“I once had occasion to pass a catheter into the bladder of a lady who presented an innumerable train of nervous symptoms, often bordering on insanity, but was unable to do so without exposing the parts. Although the meatus could be distinctly felt, the catheter would not enter. On exposure to view, an opening was seen in the clitoris, which was firmly bound down by preputial adhesions near the extremity of the organ. Entering the catheter at this point, it readily passed through the clitoris, then down through a passage under the mucous membrane to the natural site of the meatus, on into the urethra, and through into the bladder. In the light of recent experience, my opinion now is, that here was the cause of all the nervous symptoms in this case.”
The relative disposition in regard to the irritability of the external sexual organs as existing in the female, when contrasted with the male, is, for some reason, not sufficiently considered or understood. The idea of masturbation or of irritation from the genitals ending in reflex neuroses is always, as a rule, associated with the male, and that it has not been more associated with the female has deprived her of the same benefit that the prosecution of the study in this regard has been to the male sex. Masturbation among the feeble-minded, which is so common, must, of necessity, have for its determining cause a foundation of morbid irritability of the sexual organs. This is well known to be so among the males, whose hands seem instinctively to be drawn to those parts. Dr. C. F. Taylor, of New York, in an article on the “Effect of Imperfect Hygiene of the Sexual Function,” published in the American Journal of Obstetrics for January, 1882, gives us an account of his investigations in this regard, with the following results: “In an asylum for the feeble-minded of both sexes, it was found that the habit was about equal in the two sexes, there being only this difference: that the females began to masturbate one or two years earlier than the males, and that the habit, once established, was found to be more persistent than in the males. It was, further, ascertained that the habit came naturally, without the aid of precept or example to either sex.”
It may well be a question as to whether the feeble-mindedness be not a reflex condition from this excessive morbid irritability of the sexual organs. There is not much doubt but that, if one of the cases reported by Dr. Price had not been circumcised, the expressionless, listless infant would have grown, in time, into a masturbating, feeble-minded, idiotic creature, as many others, so situated, have done before it. Now, would it have been logical to have laid the morbid irritability of its generative organs to its feeble-mindedness, when its feeble-mindedness was fully demonstrated to have been wholly dependent on the sexual irritation? From these premises we might take another step forward, and ask whether, under a proper hygienic prophylaxis,—which would involve a thorough inspection of the genitals of all children reported to be either physically or mentally deficient,—such a course would not greatly diminish the number of paralytics, feeble-minded, and generally deficient of both sexes? If the results in private practice are any criterion, it is safe to assert that a strict adherence to the Mosaic law for the males and to some of the African customs for the females would most assuredly relieve all these cases that might come under the caption of results of reflex neuroses. Twenty years ago this subject was, to the body of the profession, a terra incognita in regard to the male, and, as the female is similarly subject to the same morbid influence, it is to be hoped that in the present decade she will receive the same attention which the profession is now beginning to pay to the male sex.[105]
In the foregoing parts of this chapter, examples of reflex neuroses have been given to show the different effects that genital irritation will produce. The cases given were chosen for the diversity of variety of symptoms, and as cases representing the affection, without any other complication. Many more could have been added, but they are unnecessary. In the writer’s practice there has been a number of cases in the adult that have exemplified that this form of ailment is by no means restricted to children, as has been shown in the case reported by Dr. Mott to Dr. Sayre, in regard to the middle-aged man with a string about his penis. One of these cases was that of a young man, six feet in stature, broad-shouldered, and well built. He applied for relief for a dyspepsia that affected his stomach and also his heart. The man had an apparently feeble and irritable heart; cold, clammy skin; disturbed digestion, and uneasy sleep; was constipated and flatulent. No treatment seemed to make any impression upon his case. At last he began to emaciate and look haggard. His mind was also becoming visibly weaker, was attacked by dizziness, and on several occasions he fell in a fit. With this condition he at last began to have frequent nocturnal emissions. On account of the latter his genital organs were examined, and the penis was found smaller than the average, with a long and narrow prepuce. The glans could easily be uncovered, but the tightness of the prepuce and its unyielding qualities made paraphimosis a possibility; so that the young man, having once or twice had considerable difficulty in returning the prepuce to its place, never attempted its retraction again. There were no adhesions, but the inner fold of the prepuce had been thickened by balanitis. Seeing the need of circumcision for the local benefit, the operation was suggested with a view of relieving the pressure on the glans, which was looked upon as the probable cause, in his broken-down condition, of the advent of the nocturnal emissions. He gladly submitted, and, to the surprise of both physician and patient, all his troubles disappeared, and he at once became a changed man. So impressed was he with the result, that, on his return to his home, he examined his younger brother, and, finding him with a like long, narrow prepuce, he immediately brought him in and had him circumcised, as a prophylactic against his being subjected to the risk of lost health as he himself had suffered.
