Historical Vignette: Attempted treatment of Sigmund Freud's oral squamous cell carcinoma by vasectomy (Steinach Operation) in 1923.

BACKGROUND: At the beginning of the 20th century, the Viennese physiologist Eugen Steinach proposed to treat the effects of physiological ageing by vasectomy. After experimenting his theory with animal, he published his results, and convinced scientists to apply this method to humans (ie men). The scientific community has been convinced by these pictures of the interest of these vasectomies, and many patients undergo it for the purpose of physical, mental and sexual rejuvenation, including Sigmund Freud. OBJECTIVES: The aim of this study is to explain How Sigmund Freud decided to do this operation. MATERIALS AND METHODS: We read and analysed a set of articles and books about Sigmund Freud live and the rejuvenation theory with the help of Sigmund Freud Museum (London). RESULTS: Freud suffered from a cancer of the right maxillary diagnosed in 1923 for which he underwent a first surgery of excision on April 20, 1923 followed by radiotherapy and a lot of another surgery to treat reccurences. Probably in despair or wanting to heal himself, he decided to have a Steinach vasectomy. DISCUSSION: Sigmund Freud knew Steinach's theories through his scientific publications, including his work on the «treatment of homosexuality¼ (sic!); he even tended to believe that biological methods were more reliable for «treating homosexuality¼ than his psychoanalyses. Because cancer was considered a disease of old age, vasectomy rejuvenation seemed to be useful (and potentially effective) in treating cancer, according to Freud. CONCLUSION: Even Sigmund Freud, who was a great scientist, was fooled by the scientific results of a badly conducted study. We must keep a critical eye on new medical developments.

Medical Rejuvenation in Georgia in the past: the Sukhumi Station.

If youth and body appearance enhancement is as old as Homo Sapiens, reliable medical technology for such activities is only about 100 years old. At the dawn of the 20th century, surgical operations performed under the Voronoff's treatment plan (monkey gonads' tissue grafting into humans) or the Steinach's technique (vasoligation) offered a promise of longevity, beauty and therefore youth restoration. The many links with a newly recognized discipline, endocrinology, offer a critical insight on the strong interactions between medicine and surgery in the promise of successful antiaging. On the front-line of scientific research, the Institute of Experimental Endocrinology's primate station in Sukhumi (West Georgia, now Abkhazia, on the Black Sea coast) developed a leadership role in the medical research, including rejuvenation with testis' tissues. Authors focus their attention to the everlasting commitment to experimental and clinical research as developed by Sukhumi scholars and the related moral, practical and ideological implications.

Male contraception: past, present and future.

Current contraceptive options available to men include withdrawal, condoms, and vasectomy, each of which has its own drawbacks. In this chapter we will describe the pros and cons for each, as well as methodological and product updates. Statistics from the U.S. Centers for Disease Control on acceptance and satisfaction will be included. Advances in vasectomy and reversal will be presented. Methods to develop new contraceptive technologies fall into two categories: hormonal and non-hormonal. Many targets and strategies have been proposed for non-hormonal male contraception within the testis. Targets include structural components in the testis, as well as enzymes, ion channels and other proteins specific to spermatozoa. Here we provide an overview of the spermatogenic mechanisms and proteins that have received research interest to date. We also discuss potential novel targets, such as ubiquitin specific proteases, that warrant greater research emphasis.

La Medicina Sexual en la Historia. Avances y controversias (Parte II) / Sexual Medicine beyond History. Advances and controversies (Part II)

El recorrido histórico de la Medicina Sexual y la Andrología por los 2 últimos siglos permite ver cómo el desarrollo científico se ha acelerado hasta un nivel que hubiera parecido imposible a nuestros predecesores. A ello han contribuido en gran parte los logros en la comprensión de la fisiología y, desde luego, la cirugía, con el descubrimiento de la anestesia y el control de las infecciones y la hemostasia, pero, sin duda, también han sido parte importante en esta historia la nueva mentalidad de trabajo en equipo y el intercambio de información, disponible de modo cada vez más dinámico y con una amplitud insospechada tan solo hace unas décadas. Por otra parte, estos avances en muchas ocasiones no han sido fáciles para quienes los han impulsado, y diferentes controversias han puesto de relieve tanto la necesidad de veracidad en la investigación realizada como la perseverancia ante las dificultades e incomprensiones. Por ello, el presente trabajo de investigación intenta recuperar la importancia del factor humano y las decisiones personales como ejes clave del avance científico, también en lo que corresponde al estudio y tratamiento de los problemas de la sexualidad humana (AU)

