When we read that only some fifty years before the times of Columbus Christian Europe had no lunatic asylum,—not that there was a lack of lunatics or that the existence of lunacy was entirely ignored, but that the then state of medicine and the general intelligence was not emancipated from the idea of demoniacs,—and we are told that the lunatics were in many instances hung, quartered and burned, hooted and chased about the streets, or chained in gloomy dungeons; until, as related by Lecky, a Spanish monk named Juan Gilaberto Joffe, filled with compassion at the sight of the maniacs who were hooted by crowds through the streets of Valencia, founded an asylum in that city. His movement in this direction called the attention of the Church and people to this class in a practical light, and from Spain a more enlightened idea in regard to this class swept onward throughout Europe. As observed, it seems strange to us of the present day that such ignorance in these matters should, or could, have so long existed. It seems impossible for us to conceive how these conditions of incoherent action and of mental derangements could have existed and their causes have not been fully appreciated; and yet we were not above, some twenty years ago only, subjecting children to punishment and scoldings for being addicted to nocturnal enuresis, or of accusing cases of nocturnal and involuntary emissions as being due to masturbation. The child was allowed then to grow up paralytic, or with a deformed limb, or continually punished to correct what was imagined to be a condition of willful carelessness, irritability, or willful moral perversion. Perversion, stupidity, and irritability of the mind or temper were not known to depend, in many instances, on preputial irritation; children were, accordingly, worried and punished for something over which they had no earthly control or the least volition. Humanity cannot, at present, sufficiently appreciate what Louis A. Sayre has done in its behalf. It is here that we realize the hidden wisdom of the Mosaic law and the truth of the assertion of the late Dr. Edward Clarke, that, “The instructors, the houses and schools of our country’s daughters, would profit by reading the old Levitical law. The race has not yet outgrown the physiology of Moses.”
These irritations from the preputial irritability are not always so slow moving as to span over either months or years in their fell work. Instances of their sudden action have been sufficiently recorded as to warrant them as being classed as causative agents in acute affections that instantly threaten life. In the London Lancet of May 16, 1846, there is a record of a very peculiar case reported to the London Medical Society by Dr. Golding Bird: “The case was that of a child seven or eight weeks old only, an out-patient of Guy’s Hospital. The child had become almost lifeless immediately after nursing, and to all appearances looked as if under the influence of some narcotic. It had not, however, had anything of the kind given to it, nor had it sustained a fall, nor was the head so large as to lead to suspicion of congenital hydrocephalus. On inquiring if the child passed water, the answer led to an examination of the prepuce, which was found to be elongated, and had an aperture only of the size of a pin-hole, like a puncture in the intestines. The urine was dribbling out; it was evident that the child had never completely emptied its bladder. Mr. Hilton slit up the prepuce, and all the symptoms were immediately relieved and soon entirely removed.” Dr. Bird referred to a case which he had related to the Society some years before, which was reported in the Lancet at the time, of a child who fell a victim to a malformation of this kind, and after death the bladder and ureter were found like those of a man who had long suffered from stricture. Mr. Hilton has seen many cases similar to the one mentioned by Dr. Bird. The greatest benefit resulted from slitting up the prepuce. In this case the benefit was very remarkable, a partial paralysis of the left side, under which the little patient labored, being quite removed in twenty-four hours.
In this case the difficulty was evidently both the result of mechanical pressure and reflex irritation. A somewhat similar case as to its results is given by Dr. Sayre, to whom the case was reported by Dr. A. R. Mott, Jr., of Randall’s Island, in January of 1880: “John English, aged 46, native of England, widower, clerk; admitted to workhouse hospital. Patient had been at work for a week as a prisoner; on the 23d of December was noticed to be restless and uneasy, and finally, in the evening, he fell from his bunk in a fit. During the next forty-eight hours he had several convulsions, and during the intervals lay in a semi-comatose condition, showing no consciousness except to stir a limb when pinched. Pulse, 120; temperature, 101-1/2°; respiration, 18. Swallowed nothing, and passed fæces in bed. Continued in this condition until December 25th (temperature having fallen to 100°), when a string was discovered passed twice around the penis behind corona and tied, the long prepuce serving to conceal it from observation. While not sufficiently tight to occlude the urethral canal, still a firm, indurated band remained after the string was cut, and did not disappear for four or five days.
