The second case bears upon the very heterodox theory of maternal impressions, and is reported in the same periodical, of dates Nov. 3, 1888, and March 23, 1889. It is that of a child born accurately circumcised, seven months and twenty days after the like operation on his elder brother (presumably in presence of the mother, although this is not stated). The local appearances in the two children are affirmed by Dr. Harvey, of Illinois, to have been exactly alike; 'the congenital case even showing the marks of the sutures.'
Both of the above cases, together with Dr. Asher's experiences, may be respectfully commended to the notice of Professor Weismann.
II NATURE OF CONGENITAL PHIMOSIS—PHYSIOLOGICAL IMPORTANCE OF THE PREPUCE.
The word 'phimosis' (φἱμὁω, I bind) signifies that condition of the penis in which the prepuce cannot be retracted beyond the corona glandis; and which may be either congenital or factitious.
The latter is a pathological phenomenon, the product of injury or of disease. To apply the term 'abnormal' to the former is, however, hardly permissible, except when the difficulties in retraction are permanent and extreme; when they cannot be overcome by judicious perseverance, and by careful manipulation in the early weeks of infant life. A certain amount of adhesion between the two contiguous surfaces of mucous membrane is almost constantly present at birth, as a continuation of the normal intra-uterine agglutination (Keating's Cyclopædia of the Diseases of Children, 1890, vol. iii.; article by Dr. De Forest Willard).
The radical defect in congenital phimosis is thus the adhesion or imperfect separation of two muco-cutaneous surfaces, normally developed in close contact. As a rule, these are so slightly connected that a very slight degree of force is sufficient to part them; but in a considerable minority of instances the defect eventually becomes permanent; with the natural growth of the organ more difficulty is experienced in procuring retraction; and various disagreeable, or even dangerous, symptoms are prone then to make their appearance.
The complaint, however, is simply one of degree. If the adhesions at the margin of the urethral meatus are so tight that they fail to be quickly separated by the stream of urine directed against them—the force of which necessarily varies in different infants—considerable impediment to micturition results; and, perhaps usefully, serves to direct early attention to the state of the parts. In rare cases, no opening at all into the urethra has been discoverable; and complete retention has necessarily ensued. Very often, however, nothing of this sort happens for several weeks, months, or even years; and the existence, or rather persistence, of the disability may not be noticed at all until adolescence of adult life. The majority of instances lie between these extremes; not seldom unpleasant symptoms begin to be observed when the boy is a few months old; but there is a wide range of variation.
The penile and preputial layers of mucous or quasi-mucous membrane being firmly adherent, and growth of the glans penis proceeding apace, certain consequences necessarily follow.