On the deleterious results of a narrow prepuce and preputial adhesions = Sur les résultats délétères d'un prépuce étroit et des adhésions preputiales = Die schädlichen Folgen einer Vorhaut und der präputialen Adhäsionen / by Lewis A. Sayre.

  • Sayre, Lewis A. (Lewis Albert), 1820-1900.
Date:
[1887]
Catalogue details

Licence: Public Domain Mark

Credit: On the deleterious results of a narrow prepuce and preputial adhesions = Sur les résultats délétères d'un prépuce étroit et des adhésions preputiales = Die schädlichen Folgen einer Vorhaut und der präputialen Adhäsionen / by Lewis A. Sayre. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    commenced by symptoms of motor and sensory irritation. He found diffuse softefiing of the cord in two cases. He thinks that a sacro-lumbar neuritis may be propagated to the cord in diseases of the bladder. “ Charcot, speaking of urinary paraplegia, says : 1 The very number of the cases in which we see paraplegia appear in the course of disease of the urinary passages is, of itself, enough to show that the phenomenon is no chance coincidence.’ ‘ ‘ From the foregoing I think that we are justified in the conclusion that phimosis and adherent prepuce give rise to varied troubles of more or less gravity7, manifesting them- selves either in the muscular, osseous or nervous systems ; and that the removal of these abnormal conditions of the penis frequently affords marked relief, and at times perfect and permanent cure.” DISCUSSION. Dr. De Forest Willard, of Philadelphia, remarked:—The former enthusiastic advocacy of circumcision by Dr. Sayre has led many rash and unthinking physicians to advise this operation in cases where it is entirely unnecessary, and has also caused them to overlook serious central lesions in cases where an adherent prepuce has been but an accidental coexisting condition. In this, as in every other complaint, too much attention cannot be given to diag- nosis and to the proper selection of cases. It is highly important to discriminate first between instances of simple adhesion and those in which actual contraction exists, since the former only require the slight operation of stripping of the glans, while for the relief of the latter, dilatation, incision or circumcision may be needed. Stripping can he accomplished in nearly all cases of adhesion under one or two years old. It is performed by manipulating the penis for a moment until slight rigidity occurs, when gentle backward pressure soon reveals an orifice, pinhole at first, but soon enlarging until the meatus is revealed. Immediately around this opening, or at some point on the glans, adhesions will usually be encountered, but they can be broken up by the thumbs of the operator as he peels off the prepuce from the glans. Rarely a probe is required. As soon as the sulcus behind the corona is fully reached, the smegma is thoroughly cleaned away and a dressing of cosmoline upon borated cotton is applied. This should be speedily adjusted, as delay sometimes produces a condition of paraphimosis, for the relief of which dila- tation or incision occasionally becomes necessary. Usually, however, two or three probes, or the rounded end of a couple of hair pins, slipped beneath the foreskin serve to permit the easy replacement of the hood. The dressing need not be disturbed until the slight inflammatory symptoms have passed, after which daily retraction and washing should be practiced throughout life. I look upon subsequent cleanliness of this region as the greatest safeguard, not only against reflex irritations, but also against masturbation. Retained filth and smegma are far more likely to call a boy’s attention to his penis by their unrecognized irritative effects than washing can possibly do. In the Philadelphia Medical Times, June, ] 883, I urged the non-mutilatory opera- tion of stripping in all cases where it was capable of giving an easily-moving prepuce; but insisted that no tight hood should be left, and that all reaccumulations should be prevented. Tlie observation of many hundred cases since that time has confirmed the opinions then expressed, and I now very rarely circumcise a young child. A recent writer states that ho seldom performs the operation after eight years of age. My practice