- Email: [email protected]
GODFREY HOUNSFIELD AND THE DEVELOPMENT OF COMPUTED TOMOGRAPHY (CT)
Vol. 179, No. 4, Supplement, Monday, May 19, 2008
North America. Masturbation and subsequent semen loss were seen as serious causes of wasting in Victorian American and Europe. This fear led to a variety of interventions, some more Draconian than others, to prevent this feared complication. Although much more rare, variants of both conditions have also been reported in women (koro as phobic fear that the breasts and/or vulva are receding and dhat as excessive vaginal discharge.) Both conditions have been reported to occur in an epidemic fashion, even recently. In 1967 two cases of koro were linked to eating SRUNYDFFLQDWHGDJDLQVWVZLQHÀXZKLFKOHGWRDZLGHVSUHDGSDQLFDQG hundreds of cases of the disorder in Singapore. In 2003, an outbreak of public hysteria over alleged malicious magical penis shrinking occurred in Senegal and led to several deaths from vigilante violence. CONCLUSIONS: Phobic anxiety about damage to/loss of the genitalia has been reported throughout history and in men from all corners of the world. On occasion, socio-cultural factors have led to widespread “penis panics” affecting entire populations. Source of Funding: None
901 THE GREAT PLAGUE – PANDEMICS CAN CHANGE HISTORY Monika H Frank, Friedrich H Moll*, Joachim Leissner, Klaus Bergdolt. Cologne, Germany. INTRODUCTION AND OBJECTIVE: In the modern imagination the plague remains the formost example of the scourge of epidemic disease.The Black Death-bubonic plague with complications¿UVWQRWHGLQ$VLDLQZDVWKHJUHDWHVWPHGLFDOGLVDVWHURIWKH0LGGOH Ages and one of the most deadly pandemics in human history. After an appearent absence of six centuries, the Black Death returned. It kills in LWV¿UVWZDYHSHUKDSVSHUFHQWRI(XURSH¶VSRSXODWLRQHVWLPDWHGDW 75 million people.The city of Florence e. g. lost almost three-quarters of its population between 1347-1447, most Italien cities lost close to a third of their population.The Black Death differed from earlier epidemics in its extend and its ubiquity and provoked the development of several new models, which were to endure for several centuries and served as a reminder of the fragility of life. Plague was to become the central epidemiological regulator.It disrupted economic, cultural and social life for a very long time. Faced with this huge challenge the authorities took action, particular in the Italian cities and decided to protect health by regulations.The pillars of government sanitary regulation were inspection RI WUDYHOOHUV TXDUDQWLQH RI VKLSV DQG OD]DUHWWRV HQFORVHG SODFHV IRU quarantining individuals.Witnessing the disaster this led to new piety of WKHVRFLHW\DQGWRF\QLFLVPWRZDUGUHOLJLRXVRI¿FLDOV'HDWKZDVVHHQ in a new and more naturalistic view, death now represents itsselve as the great social leveler in the dance macabre illustrations. The theme of the Apocalypse became a source of inspiration. Collective aggressions occured directed toward marginated populations like beggars, lepers and the Jews.Violence against the Jews was heightened by the epidemic but had occured before. All this were indicators for the turn of a new era. Church authorities proclaimed mass intercessions and propritiatory prayers.Saint Anthony and Saint Sebastian were invoked against epidemics.Witchcraft became a bone of contention between the medical and religious outlooks. METHODS: Local sources of the history of the Great Plague of the City of Cologne were compared with original sources within the literature in a hermeneutical manner. RESULTS: The magnitude of the Black Death provides a striking demonstration of just how powerful a force disease can be in history. The Great Plague belonged to early modern times and to the daily life of society. CONCLUSIONS: Epidemics are powerful factors in human history and can be important for changes in politics, economics, culture and society. As the real factor in history they were often underestimated. Source of Funding: None
902 MUMPS ORCHITIS IN THE WORLD WARS William P Conners*. Albany, NY. INTRODUCTION AND OBJECTIVE: Mumps orchitis, while rarely seen today in developed countries, has greatly impacted the