The historical journey of Sexual Medicine and Andrology over the last 2 centuries makes it possible to illustrate how scientific development has grown to such a level that would have seemed impossible to our ancestors. This growth has largely contributed to the understanding of the physiology and, of course, the surgery, with the discovery of anesthesia, infection control and hemostasis. However, undoubtedly, the new culture of teamwork and the new possibilities of an increasingly dynamic exchange of information having an extension that was unsuspected only a few decades ago has also played an important part in this history.Moreover, in many cases these advances have not been easy for those who have encouraged them. Different controversies have highlighted both the need for accuracy in the research and perseverance against difficulties and misunderstandings. Therefore, the present research work has tried to recover the importance of the human factor and personal decisions as a key to scientific advance, as well as in that corresponding to the study and treatment of the issues of human sexuality (AU)

Historical approach to the surgical treatment of erectile dysfunction.

INTRODUCTION: Throughout human history, erectile dysfunction has represented one of the most omnipresent health problems. This has resulted in a search for solutions that, one after the other, have been shown to be fruitless. In this context, the emergence of possible surgical solutions at the start of the 20th century represented a revolution that, even then, would take several decades to demonstrate their effectiveness. ACQUISITION OF EVIDENCE: We performed a literature review that shows the process in the development of potential surgical treatments for hormonal restoration for erectile dysfunction, followed by the sudden emergence of vascular surgery, with new anastomosis techniques, and in the future, the development of penile prosthetic implants as alternative treatments. SUMMARY OF THE EVIDENCE: The publication of results from erectile dysfunction surgery has been lagging for decades due to a lack of objectivity, given that sexual function is a topic restricted by patients' privacy. This situation has led to a reliance on results reported by various authors whose actual credibility could not be verified, with subsequent demonstrations showing that some of these results were not reproducible. CONCLUSIONS: This article reviews some of the most important milestones in the progress of surgeries designed to treat erectile dysfunction. The achievements and apparent failures provide a reason for reflection on how we far we have come and how far we can go in the near future.

A brief history of rejuvenation operations.

PURPOSE: We discuss the place in history of operative procedures for hormonal rejuvenation. MATERIALS AND METHODS: The scientific and historical literature was reviewed. RESULTS: In the early 20th century, building on the earlier work of Berthold and Brown-Séquard, Eugen Steinach developed a combination of vasectomy and vasoligature that became known as the Steinach operation. This procedure, along with testicular implantation popularized by Serge Voronoff, was an attempt to rejuvenate older and fatigued men around the world. The early experiments and results of Steinach, Voronoff and their followers were plagued by secrecy, subjectivity and sensationalism in an effort to produce the most scientific data. These rejuvenists used their results to outcompete one another. Ultimately the lack of verifiable outcome data and the chemical isolation of the "internal secretion" (testosterone) ended this era in surgery. CONCLUSIONS: Always a work in progress, the practice of medicine has been guided by human curiosity with trial, error and success. History records aberrant paths along the way and the rejuvenation movement was one such journey. While superseded by later knowledge, the efforts of the rejuvenists comprise an interesting chapter in the development of urology, endocrinology and transplant surgery.

State-of-the art of non-hormonal methods of contraception: VI. Male sterilisation.

A systematic Medline/PubMed and Cochrane Library review of the literature was carried out with regard to technique, effectiveness, safety and complications of male sterilisation. Vasectomy is an outpatient procedure which can be performed under local anaesthesia. The vas deferens is accessed by means of either a conventional incision with a scalpel or by using the 'no-scalpel technique'. A closed-ended vasectomy (by means of suture ligature, surgical clips or electrocautery) or the open-ended alternative is then carried out. Each of these techniques has both advantages and drawbacks. Fascial interposition has been shown to reduce the risk of failure. A promising alternative for occluding the vas consists of placing an intra-vas device. Haematoma and pain are the most common complications. Non-steroidal anti-inflammatory drugs, narcotic analgesics and neuroleptic drugs are effective for treatment of pain. The success of vasectomy reversal ranges from 30-60%. The data on record convincingly demonstrate that vasectomy is a safe and cost-effective intervention for permanent male contraception. The no-scalpel vasectomy under local anaesthesia is recommended. Occlusion of the vas is most successful when performed by means of an electrocautery; fascial interposition should complete the procedure.

