Cello scrotum, 1974-2009: history of a medical hoax.

UNLABELLED: News services recently broke the story of a medical hoax perpetrated through the literature involving purported urological symptoms of cellists, referred to as "cello scrotum". The background of this affair was researched in order to place it in an historical perspective. METHODS: The originators of the hoax were interviewed. Literature and internet searches were performed to sift fact from fiction. RESULTS: "Cello scrotum" was a descendant of some very legitimate musicians' maladies, which have been described over the past three centuries. From 1974, when it was first described, until 2009, when it was officially retracted, "cello scrotum" approached the status of an urban legend. CONCLUSIONS: The "cello scrotum" affair should not detract from the very real medical ailments of serious musicians. The entire subspecialty of performance medicine has evolved to treat patients with these concerns.

Fournier's gangrene: historic (1764-1978) versus contemporary (1979-1988) differences in etiology and clinical importance.

Experience with 11 cases of Fournier's gangrene during the decade 1979-1988, prompted this review of the English language literature to determine whether there have been changes in demography, etiology, and outcome, as compared to cases dating to 1763. All cases were evaluated according to age, sex, bacteriology, etiology, and outcome. In the decade 1979-1988, 449 cases were reported. The average age of the patients was 49.8 years; with 14 per cent occurring in females. Synergistic polymicrobial infections were present in all cases. The most commonly reported etiologies were colorectal (33%), idiopathic (26%), and genitourinary (21%). Mortality associated with colorectal etiology was highest (33%, p < 0.05). Female mortality (49%) was not significantly greater than male mortality (17%), when obstetrical etiology was excluded. Overall mortality was 22%. Comparison with 386 cases of Fournier's gangrene reported between 1763 and 1978 reveals that the mean age of patients remains relatively low, and males continue to predominate. The pathophysiologic aspects of this disease appear similar in both sexes. The mortality rate from colorectal sources is significantly greater than from other common causes. Neither the introduction of antibiotics nor the development of newer ones has reduced mortality significantly. In spite of newer diagnostic techniques, the etiology remains unclear in over one-fourth of cases.

The Charles procedure: misquoted and misunderstood since 1950.

The Charles procedure, named for Sir Richard Henry Havelock Charles, is an eponym for a surgical treatment of leg lymphedema. Sir Havelock led a fascinating life, with his travels taking him to India, the Afghan territories, and the Court of King George V of England. At the turn of this century, Sir Havelock published material describing a series of 140 consecutive patients treated successfully for scrotal lymphedema. In a book chapter published a decade later, entitled "Elephantiasis Scroti," Sir Havelock briefly described the treatment of leg lymphedema but did not document a single successful case report. The name of Sir Havelock Charles was absent from the literature until 1950, when Sir Archibald McIndoe attributed the treatment of leg lymphedema with radical excision and skin grafting to Sir Havelock. References to Charles for the treatment of leg lymphedema have proliferated since that time.

[Urology and Psychosomatics. A historical summary]. / Urologie und Psychosomatik. Ein geschichtlicher Abriss.

The investigation and description of psychosomatic interrelationships has a long tradition in the field of urology. At the beginning of last century, psychosomatic theories and therapies involving urologic questions were developed, some of which are still part of current therapeutic strategies. Numerous studies accentuated the need for a psychosomatic diagnostics and therapy of urologic diseases. The appreciation of psychosomatic urology is growing, a fact which is reflected in current urological teaching curricula.

Treatment of "hernia" in the writings of Celsus (first century AD).

Descriptions concerning "hernia" can be found from the early historical years, and its treatment was a subject mentioned by numerous physicians of Antiquity, such as Hippocrates and Praxagoras of Kos. Yet, Aulus Cornelius Celsus, a famous doctor and encyclopedist of the first century AD, was among the first to propose surgical treatment and carry it out successfully, according to his accounts. Many physicians attempted to treat several types of "hernia" before him, but more "scientific" information with details and complete descriptions could be found only in Celsus' work. In his book De Medicina, Celsus described eight types of "hernia": bronchocele, umbilical hernia, intestinal and omental hernias, hydrocele, varicocele, sarcocele (hernia carnosa), and inguinal hernia. Among them, some retain their ancient nomenclature up to now, although others have acquired gradually different terminology or are not recognized by physicians today as "hernias" (e.g. , bronchocele). For each type of "hernia", Celsus provided his readers with an extremely detailed, well reasoned description of the execution of surgical procedures accompanied usually with pre- and postoperative instructions. His innovations particularly concerned ligature of the vessels. He recommended that an injured vessel be tied in two places with lint threads and then cut between the ties. Other pre- and postoperative practices, such as sterilization and bandaging of the incised area, were elements that helped in the advances of medicine, and some of them still exist in modern medicine.

[Bernard Schapiro--an orthodox Jew as an early andrologist in the 20th century]. / Bernhard Schapiro--Ein orthodoxer Jude als früher Androloge im 20. Jahrhundert.

The unusual history and professional background of one of the first andrologists is reported. Bernhard Schapiro, born in 1888 in Dvinsk in Latvia, then a city in the Russian Pale of Settlements for Jews, grew up as an orthodox (hassidic) Jew receiving exclusively talmudic lessons until he was 18 years old. During the final years of this period of life he was educated at the famous Slobodka Talmud Academy Kenesset Israel in Kovno where he absorbed the ideals of Musar-doctrines, thus being influenced for the rest of his life. The Rogachover Gaon J. Rozin supported his desire to study medicine. After a brief stay in Frankfurt/Main he acquired by own efforts the necessary general knowledge to matriculate for access to university. Medical studies at Zurich University (1913-1919) were followed by a one-year-internship at a dermatologic department in Breslau/Silesia. The thesis for his doctorate at Zurich University in 1920 was on, Relations between Nodular Erythema and Tuberculosis'. He spent two years training in dermatology at Breslau University under Jadassohn. Back in Berlin, he married and had four children, while he worked at Magnus Hirschfeld's Institute for Sexual Sciences. After initial clinical studies in venerology he more and more turned to andrological problems, including treatment of underdeveloped male genitals, premature ejaculation and impotence in general. In this context he tested the new drug Praehormon and developed the two remedies Testifortan and Praejaculin. He was the first to describe the effect of anterior pituitary lobe hormone on the descent of cryptorchid testicles, thus initiating a treatment modality still in motion today. When Hitler came to power he and his family were spared as Swiss citizens, but he lost his base for working after the Institute was looted. He established an andrologic practice at Zurich. What he had witnessed in Germany caused him to set up a Swiss branch of Mizrachi, the spiritually based center of Zionism in Switzerland. He left Europe in 1940 for New York/USA. After compulsory repetition of medical exams in a new language he managed to establish a new existence as andrologist. His practice flourished, the more as he was trusted to treat Jewish patients according to Jewish Law. The decisive step brought him to Jerusalem, in 1951, where he founded and headed an Endocrinologic Department of the University, pursuing andrologic questions, until his death on December 31, 1966. What actually controlled his life can be read on his tombstone: 'He remained a pupil of Slobodka all the days of his life'.

A reappraisal of non-specific genital infection with reference to the work of the late Dr E. Weston Hurst.

It is easy to overlook work that is before its time, especially if it has been done in the recent past. In his animal experimental work with Chlamydia spp, the late Dr E. Weston Hurst found that although he was able to effect a clinical cure in his intraperitoneally infected mice, he was unable to eradicate their infections. As his work appears to have relevance to today's growing problems concerning genital infections associated with chlamydiae, it should not fall into obscurity.