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military throughout history, and notably in both World Wars I & II. In these FRPEDWWKHDWHUVWKRXJKWKHGLVHDVHVDZVLJQL¿FDQWDGYDQFHPHQWLQ understanding and treatment. 0(7+2'6 0XOWLSOHUHVRXUFHVZHUHXWLOL]HGLQFOXGLQJZHE based literature search involving Medline, PubMed, as well as urology, virology, and infectious disease texts. RESULTS: In the 5thFHQWXU\%&+LSSRFUDWHV¿UVWGHVFULEHG mumps orchitis in adolescdent wrestlers in the first book of the Epidemics. Later, Guillaume de Baillou acknowledged a local epidemic in Paris during the French Wars of Religion in the 16th century. In World :DU,WKHQXPEHURIPXPSVFDVHVDGPLWWHGWRWKHKRVSLWDORUFRQ¿QHG WRTXDUWHUVZDV7KLVLQFLGHQFHZDVRQO\VXUSDVVHGE\LQÀXHQ]D and gonococcal infection. Lost man days from duty during World War I amounted to 3,884,147 days. In all wars including World War II, the main problem resulting from mumps outbreaks has been the length of time lost from duty following the complication of orchitis. Mumps has a relatively long incubation period and slow mode of transmission, which prolonged the outbreaks, and seriously interfered with active-duty performance. At Camp McCoy, during World War I, orchidotomy was performed in severe cases of epididymo-orchitis. The prevailing thought regarding WKLVRSHUDWLRQDWWKHWLPHZDVWKDWWKHLQFLVLRQRIWKH¿UPHQFDSVXODWLQJ WXQLFDDOEXJLQHDPD\KDYHSUHYHQWHGVWHULOL]DWLRQRIRQHRUERWKWHVWLFOHV in severe cases. Given that bilateral epididymo-orchitis occurred in 10.6% of those with this complication, orchidotomy was used to relieve pain UDWKHUWKDQWRSUHYHQWFRPSOHWHVWHULOL]DWLRQ7KHFRQFHSWRIPXPSVZDV revised following the demonstration of transmission of mumps by salivary ÀXLGWRMacacus rhesus monkey by Johnson and Goodpasture in 1934. ,Q -RKQ)(QGHUVDQ$PHULFDQPLFURELRORJLVWGHYHORSHGWKH¿UVW vaccine. Initially delivered to troops in WWII, this vaccine, based on a killed virus, was only moderately and temporarily successful. CONCLUSIONS: As a result of this reserach, serological and skin tests used to diagnose mumps were soon developed. This paved the way for Dr. Maurice Hillman who developed the Jeryl Lynn strain of the mumps vaccine from the mumps virus that infected his 5year old daughter. As part of the MMR vaccine, it was approved for use by the FDA in 1967. Today, live mumps virus vaccines derived from this strain are responsible for the low incidence of mumps orchitis seen in our troops, and the world, today. Source of Funding: None
903 GODFREY HOUNSFIELD AND THE DEVELOPMENT OF COMPUTED TOMOGRAPHY (CT) Shikohe Masood*, Daben Dawam, Tahir R Bhat, Pardeep Kumar, Gulzar Mufti. Gillingham, United Kingdom. INTRODUCTION AND OBJECTIVE: CT is widely used in all disciplines of Medicine, including Urology. Sir Godfrey Newbold +RXQV¿HOG GHYHORSHG WKLV LPDJLQJ PRGDOLW\ ZKLFK LV QRZ LQWHJUDO WR medical diagnosis and treatment. METHODS: A systematic search of online and published material was conducted including original articles and papers. 5(68/76 +RXQV¿HOG ZDV ERUQ LQ D YLOODJH QHDU 1HZDUN Nottinghamshire, England. He spent much time on his own on his father’s farm where he developed an interest in engineering whilst building sound recorders, radio sets and water powered rockets. The concept of the CT scanner was borne during a weekend ramble in the country when he realised that “you could determine what was in a box by taking readings at all angles through it”. His employer at the time, (OHFWULFDODQG0XVLFDO,QGXVWULHV (0, UHLQYHVWHGVRPHRIWKHSUR¿WV IURPSURPRWLQJ7KH%HDWOHVLQWKHGHYHORSPHQWRI+RXQV¿HOG¶VLQLWLDO LGHDV+RXQV¿HOGFROODERUDWHGZLWK-DPHV$PEURVHDQHXURUDGLRORJLVW at Atkinson Morley’s Hospital London. Beginning with weak gamma ray source which took nine days to complete the scan, he then used X-rays and shortened the scanning time to nine hours. The initial CT scans were performed on preserved human brains obtained from local hospital PXVHXP KRZHYHUWKHLPDJHVZHUHGLVWRUWHGE\SUHVHUYDWLRQLQIRUPDOLQ so he experimented on bullock’s brains which he used to bring to the laboratory in a bucket while traveling on London buses. These images were also blurred because stunning the cow before slaughtering resulted in presence of blood in the ventricles. This problem was solved when .RVKHUNLOOHGERYLQHEUDLQVZHUHXVHG7KH¿UVWOLYHSDWLHQWWREHVFDQQHG
