In this case the disease was believed to have originated from a perineal fistula. The pathological investigation in the case, however, by Mr. Quekett, who submitted the mass to a microscopical examination, confirmed Mr. Brett in his original opinion that the disease had the same pathological conditions as the similar disease found in India, where it originates from local inflammatory causes. In this case the preputial irritation was, in all probability, the precursor of the conditions that led to the perineal fistula, the patient having had a stricture for some twelve years. Mr. Brett states that the man had been abandoned by his wife on account of his previous sexual disability, and on account, as well, of his having been incapacitated from following any vocation. After the operation all his functions were restored and his organs were sound.
Nelaton records a case reported by Wadd, in 1817, of an African negro so affected, whose penis measured fourteen inches in length and twelve and a half inches in circumference; also the case reported by Gibert, of Hospital St. Louis, of a subject “with a penis the size of a mule’s.”
Mr. Brett attributes the recovery of his case as being due in a great measure to the moral support given to the patient from the knowledge that his procreative organs were not interfered with, and on the same grounds he attributes the great fatality previously attending the operation to the fact that it previously had been the custom in many cases to make a clean general taillè à fleur de ventre, sacrificing all the genital organs. In simple hypertrophy, he considers that the body of the penis and the testicles will always be found to be in a normal condition; a careful dissection of the parts will invariably save not only the man’s sexual functions, but his moral stamina, which he sadly needs in such an emergency. In the discussion on this subject heretofore mentioned as taking place in the London Medical Society, Mr. Pye, Mr. John A. Morgan, and others insisted on the necessity of retaining the testicles, whenever possible, in all these sweeping operations upon the genitals, they being actually necessary for the moral and physical support of man, Mr. Morgan observing that their removal would depress parts controlled by the sympathetic system.
CHAPTER XXIII.
Reflex Neuroses and the Prepuce.
We have seen in the previous chapters what the immediate effects of the prepuce may lead to; we have followed its local effects in childhood to youth, thence into what it does in our prime, and we have seen how, when we are on the down grade, owing to the increase of years, then, like the minute-men of Concord, wakened up by Paul Revere’s classic ride, hanging on to the rear of the retreating and disheartened British, it harasses, worries, and downs a man here and there, striking down the man as if it had some undying, irremediable spite, which nothing but his misery and death could alleviate. Some authorities will argue that all that is required is cleanliness; that all men need do is to be like a true American, with the old Continental watchword of “eternal vigilance is the price of liberty” in continued active practice. A bowlful of some antiseptic wash and a small sponge should always be at hand, and he should be as industrious as if haltered in a tread-mill; he should make this a part of his toilet, and his daily and hourly care. This will, we are told, lessen his chances of becoming a victim to the many ills that lie in wait for him, all on account of the glory, honor, and comfort of wearing a prepuce, which is a perfectly physiological appendage.
From these visible and apparently easily understood conditions and results we are now to enter a broad field, wherein the prepuce seems to exercise a malign influence in the most distant and apparently unconnected manner; where, like some of the evil genii or sprites in the Arabian tales, it can reach from afar the object of its malignity, striking him down unawares in the most unaccountable manner; making him a victim to all manner of ills, sufferings, and tribulations; unfitting him for marriage or the cares of business; making him miserable and an object of continual scolding and punishment in childhood, through its worriments and nocturnal enuresis; later on, beginning to affect him with all kinds of physical distortions and ailments, nocturnal pollutions, and other conditions calculated to weaken him physically, mentally, and morally; to land him, perchance, in the jail, or even in a lunatic asylum. Man’s whole life is subject to the capricious dispensations and whims of this Job’s-comforts-dispensing enemy of man.
As strange as it may seem, this field of knowledge, this field of misery and suffering, disease and distortion, of physical and mental obliquity, presided over by this preputial Afrit of malignant disposition, was an unknown, undiscovered, and therefore unexplored region for some thousands of years, and it remained for an American to discover and describe this vast territorial acquisition, and to annex it to the domain of medicine, which, through its skill, could modify the influence of the evil genius that there presided and spare humanity much of the ills to which it had been subjected.
In this regard, Louis A. Sayre was to medicine what Columbus was to geography. Neither Strabo nor Herodotus had anything to say regarding what existed beyond the pillars of Hercules, and neither Hippocrates nor Galen had anything in regard to this preputial Merlin, which in their day, even, had its existence. Neither did Tissot nor Bienville, the two pioneers in the field of our knowledge regarding onanism and nymphomania, dream of the existence of this one cause of the diseases to which they gave so much time and study. It is only some twenty years since Louis A. Sayre read his paper, entitled “Partial Paralysis from Reflex Irritation Caused by Congenital Phimosis and Adherent Prepuce,” before the American Medical Association. This was the starting-point from whence the profession entered into what had previously been a veritable “Darkest Africa.”