The Barbarity of Circumcision as a Remedy for Congenital AbnormalitySnow, Herbert
Philosophy
The Barbarity of Circumcision as a Remedy for Congenital Abnormality
Snow, Herbert
Circumcision; Penis -- Abnormalities
Both of the above cases, together with Dr. Asher's experiences, may be
respectfully commended to the notice of Professor Weismann.
II
NATURE OF CONGENITAL PHIMOSIS--PHYSIOLOGICAL IMPORTANCE OF THE PREPUCE.
The word 'phimosis' ([Greek: phimoô], I bind) signifies that condition
of the penis in which the prepuce cannot be retracted beyond the _corona
glandis_; and which may be either congenital or factitious.
The latter is a pathological phenomenon, the product of injury or of
disease. To apply the term 'abnormal' to the former is, however, hardly
permissible, except when the difficulties in retraction are permanent
and extreme; when they cannot be overcome by judicious perseverance, and
by careful manipulation in the early weeks of infant life. A certain
amount of adhesion between the two contiguous surfaces of mucous
membrane is almost constantly present at birth, as a continuation of
the normal intra-uterine agglutination (Keating's _Cyclopædia of the
Diseases of Children_, 1890, vol. iii.; article by Dr. De Forest
Willard).
The radical defect in congenital phimosis is thus the adhesion or
imperfect separation of two muco-cutaneous surfaces, normally developed
in close contact. As a rule, these are so slightly connected that a very
slight degree of force is sufficient to part them; but in a considerable
minority of instances the defect eventually becomes permanent; with the
natural growth of the organ more difficulty is experienced in procuring
retraction; and various disagreeable, or even dangerous, symptoms are
prone then to make their appearance.
The complaint, however, is simply one of degree. If the adhesions at the
margin of the urethral meatus are so tight that they fail to be quickly
separated by the stream of urine directed against them--the force of
which necessarily varies in different infants--considerable impediment
to micturition results; and, perhaps usefully, serves to direct early
attention to the state of the parts. In rare cases, no opening at all
into the urethra has been discoverable; and complete retention has
necessarily ensued. Very often, however, nothing of this sort happens
for several weeks, months, or even years; and the existence, or rather
persistence, of the disability may not be noticed at all until
adolescence of adult life. The majority of instances lie between these
extremes; not seldom unpleasant symptoms begin to be observed when the
boy is a few months old; but there is a wide range of variation.
The penile and preputial layers of mucous or quasi-mucous membrane being
firmly adherent, and growth of the glans penis proceeding apace, certain
consequences necessarily follow.
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