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in October 1971 was a woman with a suspected brain tumour, which VKRZHGFOHDUO\WKHVLWHRIDQLQWUDFHUHEUDOF\VW+RXQV¿HOGUHFHLYHG many awards including the MacRobert Award, the Albert Lasker award DQGWKH1REHOSUL]HIRU3K\VLRORJ\DQG0HGLFLQHLQ +HVKDUHG WKH1REHOSUL]HZLWK$OODQ&RUPDFNZKRKDGLQGHSHQGHQWO\SURSRVHG DQGSXEOLVKHGWKHPDWKHPDWLFDOEDVLVRI&7VFDQQLQJ+RXQV¿HOGVSHQW very little time or money on himself. When presented with the 1972 0DF5REHUWDZDUGKHNHSWWKH SUL]HLQUHVHUYH³LQFDVHVRPH new research idea turns up, in which case I can plough it back”. Other memorable words of advice from him include “not to worry about passing exams so long as you have understood the subject”. &21&/86,216 +RXQV¿HOG¶V FRQWULEXWLRQ WR 0HGLFLQH LV VLJQL¿FDQWDQGKLVZRUNKDVXQGRXEWHGO\UHYROXWLRQL]HGWKHGLDJQRVLV investigation and management of disease around the world. Source of Funding: None
904 JFK AND HIS ADDISON’S DISEASE: AN (ADVERSARIAL) ALLY? Jonathan D Kaye*, Robert S Waldbaum. New Hyde Park, NY. ,1752'8&7,21$1'2%-(&7,9( -RKQ)LW]JHUDOG.HQQHG\ -). ZKRZRXOGEHFRPHWKHWKLUW\¿IWKSUHVLGHQWRIWKH8QLWHG6WDWHV ZDV ¿UVW GLDJQRVHG ZLWK$GGLVRQ¶V GLVHDVH LQ E\ DQ (QJOLVK SK\VLFLDQZKLOHRQDWULSWR/RQGRQDVD&RQJUHVVPDQ$IÀLFWHGZLWK pain and various ailments throughout much of his adult life, JFK likely suffered from Addison’s disease well before this time. In this study, we examine JFK’s life-long battle with Addison’s disease, the urologic care he received, and its ironic effects on American history. 0(7+2'6 'UDZLQJRQKLVWRULFDOUHSRUWV¿UVWKDQGDFFRXQWV and original documents, we chronicled JFK’s experience with Addison’s disease and his attempts at concealing it from the voting public. We begin our investigation with his boarding school days in Connecticut SUHGDWLQJKLVRI¿FLDOGLDJQRVLVE\PDQ\\HDUV DQGIROORZ-).WKURXJK his presidency. In particular, we explore the urologic care he received by Dr. Victor Marshall, as well as at the Leahy Clinic in Massachusetts, IURPZKHUHDFDVHUHSRUWRI³DPDQ\HDUVRIDJH>ZKR@KDG$GGLVRQ¶V disease for several years” was submitted and published in the November, 1955 Archives of Surgery. In 1967, this man was found to be JFK. We also examined the effect of JFK’s Addisonian appearance on his political VXFFHVVZLWKVSHFL¿FHPSKDVLVRQKLVWHOHYLVHGGHEDWHZLWK5LFKDUG 1L[RQ/DVWO\'U-RKQ./DWWLPHU¶VFRQ¿UPDWRU\SRVWPRUWHPVWXG\WKDW JFK did in fact suffer from Addison’s disease is reviewed. RESULTS: Despite his and his family’s claims to the contrary, JFK indeed suffered from Addison’s disease. Ironically, however, WKH VDPH GLVHDVH WKDW FDXVHG KLP VLJQL¿FDQW SULYDWH VXIIHULQJ DQG convalescence may have also helped him to win the 1960 presidential HOHFWLRQ KLVH[WUHPHO\QDUURZYLFWRU\RZHGODUJHO\WRKLVWDQEURQ]HG (Addisonian) appearance on national television during his debate against Richard Nixon who, in contrast, appeared pale and sickly. CONCLUSIONS: JFK’s Addison’s disease was at times extremely deleterious for him, but may have ultimately proven to be an ironic ally in his bid for the presidency. The involvement of at least two urologic luminaries in this history makes it not only fascinating, but also extremely relevant to the annals of urology. Source of Funding: None
905 THE EPIDEMIC OF PENILE AMPUTATION IN THAILAND IN THE 1970’s Genoa G Ferguson*, Steven B Brandes. Saint Louis, MO. INTRODUCTION AND OBJECTIVE: Despite the fact that WKHPDMRULW\RISHQLOHDPSXWDWLRQVDUHVHOILQÀLFWHGWKHODUJHVWVHULHV of penile replantation surgeries in the urologic literature is a series of penile amputations during the 1970’s, in which an estimated 100 men in Thailand had their penises cut off by their wives. Eighteen of these were replanted and reported. We sought to understand how and why this epidemic took place. METHODS: Using previously published articles in both the academic and lay literature, we reviewed discussion about both the culture of Thailand and the penile amputations in Thailand.
