SPINAL ANEMIA WITH PARTIAL PARALYSIS AND WANT OF COORDINATION, FROM IRRITATION OF THE GENITAL ORGANS.

BY LEWIS A. SAYRE, M.D.,

OF NEW YORK.

IN 1870 I presented to the American Medical Association a short paper upon Partial Paralysis from Reflex Irritation, caused by Congenital Phimosis and Adherent Prepuce, illustrated by several cases, and published in their Transactions of that year.

This paper produced a marked effect upon the professional mind, as I received letters from all parts of our own country, as well as from some of the most distinguished surgeons of Europe, thanking me for the explanation given and confirming the views expressed, by the narration of cases which had come under their own personal observation, but which, until this explanation had been offered, they had not thoroughly comprehended.

Dr. Atlee, of Lancaster, Pennsylvania, wrote me that on reading the paper it brought to his mind a case at some distance from his residence which he had seen several months previous without fully understanding it; but that the explanation made it so clear to him that he at once visited the family, explained it to the parents, and performed the operation, which was followed by the perfect recovery of the use of the child's limbs.

The following letter from Dr. Pitcher explains the same idea:—

"LEWIS A. SAYRE, M.D.

"DETROIT, Dec. 3, 1870.

"My Dear Sir: I have read with pleasure your pamphlet on the subject of Partial Paralysis from Reflex Irritation which you were kind enough to send me. It enables me to study a case sent

to me from the interior of this State some time since from a new standpoint. Others I am sure will thank you for the use of this key to unlock some of the obscurities we meet with.

"With respectful consideration, I am

"Yours, etc.,

Z. PITCHER."

Many similar letters were received from different sections of the country, and some of them describing cases of hernia, and others prolapsus of the rectum dependent upon the same cause, and which had been relieved by the operation.'

The same ideas suggested by me at the time, also occurred to Mr. Barwell of London, who, in his Lectures on Infantile Paralysis, gave a very vivid description of the peculiar form of paralysis dependent upon irritation, caused by adherent prepuce, and stated that the fact had never before been observed; but upon reviewing a copy of the Transactions containing the article, he wrote me a beautiful letter, acknowledging my priority of observation and description, but fully confirming the views expressed, and stating that he had seen a number of cases which he had traced distinctly to this cause, and which recovered by proper treatment.

So many cases of a similar nature have come under my observation since that time, some of them being aggravated by other and more serious nervous complications, that it has seemed to me proper to bring the subject before the profession more fully, as I am well satisfied that there are many grave affections of the nervous system attributable to this cause that have not, as yet, even been suspected. Some of these cases have been in children of the opposite sex, and I have, therefore, headed my paper "Irritation of the Genital Organs," as each sex seems liable to the same exciting cause.

I have no theory of explanation that is perfectly satisfactory even to my own mind, and for that reason I have brought the matter before the Society for a more elaborate discussion, and to see if we cannot obtain a true explanation. It has seemed to me in many cases that an anæmic condition of the spinal cord is in some way connected with the disease, as some of the patients lose entire muscular power, even the power of speech, in the erect posture, and yet, lying upon their backs for some little time, and when the cord could be nourished with more blood, they could, in a measure, recover the power of speech and motion.

It may, however, be a hyperæmic condition of the cord, instead of

1 Congenital Phimosis.- Vide Med. Times and Gazette, May 16, 1868. Clinical Lecture by Mr. Thomas Bryant on " Adherent and Elongated Prepuce; eight cases illustrating incontinence of urine, difficulty of micturition, pain, intermittent flow, prolapsus recti, hæmaturia and priapism dependent upon the condition of the prepuce."

anæmic, the paralysis being produced by over-pressure on the nerves from an engorged condition of the vessels.

As before remarked, I have no fixed theory upon the subject, and will, therefore, simply present the cases, accurately detailed, and let the Society make such explanations as they think proper.

CASE I.—In March last [1874] I received the following letter from a highly cultivated lady, the daughter of one of the most distinguished surgeons of our Southern States, and as it is such a graphic recital of her child's disease, I have obtained consent for its publication, and, therefore, offer such parts as seem apposite :

"DR. SAYRE.

66

"WASHINGTON, D. C., March 7, 1874.

Dear Sir: I have a child, now three years old, who has never walked; never reached out his hands to take hold of anything; he has never talked, and, I venture to add, has never used his eyes to look at any object; and yet there is no blindness, no paralysis, and the child is intelligent.

"He was born with a urinary trouble, and has suffered in those parts all his life-at times is a martyr.

