Adherent and contracted prepuce, commonly called congenital phimosis : read before the Philadelphia County Medical Society, April 11, 1883 / by De Forest Willard.

  • Willard, De Forest, 1846-1910.
Date:
1883
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Licence: Public Domain Mark

Credit: Adherent and contracted prepuce, commonly called congenital phimosis : read before the Philadelphia County Medical Society, April 11, 1883 / by De Forest Willard. 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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    willing to give their penis the same care that their hands and feet receive. Un- cleanliness, in any part of the body, is productive of disease, and the penis is no exception to the rule. As to the theory that the uncovered glans can be more easily cleansed after a foul coitus, or reached in case of chancre, I cannot con- ceive that it is any part of the duty of a surgeon to prepare men for the leading of corrupt lives. The observations of Otis,* Mastin,f and others show that the removal of the prepuce subjects the glans to an abnormal irritation, which ends in contraction of the meatus and hardening of the mem- brane from plastic exudation. Surely such a condition, in case of gonorrhoea, would counterbalance the danger of chan- crous infection in a prepuce which could easily be drawn back for purposes of ab- lution. Masting has found this condition in nearly all Jews examined, and believes that it may become as much a source of genital irritation, with the results of ureth- ral, vesical, and even general involve- ment, as is contracted prepuce itself. Se- guin also states that Hebrews present evidences of marked reflex disturbances from genital origin with remarkable fre- quency ; and Beard holds the same view. I had prepared a series of histories of individual patients, but, as the details would extend this paper far beyond its desirable limits 1 will rather venture to give you the impressions that these cases have made upon my own mind. The re- sults of contracted prepuce are exceed- ingly varied, but we will first consider the influence upon the urinary organs them- selves. First, we may mention frequeiit priapism. That the constrained position of the glans, and the retained smegma, should act as a disturbing influence, is most natural; and the results of undue ex- citation must, in time, have a decided effect upon the impressible nervous system of the child. Let me remark Just here, in answer to a question w'hich must arise in the minds of each one of you, if the glans is adherent in the majority of young children, why do not the majority of children pre- sent resultant symptoms? To this the only answer is that in this, as in every other condition, a certain number of indi- * New York Med. Rec., November ig, 1881, p. 578. t Annals Anat. and Surg. Soc. Hrooklyn, 1881, iii. 123. J New York Med. Rec., November ig, 1881, p. 578. o ' viduals will possess counterbalancing or resistive powers, while others will be easily overcome. A hundred men subjected to the same harmful external influences will present almost as many varieties of result; even twin children, having the same extra- and intra-uterine surroundings, will j fail to correspond, either in their men- tal, moral, or physical susceptibilities. Hence a majority of the children wdth ad- herent prepuces may escape all trouble and continue healthy, while the others will present various forms of irritation.§ The next result which I have commonly seen is dysuria^—a condition which may vary from that of a too frequent desire, up to the tenesmus and pain which will some- times produce a convulsion. As I have met with these cases, the gravity of the symptoms has seemed to depend in great measure upon the amount of difficulty ex- perienced in forcing the water through the narrowed orifice. When the back- pressure is great, as it is in pin-hole steno- sis, the bladder soon becomes excessively irritable, and actual cystitis may result. Frequently the patient w’ill cry and strain until exhausted, while the reflex spasm will be so great that retention will often continue until hot baths and apjjro- priate remedies have given relief. The spasmodic desire to urinate will sometimes awaken an infant from a sound sleep, and not even food will appease the violent screams. This condition is often mistaken for colic ; but careful observation wall show that relief comes after a discharge of urine, not of faeces or of flatus. In older chil- dren, the pain will render the patient rest- less and fretful at night, the distress often being so great that perspiration is ])rofuse, and, if the spasmodic contractions are vio- lent, even convulsions will result. It is chiefly in these cases that I have seen true convulsions occur from this cause, and in a few severe attacks I was satisfied that the preputial condition w'as at fault, as no other reasonable explanation could be given, and the kidneys and other or- gans were not diseased. Eustace Smith,1| in a recent article on “ Convulsions in Children,” does not give this as one of the causes; but the relation ? Med. Rec., New York, 1882, xxii. p. 617. Proposi- tions, Beard; also St. Louis Med. and Surg. Jour., .April 1882, p. 438: also Transac. Med. Assoc. Georgi.a’, i88o’ xxxi. p. 143, Richardson; also Quar. Trans.ac. Lancaster City and County Med. Soc., 1881, ii. 65, Roland. II l.ondon Lancet, Aincr. ed., Oct. 1882, p. 266.