Vol. 179, No. 4, Supplement, Monday, May 19, 2008
RESULTS: From 1973 to 1980, an estimated 100 men had their penises amputated by their wives using kitchen knives while they slept. These men had all engaged in extra-marital affairs. The vast majority of women in Thailand have only one lifetime sexual partner and strongly believe in virginity until marriage and monogamy following their nuptials. Thai people also have a strong belief in honor and these women reported feeling humiliated. Usually, the severed penis was thrown into family-owned animal pens, often under their own home (many Thai homes are on stilts). Many penises were never able to be found, due to destruction by the men’s own animals. For those penises able to be found, the penises were universally contaminated. Additionally, this took place during the 1970’s, during the height of the women’s movement, LQ ZKLFK IHPDOH HPSRZHUPHQW ZDV ÀRXULVKLQJ DQG DPSXWDWLRQ ZDV thought to be an empowering act. The amputations were highly reported in the news, with well-known women encouraging this practice. The details of the attacks were also extensively and graphically reported in the news, giving women strict instructions to replicate the attacks. News of the amputations spread quickly to all classes, making copy cat attacks more wide spread. CONCLUSIONS: The combination of strict beliefs in sexual monagomy by wives combined with public encouragement of the act of SHQLOHDPSXWDWLRQIRULQ¿GHOLW\EXLOWDQHSLGHPLFRISHQLOHDPSXWDWLRQ in Thailand. Women publicly encouraging and inciting other scorned women to commit this act worsened the epidemic. The vast majority of worldwide reports of penile replantation, to this day, are a result of ZKDWEHFDPHDWUHQG\IRUPRIUHWULEXWLRQLQDFRXQWU\LQZKLFK¿GHOLW\LV a strongly appreciated value. Source of Funding: None
906 THE JOURNEY OF THE HERMAPHRODITE – DISORDERS OF SEXUAL DEVELOPMENT FROM ANTIQUITY TO PRESENT Jennifer H Yang*, Dix P Poppas. New York, NY. INTRODUCTION AND OBJECTIVE: To examine the history of the hermaphrodite and cases of ambiguous genitalia through the ages. To understand the implications of sociocultural forces on the management of disorders of sexual development. METHODS: The historical literature regarding several notable hermaphrodites was examined, including Hermaphroditus, god of hermaphrodites, and Thomas/Thomasine Hall. The societal and cultural forces, which then in turn modeled contemporary physicians in their management of intersex, were discussed. RESULTS: Hermaphroditus was the son of Hermes and Aphrodite, gods of male and female sexuality. A nymph named Salmacis fell in love with Hermaphroditus and prayed to be united with him forever. Henceforth “Both bodies in a single body mix, A single body with double sex.” Perhaps this was the Ancient Greeks’ way of explaining the origin of hermaphrodites. During the medieval period and early Renaissance, hermaphrodites were considered “monsters” and appeared in all genres of literature. Monsters were interpreted as signs from God, signs which demanded interpretation, perhaps secondary to the relative unknown. %XWDVVXUHO\DVWKH¿HOGVRIVFLHQFHDQGPHGLFLQHJDLQHGNQRZOHGJH these monsters became focused studies of aberrant physiology and DQDWRP\,Q WKH¿UVWDFFRXQWRIDKHUPDSKURGLWHLQ$PHULFDZDV Thomas/Thomasine Hall. Although Hall was never subjected to medical treatment, the Virginian court ruled that Hall must abide by the selfdescription of embodying both sexes and live publicly as simultaneous male and female. Subsequent reports of cases of ambiguous genitalia were common in medical literature, and physicians attempted to correct the apparent pathology which threatened the established dichotomy RIPDOHRUIHPDOH7KHWUHDWPHQWRILQWHUVH[LVDUHÀHFWLRQRIVRFLHWDO pressures which demand the maintenance of normalcy. As concepts of gender identity continue to evolve, so will the accepted perspective of treatment of these conditions. Currently, the opinions regarding the surgical treatment of disorders of sexual differentiation remain controversial. CONCLUSIONS: The role of hermaphrodties as mythological GHLWLHVVRFLDORXWFDVWVRUPHGLFDOHQLJPDVUHÀHFWVWKHFRQWHPSRUDU\ social and cultural constructs of gender identity.