"A physician here has traced a case on record where Dr. Marion Sims writes you a letter to visit a little fellow whose legs were crooked, and perform some operation for paralysis. In that case you describe my baby's symptoms exactly. You questioned the nurse, and the result was not an operation for paralysis, but circumcision.

"All the physicians of the Union, excepting yourself and some others of New York, have seen the child. He is so strong, so beautiful, so full of life, I cannot give him over to such infirmity.

"I am the daughter of a physician of celebrity in L——————————, and, although he is no longer living, I feel that I have a claim upon the profession for my son's peculiar infirmity.

MRS. W. B. E."

As it was impossible for me to leave for Washington (as was requested) at that time, I was compelled to postpone my visit until after the lecture season was over, and some professional engagements would allow me the opportunity. During the delay I received numerous communications, the last one of which is here presented.

"WASHINGTON CITY, Sunday, March 29, 1874. "Dear Doctor: The period of your delay from our little one has now expired, and we are watching the trains with beating hearts, hoping every day to see you.

"We feel assured that you will deliver our little darling from his sad thraldom, and we beg that you will no longer delay your coming, and you will have the blessings of a mother who has passed three years in anxious vigils and tears.

MRS. W. B. E."

That evening I left for Washington, and fortunately I found in the same train my friend Dr. Keyes, of this city, who was going to the same place. We arrived in Washington about seven in the morning, and on our way to the Arlington stopped at the hotel of the lady. I requested Dr. Keyes to see the case with me, as it was possible I might require his services during the day. The child was brought into the room presenting almost the exact appearance seen in photograph of page 266, which being almost impossible to describe, I refer to the picture.

The following is the history as taken at the time :

Wm. R. E., aged three years four months. Born in New Orleans of healthy parents on 10th November, 1870. Was perfectly natural at birth, and sight was good. For some days passed no 'urine. Was subject to severe fits of crying which were thought to be due to colic, and for which various remedies were used, until, accidentally, the mother discovered great erection of the penis. Applied hot fomentations over the parts with immediate relief, since which time the mother has always resorted to the same means with equally good effect. Has frequently through the day what the mother terms "spasms of ecstasy" in which he laughs immoderately, and his eyes are bright and glistening, but yet he apparently sees no object, and the penis is in a state of extreme erection. Dr. Levis, of Philadelphia, examined his eyes in 1871, and stated that there was no amaurosis or blindness of any kind, that everything belonging to the structure was normal, and yet he could not see, and he could not explain the case.

Present condition, April 1, 1874. Very large and well developed child; rather white. Unable to stand; incapable of voluntarily contracting any of his muscles when standing, or rather, when being held in the upright posture, as it was impossible for him to stand, but when lying on his back for some time can move

his hands and can turn over; but when held upright his legs always spasmodically cross each other, hands close, wrists flex, elbows the same; in fact, all the adductor and flexor muscles act, and produce a strange distortion: the mouth opens, and there is a vacant stare of idiocy with a curious laugh of half intelligence.

The penis is in a state of almost constant erection, and greatly excited at the least irritation. The orifice is red and tender.

Teeth nearly all destroyed by medicine, and is now nourished on a bottle.

Assisted by Dr. Keyes, of New York, I examined him carefully and found the prepuce firmly adherent to the glans and very much constricted at the orifice. A probe passed into the bladder found all natural.

I immediately nicked the prepuce and tore it off from the glans; tore the frænum and completely uncovered the organ. Nearly a complete circle of hardened smegma was behind the corona. Considerable hemorrhage following, rags dipped in persulph. ferri were wrapped around the penis, and in less than an hour the child. had fallen asleep without any opiate or narcotic of any kind, a thing the mother states had never occurred before.

She says that in his states of "ecstasy" nothing will quiet him, although he has frequently taken doses sufficient for an adult, of chloroform, paregoric, bromide of ammonia, hot toddies, all without effect, his frenzy of laughing and curious actions continuing until she applied very hot water to the privates and opened the window and let the air blow upon his face.

At 5 P. M. called to see the child, and was amazed to see him put out his hand to shake hands with me the very moment he heard my voice. He could not speak, and I am not certain that he saw me, but he gave the most marked evidence of delight at my presence, although I had hurt him so badly only a few hours previous. His mother almost swooned with delight, and said it was the first time he had ever put out his hand to take hold of anything in his life. He seemed to comprehend what she said, and expressed in his queer way great satisfaction. The mother stated that formerly whenever she went to Dr. Pancoast's office he would always cry the moment she opened the door, and the same thing occurred with all the different physicians who had seen him more than once or twice.

At 8 P. M. called with Dr. Busey, and found the child sleeping perfectly natural, with his mouth closed, lying on his side, and