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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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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    hernia, the explanation of which is easy, and has been noted by others.* Balanitis in boys and vaginitis in girls are, of course, natural sequences, and dis- ease of the kidneys would not be improb- able. Some go so far as to ascribe even struma f to genital irritation ; and, while this con- dition does greatly interfere with healthful nutrition, yet it seems far more probable that the morbid tendency to languid forms of inflammation would have existed had the child been absolutely free from any genital abnormality from birth. Its feeble condition might very probably, however, render the jn'esence of an adherent pre- jHice an additional factor in developing wasting disease. Foil's disease, even, is attributed to this cause; and, while everything that lowers general vitality may assist in such destruc- tive inflammation of the bodies of the vertebrae, yet I cannot conceive that the preputial was the primary cause. True, we shall find adherent prepuce in Pott’s dis- ease, as in typhoid fever, but it should not be looked upon as prime factor. The coexistence of adhesion with mor- bus coxarius has also been frequently noted; but, save by lowering general vi- tality, I am not able to trace the relation of cause and effect. The relation may be the same as expressed in regard to cases of spinal caries,—merely one of several fac- tors ; altliough Barwin reports eighty-five per cent, of balanitis and adhesion in his coxalgic cases. Dana.'j; has seen cases in which medicines and hygiene had accomplished all claimed for circumcision, even where the prepuce was adherent. Taylor§ believes that imperfect sexual hygiene has much to do with reflex irrita- tions-, and advises operative relief. Beard II advises that the genital cause of irritation be taken with caution' Seguing gives excellent diagnostic points in relation to sclerosis. The writings of Sch weigger-Seidel ** and of Bokaiff have brought the subject of genital irritation ably before their neigh- bors abroad, as have also the notes of Ver- neuilll and Picard ;§§ but the majority of testimony has been collected u^on this side of the water. Epilepsy I have seen occasionally a.sso- ciated with this adhesion, but have not obtained much relief from uncovering the glans, and am inclined to believe that the true difficulty is central and not j)eripheral. I Gastralgia,|||| diabetes,even diarrhoea, i are all mentioned as results; but we must be careful to eliminate unreliable notes. Urremic*** poisoning has been noted, as have also a score of other difficulties.fff Passing to the wider effects of nervous pJmiomena, I am sometimes inclined to feei that the existence of reflex symptoms is still debatable, and that we are too often inclined to refer choreic, incoordinate, and irregular muscular moVements to genital irritation simply because an adherent or contracted prepuce is found to exist; but the more I study these cases of lack of coordination and eliminate every other reasonable causative influence, and the ! more I review the notes of my cases, the j more satisfied I am that reflex movements do sometimes occur from this as a sole or most probable cause, and that the removal of this cause acts most promptly and per- manently in effecting a cure. On the other hand, I do not believe that we should infer at once that we have discovered the cause of a reflex paresis simply because the patient has an adherent prepuce. So many children are subject to this con- dition that a careful examination must be instituted to discover whether a deeper and more central disease may not be found which is the chief factor in producing the nervous conditions noted. If sclerosis ex- ist, or if central brain-power be wanting, removal of the prei)uce cannot restore what has been destroyed, or produce what has never existed ; yet even here the genital condition may act as an irritant to already weakened central ganglia, and the removal of even a minor exciting cause is desirable. 1 he operation of circumcision may now * Osborn, Brit. Med. Jour., 1881, i. 427. t St. Louis Med. and Surg. Jour , IJecember, 1881, p. 628. J New York Med. Rec., 1881, p. 569. \ Brooklyn Ann.-ils Anat. and Surg. Soc., 1881, July, p. i. II New York Med. Rec., 1879, .xv. p. 73; also Transactions Anier. Med. Assoc. Arch. Scientif. and Prac Med., February, 1873. Archiv. Med., February, 1879, New York. ** Jahrbuch fiir Kinderheilk., 1!. v. Heft i. ft Arch., Hd. x.wii. Heft ii. Gaz. des Hop., Paris, 1881, liv. j>i! Annal. de Gynecol., Paris, 1882, xvii. 364. Ill] St. Louis Alienist and Neurologist, 1881, ii. p. 648, San- transactions Amer. Med. .•Vssoc., 1880 New York Med Rec., .882. xx. 65, Hart. T++t Med. News, 1882, xiii pp. 25, 49 ; also .Amer. lour. Med. Sci., 1880, Ixxix. p. 444, Simmons; also Atlanta Med. and Surg. Jour., Jordan. 1880-1, xviii. p. 5,3- also Mississippi Valley Med. Moiiilily, 1882, ii. p. 99, Mcdec- also Glasgow Med. Journal, iJiiiilap, 1882, vii. p. 288.