North America. Masturbation and subsequent semen loss were seen as serious causes of wasting in Victorian American and Europe. This fear led to a variety of interventions, some more Draconian than others, to prevent this feared complication. Although much more rare, variants of both conditions have also been reported in women (koro as phobic fear that the breasts and/or vulva are receding and dhat as excessive vaginal discharge.) Both conditions have been reported to occur in an epidemic fashion, even recently. In 1967 two cases of koro were linked to eating SRUNYDFFLQDWHGDJDLQVWVZLQHÀXZKLFKOHGWRDZLGHVSUHDGSDQLFDQG hundreds of cases of the disorder in Singapore. In 2003, an outbreak of public hysteria over alleged malicious magical penis shrinking occurred in Senegal and led to several deaths from vigilante violence. CONCLUSIONS: Phobic anxiety about damage to/loss of the genitalia has been reported throughout history and in men from all corners of the world. On occasion, socio-cultural factors have led to widespread “penis panics” affecting entire populations. Source of Funding: None
901 THE GREAT PLAGUE – PANDEMICS CAN CHANGE HISTORY Monika H Frank, Friedrich H Moll*, Joachim Leissner, Klaus Bergdolt. Cologne, Germany. INTRODUCTION AND OBJECTIVE: In the modern imagination the plague remains the formost example of the scourge of epidemic disease.The Black Death-bubonic plague with complications¿UVWQRWHGLQ$VLDLQZDVWKHJUHDWHVWPHGLFDOGLVDVWHURIWKH0LGGOH Ages and one of the most deadly pandemics in human history. After an appearent absence of six centuries, the Black Death returned. It kills in LWV¿UVWZDYHSHUKDSVSHUFHQWRI(XURSH¶VSRSXODWLRQHVWLPDWHGDW 75 million people.The city of Florence e. g. lost almost three-quarters of its population between 1347-1447, most Italien cities lost close to a third of their population.The Black Death differed from earlier epidemics in its extend and its ubiquity and provoked the development of several new models, which were to endure for several centuries and served as a reminder of the fragility of life. Plague was to become the central epidemiological regulator.It disrupted economic, cultural and social life for a very long time. Faced with this huge challenge the authorities took action, particular in the Italian cities and decided to protect health by regulations.The pillars of government sanitary regulation were inspection RI WUDYHOOHUV TXDUDQWLQH RI VKLSV DQG OD]DUHWWRV HQFORVHG SODFHV IRU quarantining individuals.Witnessing the disaster this led to new piety of WKHVRFLHW\DQGWRF\QLFLVPWRZDUGUHOLJLRXVRI¿FLDOV'HDWKZDVVHHQ in a new and more naturalistic view, death now represents itsselve as the great social leveler in the dance macabre illustrations. The theme of the Apocalypse became a source of inspiration. Collective aggressions occured directed toward marginated populations like beggars, lepers and the Jews.Violence against the Jews was heightened by the epidemic but had occured before. All this were indicators for the turn of a new era. Church authorities proclaimed mass intercessions and propritiatory prayers.Saint Anthony and Saint Sebastian were invoked against epidemics.Witchcraft became a bone of contention between the medical and religious outlooks. METHODS: Local sources of the history of the Great Plague of the City of Cologne were compared with original sources within the literature in a hermeneutical manner. RESULTS: The magnitude of the Black Death provides a striking demonstration of just how powerful a force disease can be in history. The Great Plague belonged to early modern times and to the daily life of society. CONCLUSIONS: Epidemics are powerful factors in human history and can be important for changes in politics, economics, culture and society. As the real factor in history they were often underestimated. Source of Funding: None
902 MUMPS ORCHITIS IN THE WORLD WARS William P Conners*. Albany, NY. INTRODUCTION AND OBJECTIVE: Mumps orchitis, while rarely seen today in developed countries, has greatly impacted the