Another case, a man of forty-five, also a farmer, was afflicted with dyspepsia, palpitation of the heart, general debility, constipation, constant headache, etc. He could not cut up an armful of wood without bringing on palpitations and gaseous eructations, or being upset for the day; and after having connection with his wife he generally had a terrific headache, lasting for two or three days;[106] he could stand no protracted mental effort, even such as is required to make an addition of a long line of figures, or the least business worry, without the supervening headache. All treatment against these conditions was useless; the colon was kept empty, the diet was changed; pepsin and bismuth, tonics, frictions, Turkish baths, and all hygienic observances and moral treatment were all of no avail. One day, on consulting the writer, he complained of a pruritus at the head of the penis. On examination it was found that he had a narrow, long prepuce, a congenitally-contracted meatus, and was then suffering with a slight balanitis. He was very careful to keep the parts clean, but, he informed me, that in spite of all precautions, these attacks would come on. The mucous covering of the inner fold of the prepuce and glans was so irritable that connection often brought it about. The glans was small and elongated, with the meatus red, and with lips œdematous and congested. To free him from this tormenter, circumcision was advised. The party could not, however, remain away from home for the time required for the operation; so that a compromise operation was performed,—one that would not keep him from business, and, at the same time, relieve the contracting pressure on the glans. This was by Clouquet’s operation and bandaging back the prepuce over the penis, back of the corona,—an operation that, in my hands, has often filled all the desired purpose. The meatus was also incised. After the operation all of his troubles disappeared, as they had done in the preceding case, and he was soon a hearty and well man, able to chop wood, attend to business, and, in case of need, do family duty for a Turkish harem without recurrence of his old tormenting, dyspeptic palpitation or sick-headache.
The writer has resorted to circumcision in many cases to improve the temper and disposition of children, with the best of results, and in one case, in association with another physician, performed the operation on a lunatic, whose lunacy ran to women and girls, with whom he would fall desperately in love, without any encouragement or provocation, or even acquaintance; finally reaching spells of such incoherence of action and speech that confinement would be required. The peculiarity of his hallucinations called attention to the genital organs. This man had never masturbated, and was, when well, a compactly-built, active, and intelligent man. By occupation he was a contractor, and a man of more than usual executive ability besides. On examination it was found that he was a subject of congenital phimosis, never having been able to uncover the glans. He had been in the habit of washing out the preputial cavity by the aid of a flat-nozzled syringe. The prepuce was long, but not thick; nevertheless, it was inelastic and very firm. The examination seemed to have a good mental effect upon the man, as it made him quite rational for the moment. He entered into the idea that this condition had some connection with his derangement very intelligently, even suggesting many symptoms and attacks that he had suffered from childhood up as probably gradual-stepping processes through which his present condition had been reached. He cheerfully submitted to a thorough circumcision, which had the effect of ameliorating his condition. He was subsequently sent to an asylum, where, after a short time, he was discharged well. Some years afterward, conscious of feeling a return of the mental derangement, he voluntarily applied for admission to the same institution and remained until better.
This case is very instructive. The patient readily connected his mental trouble, by a retrospective view through a series of gradually-increasing troubles, that originated in the preputial condition, to the phimosed condition of that appendage, and he was certain that this prepuce had been at the bottom of all the physical and mental trouble he had experienced. The reflex nervous train of affections had undoubtedly produced some localized lesion in the brain-structure. The natural sound, healthy organism of that organ, and the bright, active nature of his mind, however, prevented a total wreckage of the mental faculties. It is safe to assume that, had he had the ordinary listless, unresisting mind, disposed to brood, and easily cast down, he would, from the first derangement, have become a hopeless and demented lunatic. The circumcision could not undo all the mischief that had been accomplished, some of which had certainly left a permanent taint, but the mildness of his future attacks and the better exercise of his volition were the undoubted results of the operation.