Chordee was variously described as a hardening of the penile shaft or painful, sustained erection.
This may represent either priapism or an inflammatory infiltration of the shaft. It was almost always associated with a venereal infection. One treatment was ointment of camphor in brandy and mercury and was obviously a very painful condition; a grain of opium was suggested at bedtime. The preferred management of both phimosis and paraphimosis was medical; calomel or mercury ointment was commonly used and only rarely was surgery resorted to. John Burrows, the boatswains mate of HMS Seahorse , after failure of medical treatment, had the surgeon remove half an inch of prepuce for a venereal phimosis so severe that urine would scarcely pass.
Many men complained of painful swollen testicles. Then, as now, in these young men, this often represented epididymitis secondary to sexually transmitted disease. There were 30 cases that presented with swollen testicles, 15 cases of hernia and 17 cases of hernia humoralis. The latter is a description of a reactive hydrocoele, after venereal orchitis. Treatment was with a bread and milk poultice, mercury, and a truss.
Scrotal swelling was a well recognised occupational hazard of sailors.
Rough Medicine: Surgeons at Sea in the Age of Sail
It was particularly common in topmen who worked in the high rigging , because of the trauma of sliding down the back stays ropes running backwards from the mast to the deck level or lying on the yards. Hernia, or rupture, was another common condition in sailors undertaking heavy manual labour. An irreducible hernia was treated with warm baths and a grain of opium every eight hours coupled with attempts at reduction. If this failed, surgery was indicated; Van de Burgh warned a delay of 36 hours would lead to inevitable mortification and death! Cases of swollen testicles were also seen after injection of chemicals up the urethra.
They had attempted to cure themselves of venereal disease by injecting substances urethrally. There was a least one man who may have had a testicular cancer. Martin McDonald, a 32 year old landsman, gives a three year history of testicular problems after trauma to the scrotum. Ardor urinae, or difficulty passing urine, was described in 23 patients. In 18, the term dysuria was used, meaning pain on passing urine and once again was usually associated with venereal disease. There were 24 cases of urethral discharge; this was also called gleets or running and was a diagnostic symptom of gonorrhoeal infection.
One man was described as having strangury, six had stoppage of water or urinary retention.
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Difficulty in passing urine or strangury could have many causes. As detailed above it was often associated with the acute phase of venereal disease but episodes of bladder stone and ureteric colic can also cause strangury. Furthermore, Joseph Germain, a 52 year old seaman, presented in retention. In five cases a diagnosis of urethral stricture was given.
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Chronic gonococcal infection leads to stricture. Seaman Graham, a supernumary, presented with retention and a urethral bougie was passed enabling him to void. His ship, the Albion was anchored in the Thames making possible an early transfer to a nearby hospital ship. As well as bougies, the surgeon carried silver catheters fig 3 and catheters of the rarer gum elastic, a comparatively new rubber like substance.
These were used sparingly; medical treatments were always tried first such as hot baths or poultices. Able Seaman Owen Davies of HMS Alkmaar presented with lower abdominal pain and difficulty passing urine and was treated by blistering, a counter-irritant technique, the cups or vesicants being placed on the abdominal wall over the bladder and on the perineum.
He was declared cured after five days. Benjamin Gagen was kicked in the groin and was unable to make water. At first he was treated with bleeding and clysters another counter irritant , then warm baths and opioids.
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After nearly two months on the sick list he was discharged to the hospital. He presented with abdominal pain, vertigo, vomiting, loss of vision and speech, and suppression of urine. The surgeon, Mr Loughlin, believed he and his three messmates had been poisoned.
Loughlin passed a silver catheter relieving him of a pint of red fluid. The surgeons also had trocars to perform suprapubic catheterisation fig 3. The puncture could be made above the os pubis, in the perineum or via the anus or vagina. Upon opening the body, the bladder was found to be inflamed and the scrotum and urethra were gangrenous. Stones in the bladder were of course well known. One sailor, James Williams, aged 50, was said to have a known stone. He was discharged ashore to Port Royal Hospital for treatment. Lithotomy was not common; understandably, it was avoided at all costs. Many less invasive treatments were tried first including poultices, application of hot flannels, cupping, blistering, and bleeding.
It was recognised even then, that smaller stones could form in the kidney and pass down the ureter presenting with colic. In five cases, a diagnosis of nephritis was given. Joseph Daykens, the tailor of HMS Albion , for example, presented with pain in the back, fevers, rigors, and with turbid urine containing sediment. His story is consistent with pyelonephritis. A huge number of presentations to the surgeon in the journals are with abdominal pain.
Although these are sometimes well described it was not often possible to make an attempt at a modern diagnosis. There were five cases however that did suggest a probable diagnosis of renal colic. For example, Marine Thomas Russel of HMS Alkmaar , presented with loin pain and testicular pain with no visible disease of the testicle. The pain was such it deprived him of his zest and appetite. He also complained of strangury. He was given opium for the pain and sent to the hospital ship.
Trauma to the external genitalia was also seen. This was unsurprising in this wooden world of constant manual labour. The sailing of these vessels was skilled work that required balance, timing, and strength and the ships were dangerous places to live and work. There were 22 cases of genitourinary trauma. These included contusions of the testicles in 12 cases, the loins in two, and the groin in two. A further three men were gored in the groin by a young bullock. It was not unusual for a living larder of animals to be kept aboard ship.
One man, John Brimmer, sustained serious pelvic trauma, his case has been discussed above. One man was hit in the scrotum by a splinter and another by a pistol ball. Michael Chris, a 28 year old sailor, like many of his comrades fell down a ladder joining decks and landed heavily on his perineum. The scrotum swelled to a huge size and, by the time he presented to the surgeon, had ulcerated. It was treated with bed or rather hammock rest and a scrotal support as well as a variety of poultices.
Patrick Wade of HMS Aboukir also sustained a contusion to his scrotum, he was also sent to the hospital, but this time, for leeches to bring down the swelling. Mr Francis Bazze, midshipman, was hit by a pistol ball while duelling in Cadiz. The ball entered the right thigh below the greater trochanter, passing through the leg it entered the scrotum.
The surgeon dressed the wound and the patient recovered rapidly, he was in the sick bay for 39 days. Splinter injuries were a major hazard during sea battles. A cannonball slicing through the wooden structure of the ship sent a deadly spray of oak splinters, some over a foot long, flying across the decks.
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