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military throughout history, and notably in both World Wars I & II. In these FRPEDWWKHDWHUVWKRXJKWKHGLVHDVHVDZVLJQL¿FDQWDGYDQFHPHQWLQ understanding and treatment. 0(7+2'6 0XOWLSOHUHVRXUFHVZHUHXWLOL]HGLQFOXGLQJZHE based literature search involving Medline, PubMed, as well as urology, virology, and infectious disease texts. RESULTS: In the 5thFHQWXU\%&+LSSRFUDWHV¿UVWGHVFULEHG mumps orchitis in adolescdent wrestlers in the first book of the Epidemics. Later, Guillaume de Baillou acknowledged a local epidemic in Paris during the French Wars of Religion in the 16th century. In World :DU,WKHQXPEHURIPXPSVFDVHVDGPLWWHGWRWKHKRVSLWDORUFRQ¿QHG WRTXDUWHUVZDV7KLVLQFLGHQFHZDVRQO\VXUSDVVHGE\LQÀXHQ]D and gonococcal infection. Lost man days from duty during World War I amounted to 3,884,147 days. In all wars including World War II, the main problem resulting from mumps outbreaks has been the length of time lost from duty following the complication of orchitis. Mumps has a relatively long incubation period and slow mode of transmission, which prolonged the outbreaks, and seriously interfered with active-duty performance. At Camp McCoy, during World War I, orchidotomy was performed in severe cases of epididymo-orchitis. The prevailing thought regarding WKLVRSHUDWLRQDWWKHWLPHZDVWKDWWKHLQFLVLRQRIWKH¿UPHQFDSVXODWLQJ WXQLFDDOEXJLQHDPD\KDYHSUHYHQWHGVWHULOL]DWLRQRIRQHRUERWKWHVWLFOHV in severe cases. Given that bilateral epididymo-orchitis occurred in 10.6% of those with this complication, orchidotomy was used to relieve pain UDWKHUWKDQWRSUHYHQWFRPSOHWHVWHULOL]DWLRQ7KHFRQFHSWRIPXPSVZDV revised following the demonstration of transmission of mumps by salivary ÀXLGWRMacacus rhesus monkey by Johnson and Goodpasture in 1934. ,Q -RKQ)(QGHUVDQ$PHULFDQPLFURELRORJLVWGHYHORSHGWKH¿UVW vaccine. Initially delivered to troops in WWII, this vaccine, based on a killed virus, was only moderately and temporarily successful. CONCLUSIONS: As a result of this reserach, serological and skin tests used to diagnose mumps were soon developed. This paved the way for Dr. Maurice Hillman who developed the Jeryl Lynn strain of the mumps vaccine from the mumps virus that infected his 5year old daughter. As part of the MMR vaccine, it was approved for use by the FDA in 1967. Today, live mumps virus vaccines derived from this strain are responsible for the low incidence of mumps orchitis seen in our troops, and the world, today. Source of Funding: None
903 GODFREY HOUNSFIELD AND THE DEVELOPMENT OF COMPUTED TOMOGRAPHY (CT) Shikohe Masood*, Daben Dawam, Tahir R Bhat, Pardeep Kumar, Gulzar Mufti. Gillingham, United Kingdom. INTRODUCTION AND OBJECTIVE: CT is widely used in all disciplines of Medicine, including Urology. Sir Godfrey Newbold +RXQV¿HOG GHYHORSHG WKLV LPDJLQJ PRGDOLW\ ZKLFK LV QRZ LQWHJUDO WR medical diagnosis and treatment. METHODS: A systematic search of online and published material was conducted including original articles and papers. 5(68/76 +RXQV¿HOG ZDV ERUQ LQ D YLOODJH QHDU 1HZDUN Nottinghamshire, England. He spent much time on his own on his father’s farm where he developed an interest in engineering whilst building sound recorders, radio sets and water powered rockets. The concept of the CT scanner was borne during a weekend ramble in the country when he realised that “you could determine what was in a box by taking readings at all angles through it”. His employer at the time, (OHFWULFDODQG0XVLFDO,QGXVWULHV (0, UHLQYHVWHGVRPHRIWKHSUR¿WV IURPSURPRWLQJ7KH%HDWOHVLQWKHGHYHORSPHQWRI+RXQV¿HOG¶VLQLWLDO LGHDV+RXQV¿HOGFROODERUDWHGZLWK-DPHV$PEURVHDQHXURUDGLRORJLVW at Atkinson Morley’s Hospital London. Beginning with weak gamma ray source which took nine days to complete the scan, he then used X-rays and shortened the scanning time to nine hours. The initial CT scans were performed on preserved human brains obtained from local hospital PXVHXP KRZHYHUWKHLPDJHVZHUHGLVWRUWHGE\SUHVHUYDWLRQLQIRUPDOLQ so he experimented on bullock’s brains which he used to bring to the laboratory in a bucket while traveling on London buses. These images were also blurred because stunning the cow before slaughtering resulted in presence of blood in the ventricles. This problem was solved when .RVKHUNLOOHGERYLQHEUDLQVZHUHXVHG7KH¿UVWOLYHSDWLHQWWREHVFDQQHG
