The Prostate Gallery

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Feb. 1 2000 3:30 AM

The Prostate Gallery

A museum explains how urology left the Stones Age.

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Rainer M. Engel, M.D., opens a glass case with a small key. He takes out a circular metal object—it looks like one cookie cutter placed inside another—and snaps its inner ring neatly around his index finger. The larger band is circled by an inward-facing row of saw teeth. The device is marked "Anti-masturbation ring circa 1908." "Medical geniuses developed for boys this device," Engel says, traces of his youth in Germany clear in his diction. Before going to bed, a boy would fit the inner ring around his penis. "Normal males have erections during the night, which would cause the penis to cut into the teeth, leading to a yelp and the loss of the erection," Engel explains. "You can't get find these anymore, although you could find that in the Sears catalog in those days."

Engel is the curator of Baltimore's William P. Didusch Museum of the American Urological Association, which chronicles the history of treatment for diseases of the male and female urinary tracts and for the male reproductive organs. The museum could be said to view history from the perspective of the urethra. Benjamin Franklin, for example, makes an appearance not as a founding father or a diplomat, but as an amateur urologist. It turns out Franklin's brother suffered from an obstructed bladder, so the polymath inventor (who was himself a victim of stones) created a catheter for him. The museum showcases a facsimile of Franklin's original design description as well a prototype made from his specifications. It is a long, slender, tightly coiled metal spiral—it would make a stunning necklace—paired with a stiffening rod for easy insertion. Apparently it worked. "His brother did well for years thereafter," says Engel.

Other famous stone sufferers have included Peter the Great, Isaac Newton, and Napoleon III. Stones may have led to some of the darkest hours of the 20th century: The blundering Napoleon III was in the grip of a severe stone crisis when he led the French army to surrender in 1870 in the Franco-Prussian War. France's thirst for revenge helped spark World War I, in which Germany was defeated, which led to … OK, so even if better treatments for stones wouldn't have prevented World War II, they are still bad news.

If you want to know just how bad, all you need to do is look at the hand-grenade-sized object covered with sharp spikes labeled "Staghorn calculus circa 1940"--in other words, the museum's 60-year-old kidney stone. And the cure was almost as painful and dangerous as the disease. For most of history, physicians left the removal of bladder stones to amateurs. The case labeled "Stone Surgery Through the Ages" has on it a quotation from the Hippocratic oath: "I will not use the knife, not even on sufferers from the stone, but will withdraw in favor of such men as are engaged in this work." Hippocrates was too polite to say it, but what he really meant was, "Let them kill people." Even though stone-cutting operations had mortality rates of up to 40 percent, people submitted because they would be cured or killed. Either was preferable to stones.

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Emily Yoffe Emily Yoffe

Emily Yoffe is a regular Slate contributor. She writes the Dear Prudence column. 

E ventually some able practitioners emerged. A Frenchman who worked in the late 17th century, Jacques de Beaulieu, supposedly performed some 5,000 operations, most of them successful. He became popularly known as Frère Jacques. The Frère Jacques? "Yes, absolutely," says Engel. "A French urologist tried to establish a clear linkage. The linkage is weak, but it's there."

Totems of urological ingenuity on display include patent medicines (" 'Swamp Root' … to promote the flow of urine …," " 'Kickapoo Sagwa' for the relief of Biliousness, Constipation, Sluggish Liver' "); medical illustrations (Vesalius' 1543 rendering of "The Peculiar Muscles of the Penis"); and a stamp collection honoring urological pioneers (a 1959 issue celebrates Ephraim McDowell, 1781-1830, who "performed cystolithotomy 22 times in succession without losing a patient"). One case holds an umbrella and walking stick from the mid-19th century designed to provide elegant and discreet relief of bladder obstruction. The top of each screwed off to reveal a catheter and a jar of lubricant. When nature called but the bladder didn't answer, a gentleman could retire with his cane or umbrella and catheterize himself.

Another display holds the first modern tools used to remove the overgrown prostate tissue that can block urination. Merely reciting their names is, if not a howl into the void, a howl about the inability to void: blunt urethral curettes, incisors, cold punches, dilators, loops, modified resectoscopes, obturator for urethral massage, perineal fistula reamer.

Engel takes out one of the museum's cold punches, a 10-inch long tube of metal with a curved tip and a notch cut out of one side. It was inserted into the penis until the notched portion reached the offending prostate matter. Then another tube, the obturator, was placed inside the punch, and the tissue was chipped off. Engel smartly demonstrates the chipping action.

This cold punch is this museum's Wright brothers airplane. In 1912, Dr. Hugh Hampton Young, a bold, innovative, oh, all right, cocky young surgeon at Johns Hopkins, used it on the railroad magnate James Buchanan Brady, better known as Diamond Jim Brady. "He was very, very wealthy," says Engel, "very obese, diabetic, hypertensive, and he couldn't pee." (Such a set of circumstances could not occur today because rich people are no longer very fat.) Young got Brady peeing again, and Brady donated the money to create the Brady Urological Institute at Johns Hopkins, which is, according to Engel, "probably the No. 1 urological program in the country, if not the world." And Young, who lived in the very building that houses the museum, became known as the father of modern urology. The museum is named for the medical artist who for decades documented Young's work and who was a subsequent resident of the building.

The museum offers little on the subject for which urology is probably best known today, but Engel promises a presentation on erectile dysfunction is coming soon. Though urologists long ago claimed the male genitals as their medical territory, only in the past 20 years or so have urologists shifted their attention to enabling copulation as well as urination. Impotence was once considered a psychological problem best left to shrinks. Engel recalls that when he started practicing in 1970 impotence was a urological no man's land; doctors simply told patients, "It was nice having it, now you don't." Then researchers started studying the hydraulics of male erections. This led to treatments that could be called the era of insertables, inflatables, and injectables, which have all now been eclipsed by Viagra.

At the end of our tour Engel muses on the changes in urology he's witnessed in his 30 years of practice. "When I look at all this it reminds me of the fact that when I finished my training I finished at the top program in the country. It was at the cutting edge. And 80 percent of it doesn't apply anymore." Which is good news for anyone who ever faced a perineal fistula reamer.