History of vasectomy.

Vasectomy as a medical term is a misnomer because only part of the vas deferens is excised during the procedure. Vas deferens as an anatomic structure was not a subject of significant clinical and research interest until the nineteenth century. It is difficult to find another surgical procedure as simple as vasectomy that has sparked so much medical and social controversies for more than a century. Vasectomy is a historical, social, philosophic, medical, demographic, and legal phenomenon. It is not surprising that the history of this procedure combines not only a constant quest for ideal technique and better results but also misconceptions, false beliefs, and erroneous indications.

Injection, ligation and transplantation: the search for the glandular fountain of youth.

PURPOSE: During the 19th and early 20th centuries there was great interest in antiaging remedies. This search for the eternal fountain of youth stemmed from the concept of aging as a pathological condition that destroyed the body and mind. In addition, great emphasis was placed on the economic challenge that the elderly presented to society. We examine the history of antiaging therapies from the perfection of cell nutrition to glandular transplants. MATERIALS AND METHODS: A literature review was performed including direct first person sources such as historical documents, letters of correspondence, newspaper articles and journal publications. Historical texts were also consulted for accuracy. RESULTS: The history of antiaging medicine includes a variety of remedies. E. Metchnikoff advocated a diet rich in lactic acid which he thought would eradicate the body of intestinal putrefaction and decay. Others believed the fountain of youth lay within the endocrine system. C. E. Brown-Sequard linked the decrease in sexual function with the aging body and claimed he could restore a youthful state with the injection of a mixture of animal sex glands. The compound Spermine was subsequently marketed as an injection that promised the effects observed by Brown-Sequard. The early 20th century was marked by a number of surgical attempts at the restoration of youth. L. L. Stanley reported on more than 643 inmates at the San Quentin prison on whom he had performed testicular transplantation. This idea of gland grafting gained international interest and led others such as S. Voronoff to experiment with the transplantation of various animal glands into humans. In addition to gland grafting, vasoligation was advocated by E. Steinach in an effort to direct sperm from the testicles back to the body. The Steinach operation was claimed to restore youth and vigor. Although most physicians directed their attention toward remedies for men, some came to advocate remedies for women including ovarian transplantation and radiation. CONCLUSIONS: The search for the glandular fountain of youth ultimately led to the discovery of testosterone. The modern day interest in plastic surgery, testosterone replacement and growth hormone injection underscores the concept of aging as a disease process. We have yet to determine whether aging represents physiology or pathology. However, it is certain that the search for the fountain of youth will continue.

'Dr Steinach coming to make old young!': sex glands, vasectomy and the quest for rejuvenation in the roaring twenties.

In the 1920s, research on the endocrine glands--especially the sex glands--was widely expected to lead to revolutionary new ways of improving human life. The medical marketplace was crowded with glandular techniques to revitalize the aged. 'Monkey glands' apart, the Austrian physiologist Eugen Steinach's simple, vasectomy-like operation was perhaps the most popular of these. Steinach was one of the leading endocrine researchers of the early 20th century and the Steinach Operation was based on rigorous laboratory research. It was much more than a simple scientific error, and its history shows us how early endocrine research was shaped by broader social and cultural forces.

Versemaking and lovemaking--W. B. Yeats' "strange second puberty": Norman Haire and the Steinach rejuvenation operation.

This article examines the Steinach rejuvenation operation (a vasectomy) which Norman Haire performed on W. B. Yeats in 1934: while this method is now discredited, many others are still used in similar attempts to "cure" old age and restore youthful vitality. The article deals substantially with ideas which were popular among well-read people and intellectuals in the 1920s and 1930s and discusses whether the poet's late-in-life burst of creativity was caused by a medical breakthrough, Haire's more general medical advice, the placebo effect, or by a combination of factors: questions which still have relevance to theories about age, sexuality, and mind-body relationships.

Rejuvenation in the early 20th century.