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in October 1971 was a woman with a suspected brain tumour, which VKRZHGFOHDUO\WKHVLWHRIDQLQWUDFHUHEUDOF\VW+RXQV¿HOGUHFHLYHG many awards including the MacRobert Award, the Albert Lasker award DQGWKH1REHOSUL]HIRU3K\VLRORJ\DQG0HGLFLQHLQ +HVKDUHG WKH1REHOSUL]HZLWK$OODQ&RUPDFNZKRKDGLQGHSHQGHQWO\SURSRVHG DQGSXEOLVKHGWKHPDWKHPDWLFDOEDVLVRI&7VFDQQLQJ+RXQV¿HOGVSHQW very little time or money on himself. When presented with the 1972 0DF5REHUWDZDUGKHNHSWWKH SUL]HLQUHVHUYH³LQFDVHVRPH new research idea turns up, in which case I can plough it back”. Other memorable words of advice from him include “not to worry about passing exams so long as you have understood the subject”. &21&/86,216 +RXQV¿HOG¶V FRQWULEXWLRQ WR 0HGLFLQH LV VLJQL¿FDQWDQGKLVZRUNKDVXQGRXEWHGO\UHYROXWLRQL]HGWKHGLDJQRVLV investigation and management of disease around the world. Source of Funding: None
904 JFK AND HIS ADDISON’S DISEASE: AN (ADVERSARIAL) ALLY? Jonathan D Kaye*, Robert S Waldbaum. New Hyde Park, NY. ,1752'8&7,21$1'2%-(&7,9( -RKQ)LW]JHUDOG.HQQHG\ -). ZKRZRXOGEHFRPHWKHWKLUW\¿IWKSUHVLGHQWRIWKH8QLWHG6WDWHV ZDV ¿UVW GLDJQRVHG ZLWK$GGLVRQ¶V GLVHDVH LQ E\ DQ (QJOLVK SK\VLFLDQZKLOHRQDWULSWR/RQGRQDVD&RQJUHVVPDQ$IÀLFWHGZLWK pain and various ailments throughout much of his adult life, JFK likely suffered from Addison’s disease well before this time. In this study, we examine JFK’s life-long battle with Addison’s disease, the urologic care he received, and its ironic effects on American history. 0(7+2'6 'UDZLQJRQKLVWRULFDOUHSRUWV¿UVWKDQGDFFRXQWV and original documents, we chronicled JFK’s experience with Addison’s disease and his attempts at concealing it from the voting public. We begin our investigation with his boarding school days in Connecticut SUHGDWLQJKLVRI¿FLDOGLDJQRVLVE\PDQ\\HDUV DQGIROORZ-).WKURXJK his presidency. In particular, we explore the urologic care he received by Dr. Victor Marshall, as well as at the Leahy Clinic in Massachusetts, IURPZKHUHDFDVHUHSRUWRI³DPDQ\HDUVRIDJH>ZKR@KDG$GGLVRQ¶V disease for several years” was submitted and published in the November, 1955 Archives of Surgery. In 1967, this man was found to be JFK. We also examined the effect of JFK’s Addisonian appearance on his political VXFFHVVZLWKVSHFL¿FHPSKDVLVRQKLVWHOHYLVHGGHEDWHZLWK5LFKDUG 1L[RQ/DVWO\'U-RKQ./DWWLPHU¶VFRQ¿UPDWRU\SRVWPRUWHPVWXG\WKDW JFK did in fact suffer from Addison’s disease is reviewed. RESULTS: Despite his and his family’s claims to the contrary, JFK indeed suffered from Addison’s disease. Ironically, however, WKH VDPH GLVHDVH WKDW FDXVHG KLP VLJQL¿FDQW SULYDWH VXIIHULQJ DQG convalescence may have also helped him to win the 1960 presidential HOHFWLRQ KLVH[WUHPHO\QDUURZYLFWRU\RZHGODUJHO\WRKLVWDQEURQ]HG (Addisonian) appearance on national television during his debate against Richard Nixon who, in contrast, appeared pale and sickly. CONCLUSIONS: JFK’s Addison’s disease was at times extremely deleterious for him, but may have ultimately proven to be an ironic ally in his bid for the presidency. The involvement of at least two urologic luminaries in this history makes it not only fascinating, but also extremely relevant to the annals of urology. Source of Funding: None
905 THE EPIDEMIC OF PENILE AMPUTATION IN THAILAND IN THE 1970’s Genoa G Ferguson*, Steven B Brandes. Saint Louis, MO. INTRODUCTION AND OBJECTIVE: Despite the fact that WKHPDMRULW\RISHQLOHDPSXWDWLRQVDUHVHOILQÀLFWHGWKHODUJHVWVHULHV of penile replantation surgeries in the urologic literature is a series of penile amputations during the 1970’s, in which an estimated 100 men in Thailand had their penises cut off by their wives. Eighteen of these were replanted and reported. We sought to understand how and why this epidemic took place. METHODS: Using previously published articles in both the academic and lay literature, we reviewed discussion about both the culture of Thailand and the penile amputations in Thailand.
