Probably the most remarkable case of the immediate continuous effects resulting from phimosis is the one recorded by Vidal, in the fifth volume of the third edition of his “Surgery.” This was a young man with a congenital phimosis, having but a very small aperture; on an operation to relieve the phimosis there was a gush of water, but this only fell at the feet of the patient, without being ejected at any distance; the urethra was found to have undergone precisely the same dilatation back of this preputial orifice that it usually undergoes back of a stricture; the whole urethra from the meatus backward was found to have exceeded the calibre of that of the vesical neck; the bladder was greatly dilated.
CHAPTER XXV.
General Systemic Diseases Induced by the Prepuce.
Aside from all the local affections or reflex neuroses, either mental or physical, that a prepuce may induce, there are an innumerable train of diseases that may originate in this one cause that at first sight would seem to have no connecting-link with any preputial condition.
It has already been suggested that the prepuce does not at all ages bear the same analogous relation to man. In childhood, especially during our earliest years, it is out of all proportion in size when compared to the rest of the organ, or to any use it may have placed to its credit. Man does not, then, certainly need that refinement of nervous sensitiveness in the corona that is useful in after life in inducing the flow or ejaculation of the seminal fluid; neither is there at that age much of a corona to protect. In middle life, or what might be called the procreative period of man, when the corona would seem to require all its excitability or sensitiveness, seems to be the very season in life when the glans is most apt to remain uncovered; so that nature and this hypothetical idea of the use of the prepuce are evidently at variance. So we go through childhood with this long funnel-shaped appendage into manhood, when the increasing size of the body of the penis restores a sort of equilibrium between the size and bulk of the organ and its integumentary covering. At this period, as we have seen, although it does not, from the equilibrium restored, and the more or less use to which it is subjected, induce any great immediate or uncomplicated troubles, it nevertheless endangers the existence of the penis through the accidental course of some putrid or continued fever, or it subjects man to the manifold dangers of venereal or tubercular infections.
In advanced age, owing to the diminution in size of the organ, the prepuce resumes the proportionate bulky dimensions of childhood, and as the organ recedes and becomes more and more diminutive, the prepuce again, like in childhood, begins to tend to phimosis; the urine of the aged is also more irritating and prone to decomposition or putrefaction, and the constant state of moisture that the preputial canal of the aged is necessarily kept in, either by frequent urination or the incomplete emptying of the urethra that is peculiar to old age, and which results in more or less dribbling, is a powerful factor in inducing the many attacks of posthitis and balanitis, as well as those attacks of excoriation and eczema which are so annoying to the aged. I have often seen such cases happening to men past fifty, who, being widowers, and never having had anything of the kind, as well as being in the most complete ignorance of the nature of the disease, have, from delicacy and fear that the disease might induce some suspicions as to their conduct in the minds of those whose good opinions they value above all else, gone on suffering untold miseries, especially if the urine were in the least diabetic.
One such case that fell under my observation not only produced such misery as to entail a loss of rest and of appetite, but even induced such a disturbance of assimilation and nutrition that the resulting hypochondriacal condition that developed from these enervating causes ran the patient into a low condition, ending in complete prostration of all vital powers and death, without the intervention of any other disease. The subject was a timid, retiring man of about fifty-five years, and this was the first and only time that the prepuce had ever caused him any annoyance,—a circumstance which greatly preyed upon his mind, as he could not disconnect it with the idea that it must be suspected as venereal, although he had always led a most continent life since the death of his wife. This is, of course, an extreme case; but as it is a result beginning in a certain condition, be it an extreme, erratic, or infrequent occurrence, it is, nevertheless, an example of what may happen in advanced life, even where the prepuce has never before been a source of the least disturbance or annoyance. Persons who, with the increase of years, are also liable to an increase of adipose tissue, are more subject to this dwindling down of the penis and consequent elongation of the prepuce, with all the attendant annoyances, than thin or spare people.
In this irritation that the prepuce is liable to cause, we have not only to encounter the dangers that its thickenings or indurations may bring on in their train, in the shape of cancer, gangrene, or hypertrophies, but other and no less serious results are liable to follow a herpetic attack, or in consequence of an attack of balanitis or posthitis. The dysuria attending any of these conditions may be the initial move for such a serious complication that life may be brought to a sudden end, even in infancy, to say nothing of the ease with which life is taken off in after years and in old age; with debilitated and imperfect kidney action, it takes very little to hustle us off from life’s foot-bridge.
A case as occurring in Henoch’s clinic, already mentioned or referred to in a previous chapter, shows what a simple phimosis is capable of inducing. In the history of the case the phimosis and the resulting retention in the preputial cavity no doubt were the causes of the calculus found there; and the succeeding calculi and abnormal condition of the urinary organs, we can safely assume, were a subsequent creation to that in the prepuce. The case is taken from Henoch’s “Lectures on Diseases of Children,” Wood Library edition, page 256, and is as follows:—