The first theoretical reflections concerning the relation of hormone production with the ageing process stemmed from Charles Edouard Brown-Séquard (1817 1894). At the age of 72 years he experimented on himself with an injection of animal testicular extract. The Viennese physiologist Eugen Steinach (1861 1944) gained world-wide acknowledgement for his theory of 'autoplastic' treatment of ageing. He deduced that after vasoligation, an increased incretory hormonal production would ensue following the cessation of the secretory output of the gonads. The first operation was performed in 1918 and resulted in a vasectomy boom over the next two decades. The Russian Serge Voronoff (1866 1951), working in Paris, was one of the first to transplant testicular tissue from a monkey into a human reproductive gland in 1920. Five years later he had already performed this procedure on 300 patients and attracted patients from all over the world. In America early efforts of human testicular transplantation were performed by Frank Lydston and V.D. Lespinasse. Steinach's vasoligation was taken over by many American doctors, e.g., Harry Benjamin and Charles H. Chetwood. Among the patients who underwent a rejuvenation operation according to Steinach's method were Sigmund Freud (1856 1939) and the Irish poet and Nobel Prize winner William Butler Yeats (1865-1939). Two caricatures from the German magazine Simplicissimus published in 1927, confirm that the rejuvenation operations were constantly in the limelight of the printed media. From 1935 onwards rejuvenation operations gradually lost their appeal due to the introduction of artificial androgens.

[Vasectomy]. / Vasektomi.

PIP: The first vasectomy operation was carried out 100 years ago in patients with prostate hyperplasia with symptoms. Then it became extensively used for hereditary hygiene purposes/eugenics, especially after the passing of the sterilization law in Denmark in 1935. In Nazi Germany, vasectomies and castrations were also used for forced sterilization of undesired races. Vasectomy has become a popular method of fertility control, especially in the US. In Denmark it is also popular, and since the 1973 sterilization law, approximately 100,000 procedures have been performed with a 95% rate of satisfaction. Vasectomy seems not to be as harmless as previously thought. The blockage of the transport route from the testes does not stop spermatogenesis. Spermatozoa are a certain kind of foreign matter which are first produced in puberty and act as antigens vis-a-vis other organisms. Certain immune complexes are formed that can have implication for a number of autoimmune diseases. Later in life vasectomy can be a potentiating factor in arteriosclerosis according to rhesus monkey experiments. Men with hypertension, hyperlipidemia, or heavy smokers should not undergo vasectomy. On the other hand, a 1990 epidemiological study showed no increased risk of cardiovascular diseases in vasectomized men. Yet the immune complexes could have other, more serious biological consequences. In large cohort studies the connection to testicular cancer has not been proven with certainty, but there may be an increased risk of prostate cancer among the vasectomized. The American Urological Association (AUA) has recently recommended that men over 40 who had been vasectomized should undergo examination and tests for prostate-specific antigen every year for early detection of cancer. There has been no indication of an increased mortality from prostate cancer among vasectomized men in the above epidemiological studies, but the AUA advises counseling patients about the possible connection.^ieng

[Male sterilization. Historic review and current methods in Denmark]. / Sterilisation af maend. Historisk tilbageblik og metoder i Danmark i dag.

PIP: In a survey of 75 departments in Danish hospitals carrying out male sterilization, 48 reported that they had prescribed procedures pertaining to the incision, resection and occlusion of the vas as well as placement of the vas ends. In the consensus method the testicular ends of the ducts should be buried under the membranes in order to avoid formation of fistulae and the ends should be buried each at its level in order to avoid recanalization. Scar tissue has been shown to be minimal around the ends of the duct when occluded by means of metal clips and bipolar electrocoagulation. In Denmark 4000-5000 men are officially sterilized each year and in all the Ministry of Health has recorded more than 71,000 cases of voluntary sterilization since 1973. Medical sterilization was 1st carried out in Indiana in 1899 and spread in the USA until 22 states had sterilization laws in 1929. In the same year, Switzerland was the 1st country in Europe with a sterilization law; Denmark introduced a test law which became final in 1935. Both were based on genetic indications. Between 1933 and 1945 the totalitarian regimes used forced sterilization for genetic diseases and on undesired races. In the 1950s family planning was introduced as a basis for male sterilization, 1st in Asiatic countries. The operative methods that are in use today were essentially developed by the early 1970s with the introduction of nonirritating hemoclips and techniques for electrocoagulation of the vas ends.^ieng