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mother states that “in straining at stool and in making water his bowel would frequently come down, and give her great trouble in pusbing it up.".
He began to tumble down very frequently about a year ago, and was growing more and more clumsy in walking. He could not stand alone without support, and even when supported his legs would bend in different directions, as seen in Fig. 5, from a photograph by O'Neil, June 1, 1875.
He was circumcised on the 2d of June. The lining membrane was firmly adherent to the glans, requiring section by the knife before it could be torn off. Behind the corona was the usual hardened smegma, which had produced erosion of the mucous membrane.
The parts were dressed with an oiled rag and cold water.
June 4. The boy could stand without support, and had slept quietly the past two nights.
At the end of twelve days he was entirely well; could walk and run without tripping, and his bowels had become perfectly regular without any prolapsus.
The annexed photograph by O'Neil, July 1, shows the improvement in his limbs.
In the picture taken June 1, his shoes had to be laced tightly around the ankle to enable him to stand even with support; but in the last picture, July 1, it will be seen that he stands erect without any assistance.
One of his liibs is slightly abducted in the photograph, hut that was on account of his restlessness, but is not so constantly.
CASE II.—John Lovatt, aged three and a half years, brought to me for treatment, September 25, 1875, by Dr. E. D. Morgan, Jr., with the following history: Began to walk when pine months old; walked very well for three months, when mother noticed that he was somewhat lame in left leg, and was very restless at night, wanting to sit up all the time. Electricity and liniments were used without relief.
Present condition-Slight atrophy of left leg. Child very clumsy, continually falling down; foot everted; is sustained by an iron brace on outside of the leg, fastened to an iron sole inside the shoe. Penis very small and in a constant state of erection; meatus very red and papulous.
Diagnosis.-Partial paralysis due to phimosis.
Treatment.—Prepuce slit. Mucous membrane torn back. A thick roll of sebaceous matter removed from behind the corona. No hemorrhage. Dressed with cold water.
Sept. 30, 1875. Child returned very much improved. Walks without the brace, does not fall down, and mother states that yesterday, for the first time in two years, the child ran around the room alone. Appetite improved. Sleeps better than ever before.
Longview, GREGG County, Texas, June 8, 1875. Dear Doctor: I take the liberty of mentioning a case of cir. cumcision, which was presented me yesterday, and it being one of curiosity and novelty, performed by a gentleman of our profession possessing some ability, I deem it not amiss to ask your opinion, and narrate briefly its history.
Patient, J. D., aged about 27, white. Health good; habits irregular, and accustomed to dissipation. Has had syphilis (secondary), now suffering from periostitis. Being desirous of circumcision he sought surgical relief, thinking his chances would be lessened if not destroyed against a further attack (syphilitic). About six weeks ago he submitted to an operation; and such were the proceedings as related to me, etc. :
A næsthetized. A circular incision enveloping the entire penis was made behind corona glandis about one-quarter of an inch, through integument and adjacent tissues; further back toward abdomen on body of penis, the distance of an inch or more, another incision was made as the former, and completely encir. cling the entire body. This intervening space between the two incisions was dissected up and removed, and the anterior integument was brought back, and stitched to that on the body of the penis, dressed, etc.
In about four weeks the parts were well, having united by first intention, leaving a dense, hard, girdling, cicatricial tissue about opposite the first circular incision. This cicatrix feels hard and
whipcord in nature, and is even, and smooth, and regular in outline. It is free from pain and tenderness when the organ is quiet, and the integument.is movable to and fro, etc.
On each orgasm the parts are girdled, and the most intense pain is felt until the organ has returned to a calm and quiet condition. The cicatricial band becomes stationary in each orgasm, and is a fruitful source of constant irritation, keeping the organ erect, and his locomotion has been impaired.
The glans penis is cyanotic, presenting evidences of strangulation, etc. The meatus is large and free, admitting easily of a No. 12 bougie when organ is quiet.
Having for a long time patiently reviewed your lectures per my notes, and finding this process of circumcision not mentioned, and thinking it may offer some consideration for the thoughtful, I have briefly mentioned the matter to you.
J. H. ADAMS, M.D.
The italics in this case are mine. I wrote the Dr. advising him to watch the case for a few months, and observe if the paresis increased, and then to divide the cicatricial band in a number of places, so as to relieve the strangulation.
I received the annexed letter in reply, which fully explains itself.
LONGVIEW, GREGG Co., Texas, June 25, 1875. Dear Doctor: I have received your interesting and explanatory letter, and proceed to answer.
The subject of my last letter, Mr. J. D., has suffered much, and owing to this, I have nicked the penis in six places, and think it will eventually prove to be of benefit to the young man. I had hoped to witness its effects, girdled as it was, for several months, as you requested, but I was obliged to relieve him of his suffering, and operated on the 22d inst. No symptoms of cellulitis, and doing well, etc.
Since the operation he has slept well; has had no erections, and expressing himself in “perfect bliss." The impairment in his locomotion from date of my writing till operation, was progressively increasing; and I am convinced by its rapidity he would have suffered from complete paralysis of lower extremities in a few months; his digestion had become greatly impaired, and the continuous erections had completely changed him, physically and mentally. His bowels were constipated, obstinately so, but were relieved daily by injections. The lower extremities have a spongy feel, imparting to the sense of touch a boggy sensation. Greater weakness was referred to medio-tarsal junction of left foot, and more general in the whole of the right leg, having no special location, etc.
Examination of his urine from the time he came under my charge had averaged 24 ounces daily, and highly acid. Since the operation it has increased to 43 ounces, and yesterday and to day 49 ounces and normal; bowels act of their own accord; appetite good, and muscular power of lower extremities perfectly restored.
J. H. ADAMS, M.D.
ATTICA, FOUNTAIN Co., IND., Aug. 31, 1875. Dear Doctor : I send you the following report of a case, as you requested the members of the American Medical Association, at Louisville, to do:
Mr. John McGuire and wife, of our town, have but one child, a boy of fourteen months, who has been the terror of all this part of the town for six months, as he cries continually except when asleep or nursed by his mother. He would lay perfectly quiet 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 bis limbs would be rigid. This state of things grew worse until Wednesday last, Aug. 25th, when the family physician was cailed in, and found the child with fever and suffering from great nervous excitement. He pronounced it a case of remittent fever, and gave medicine accordingly, but to no purpose, as the fever and excitement increased, and the child had spasms frequently, and particularly when his bladder needed emptying; at that time the child would strain and cry, giving evidence of great suffering, and bad a tendency to prolapse of rectum. It would have several spasms at these times, which would come on rapidly and grow more severe at each succeeding time. Late Saturday night, Aug. 28th, in the absence of the family physician, I saw the child, and found paralysis of the lower half of the body, not very marked, but sufficient to be easily diagnosticated, also spinal irritation. I