Vol. 179, No. 4, Supplement, Monday, May 19, 2008
RESULTS: From 1973 to 1980, an estimated 100 men had their penises amputated by their wives using kitchen knives while they slept. These men had all engaged in extra-marital affairs. The vast majority of women in Thailand have only one lifetime sexual partner and strongly believe in virginity until marriage and monogamy following their nuptials. Thai people also have a strong belief in honor and these women reported feeling humiliated. Usually, the severed penis was thrown into family-owned animal pens, often under their own home (many Thai homes are on stilts). Many penises were never able to be found, due to destruction by the men’s own animals. For those penises able to be found, the penises were universally contaminated. Additionally, this took place during the 1970’s, during the height of the women’s movement, LQ ZKLFK IHPDOH HPSRZHUPHQW ZDV ÀRXULVKLQJ DQG DPSXWDWLRQ ZDV thought to be an empowering act. The amputations were highly reported in the news, with well-known women encouraging this practice. The details of the attacks were also extensively and graphically reported in the news, giving women strict instructions to replicate the attacks. News of the amputations spread quickly to all classes, making copy cat attacks more wide spread. CONCLUSIONS: The combination of strict beliefs in sexual monagomy by wives combined with public encouragement of the act of SHQLOHDPSXWDWLRQIRULQ¿GHOLW\EXLOWDQHSLGHPLFRISHQLOHDPSXWDWLRQ in Thailand. Women publicly encouraging and inciting other scorned women to commit this act worsened the epidemic. The vast majority of worldwide reports of penile replantation, to this day, are a result of ZKDWEHFDPHDWUHQG\IRUPRIUHWULEXWLRQLQDFRXQWU\LQZKLFK¿GHOLW\LV a strongly appreciated value. Source of Funding: None
906 THE JOURNEY OF THE HERMAPHRODITE – DISORDERS OF SEXUAL DEVELOPMENT FROM ANTIQUITY TO PRESENT Jennifer H Yang*, Dix P Poppas. New York, NY. INTRODUCTION AND OBJECTIVE: To examine the history of the hermaphrodite and cases of ambiguous genitalia through the ages. To understand the implications of sociocultural forces on the management of disorders of sexual development. METHODS: The historical literature regarding several notable hermaphrodites was examined, including Hermaphroditus, god of hermaphrodites, and Thomas/Thomasine Hall. The societal and cultural forces, which then in turn modeled contemporary physicians in their management of intersex, were discussed. RESULTS: Hermaphroditus was the son of Hermes and Aphrodite, gods of male and female sexuality. A nymph named Salmacis fell in love with Hermaphroditus and prayed to be united with him forever. Henceforth “Both bodies in a single body mix, A single body with double sex.” Perhaps this was the Ancient Greeks’ way of explaining the origin of hermaphrodites. During the medieval period and early Renaissance, hermaphrodites were considered “monsters” and appeared in all genres of literature. Monsters were interpreted as signs from God, signs which demanded interpretation, perhaps secondary to the relative unknown. %XWDVVXUHO\DVWKH¿HOGVRIVFLHQFHDQGPHGLFLQHJDLQHGNQRZOHGJH these monsters became focused studies of aberrant physiology and DQDWRP\,Q WKH¿UVWDFFRXQWRIDKHUPDSKURGLWHLQ$PHULFDZDV Thomas/Thomasine Hall. Although Hall was never subjected to medical treatment, the Virginian court ruled that Hall must abide by the selfdescription of embodying both sexes and live publicly as simultaneous male and female. Subsequent reports of cases of ambiguous genitalia were common in medical literature, and physicians attempted to correct the apparent pathology which threatened the established dichotomy RIPDOHRUIHPDOH7KHWUHDWPHQWRILQWHUVH[LVDUHÀHFWLRQRIVRFLHWDO pressures which demand the maintenance of normalcy. As concepts of gender identity continue to evolve, so will the accepted perspective of treatment of these conditions. Currently, the opinions regarding the surgical treatment of disorders of sexual differentiation remain controversial. CONCLUSIONS: The role of hermaphrodties as mythological GHLWLHVVRFLDORXWFDVWVRUPHGLFDOHQLJPDVUHÀHFWVWKHFRQWHPSRUDU\ social and cultural constructs of gender identity.