“Within one hour after the removal of the string the man sat up and asked for milk, and from this time remained perfectly well (was under observation for three months). He declared that he remembered nothing that had taken place during the past three days; had never had fits, denied venereal diseases, was moderately addicted to drink, but had led a ‘virtuous life since the death of his wife, two years before.’”
The following case in the practice of Dr. F. J. Wirthington, of Livermore, Pa., was also reported to Dr. Sayre: “When the child was born, he was considered the biggest and finest boy that had been born in the community for a long time, until, when he was about two and a-half years old, and being sick, a doctor was called in, who told them that their child was paralyzed, the paralysis being in his lower extremities, and who treated him with the usual nerve-tonic and with electricity. Notwithstanding all this, the boy went steadily down, and the paralysis continued until he was seen by Dr. Wirthington. The child was then unable to walk; on examination, the prepuce was found to be adherent almost all the way around the glans penis. Behind the corona was a solid cake of sebaceous matter. The case was promptly operated upon, and, although the previous attendant had not found any cause to account for the paralysis, a rapid recovery took place, the boy being able to walk even before the complete cicatrization of the wound, and was soon the picture of health.”
Dr. T. F. Leech, of Attica, Fountain County, Ind., reports a case of a fourteen-month-old child, who had been the terror of all that part of the town for over six months, as he cried constantly. Except when asleep or nursed by his mother, he would lie perfectly still and squall, not showing any disposition to sit up; nor did he like to be raised up. He was very nervous, and would have times when his limbs would be rigid. This state of things grew worse, until the child was accidentally seen by Dr. Leech, who, on examination, found a contracted and adherent prepuce, the child being at the time in a high fever and suffering great nervous excitement. An operation by slitting and breaking up the adhesion afforded immediate relief; the spinal irritation, partial paralysis of the lower extremities, spasms during urination, and all trouble disappeared as if by magic.
Prof. J. H. Pooley, of Columbus, Ohio, reported the case of a fine, healthy boy who, up to three months before being seen professionally, had always been well and in perfect health. His condition was found by Professor Pooley to be one of localized chorea, manifesting itself in constant convulsive movements of the head. They were nodding or antero-posterior movements, alternating with lateral or shaking and twisting motions; these movements had become almost constant during the waking hours of the child. There was no distortion of the features nor any choreic movements of the extremities; indeed, the whole affection consisted in the nodding and shaking movements of the head referred to. These were almost incessant, sometimes slow and almost rhythmical, then for a minute or two rapid and irregular, seeming to fatigue the little fellow, and accompanied by a fretful, whimpering cry. The child had been subjected to a variety of treatment, but without any benefit or effect of any kind. Upon the most careful examination of the patient and his history, Professor Pooley could not discover anything that seemed to throw any light upon the case, except a condition of well-marked phimosis. Acting upon this, the Professor immediately circumcised the child, and from the very day of the operation the spasmodic action began to diminish, and in two weeks he was entirely well, without any other treatment of any kind.
Dr. W. R. McMahon, of Huntington, Indiana, has reported three cases of epilepsy in children caused by congenital phimosis that were entirely relieved by an operation without any subsequent return of the difficulty. One of the cases was in a boy ten years old, with very firm preputial adhesions and a high grade of inflammation of the parts.
Dr. J. D. Griffith, of Kansas City, Mo., operated on a case of phimosis on a child nearly three years of age, who was afflicted with repeated attacks of convulsions and paralysis of the hips and lower extremities; the little fellow had as many as fifteen convulsions in a day; the patient was greatly troubled with painful urination and priapism. On examination at the operation, a firmly adherent prepuce and a large roll of caseous matter was found just back of the corona. A complete recovery followed the removal of these conditions.
The above cases are taken from the paper read before the Section of Diseases of Children at the International Medical Congress of 1887, by Dr. Sayre. It contains a number of additional cases of an analogous character to the above, reported to him by physicians in different parts of the country. They show the variety, extent, and far-reaching character of the diseases induced by any preputial irritation. Dr. G. L. Magruder, of Washington, D. C., in the same paper, has a record of twenty-five cases of various nervous disturbances which he had entirely relieved by circumcision or dilatation, without any medication whatever. Dr. Magruder, in concluding his report, in which he quotes the authority of Brown-Séquard, Charcot, and Leyden, as having noticed serious nervous disturbances resulting from reflex irritation due to affections of the genito-urinary organs, observes as follows:—