PARTIAL PARALYSIS FROM REFLEX IRRITATION, CAUSED BY CONGENITAL PHIMOSIS AND ADHERENT PREPUCE. BY LEWIS A. SAYRE, M. D., VICE-PRESIDENT AMERICAN MEDICAL ASSOCIATION; PROFESSOR ORTHOPEDIC PARTIAL PARALYSIS FROM REFLEX IRRITATION, CAUSED BY CONGENITAL PHIMOSIS AND ADHERENT PREPUCE. On the 9th of February, 1870, I received the following note: "DEAR SAYRE: Please let me know at what hour you can come to my house to see the son of Mr. M, of Milwaukee. The little fellow has a pair of legs that you would walk miles to see. "Yours, truly, "J. MARION SIMS. "No. 13 E. 28th Street." I immediately went to the doctor's office, and found a most beautiful little boy of five years of age, but exceedingly white and delicate in his appearance, unable to walk without assistance or stand erect, his knees being flexed at about an angle of 45°, and the Dr. had sent for me to perform tenotomy upon his hamstring tendons. After a very careful examination I discovered that when I amused the child and distracted his attention from himself, I could with very little force easily extend both of his limbs to their normal length, but as soon as I released my hold of them they would instantly become flexed again, and no irritation that I could produce upon the quadriceps muscles was sufficient to extend the legs except in the very slightest degree. I soon satisfied myself, as well as Dr. Sims, that the deformity was due to paralysis and not contraction, and it was therefore necessary to restore vitality to the partially paralyzed extensor muscles, rather than to cut the apparently contracted flexors. I therefore had him sent to my office for the purpose of apply. ing the constant current of the galvanic battery. In its application, while passing the sponge over the upper part of the little fellow's thighs, the nurse cried out, "Oh, doctor! be very careful don't touch his pee-pee-it's very sore;" and upon examining his penis I found it in a state of extreme erection. The body of the penis was well developed, but the glans was very small and pointed, tightly imprisoned in the contracted foreskin, and in its efforts to escape, the meatus urinarius had become as puffed out and red as in a case of severe granular urethritis; upon touching the orifice of the urethra he was slightly convulsed, and had a regular orgasm. This was repeated a number of times, and always with the same result. The nurse stated that this was his condition most of the time, and that he frequently awoke in the night crying because “his pee-pee hurt him," and the same thing had often occurred when riding in the stage or car; the friction of his clothes exciting his penis would cause erections. As excessive venery is a fruitful source of physical prostration and nervous exhaustion, sometimes producing paralysis, I was disposed to look upon this case in the same light, and recommended circumcision as a means of relieving the irritated and imprisoned penis. This was performed on the following day, assisted by Dr. Yale, who administered the chloroform, and Dr. Philips, and in the presence of a number of my private students. The prepuce was pulled well forward and cut off with a pair of scissors, when the tegumentary portion readily glided back over the glans, leaving the mucous portion quite firmly adherent to the glans nearly to the orifice of the urethra. Seizing the thickened mucous membrane on either side of the glans with the thumbs and finger nails of each hand, it was suddenly torn off from the glans penis, to which it was quite firmly adherent nearly to the corona. Behind the corona there was impacted a hardened mass of sebaceous material, almost completely surrounding the glans. This was removed; the mucous membrane which had been torn off from the glans was split in its centre nearly down to its reflection, and, being turned backward, was attached to the outer portion of the prepuce by a number of stitches with an ordinary cambric needle and very fine thread. The penis was then covered with a well-oiled linen rag, and kept wet with cold water. No untoward symptoms occurred, and in less than two weeks the wound had entirely healed, and the penis was immensely increased in size. The prepuce was sufficiently long to cover the glans, and could be readily glided over it without any irritation whatever. From the very day of the operation, the child began to improve in his general health; slept quietly at night, improved in his appetite, and, although confined to the house all the time, yet at the end of three weeks he had recovered quite a rosy color in his cheeks, and was able to extend his limbs perfectly straight while lying upon his back. From this time on he improved most rapidly, and in less than a fortnight was able to walk alone with his limbs quite straight. He left for his home in the west about the first of April, entirely recovered; having used no remedy, either iron, electricity, or other means to restore his want of power, but simply quieting his nervous system by relieving his imprisoned glans penis as above described. CASE II. Mr. T. N―, one of the first lawyers in our city, called on me at the very time the little fellow above described was making his farewell visit, to speak to me in reference to his son, a lad of fourteen years, that I had attended some months before for paralysis of his legs. He stated that he was not improving, and that he looked so badly in the morning that he feared he was guilty of masturbation, and was very anxious that I should talk to him seriously upon the subject, and point out to him its dangers. As the little fellow then running around the office had just recovered from a paralysis that was evidently due to genital irritation, it occurred to me that the paralysis in the son of Mr. N., for which I formerly had been consulted, might possibly be due to the same cause. He was sent to me on the following day, and after questioning him very closely, I found him unusually intelligent on the subject, strictly truthful and honest in all his statements, and perfectly free from the vice of masturbation. Upon examining his penis, I found it unusually large at the root and body, but very short, and the prepuce terminating in an opening scarcely large enough to admit a small probe. He stated that it always took him a long time to make his water, and he could never do it without great straining. His penis would become erected several times in the night and always with great pain, and this difficulty was increasing as he grew older. |