1925), vol 1, pp 240-241.
11. An Uncommon Form of Vaginismus, Med. News, 45-602, 1884.
12. Cushing, H., op. cit.