CIRCUMCISION, ITS IMPORTANCE IN THE TREATMENT AND PREVENTION OF CERTAIN REFLEX NERVOUS PHENOMENA.

BY MARK H. O'DANIEL, M.D., BULLARDS.

There is no operation in the field of minor surgery, the modus operandi of which is so easy and simple, which affords so much protection and relief to the patient as that of circumcision. It protects, in that it makes the individual less liable to the contagion of venereal diseases, balanitis, and the irritations so common and annoying in the warm season from a long, tight prepuce, and it relieves the divers reflex neuroses resulting from phimosis. The old Jewish rite of circumcision on the eighth day evidently had as its fundamental principle that of hygiene and cleanliness.

The proper time to do the operation should, however, rest in the judgment of the physician, the best time, in my opinion, being when the conditions are such as to justify it.

It is true, we could dilate the opening and break up the adhesions, but after all this does not give the satisfaction and relief a complete circumcision would do.

In the treatment of various nervous troubles found in children and even in older subjects, we should be careful that we do not overlook this cause. Indeed it is really surprising what distressing symptoms phimosis will cause, and if let alone what serious results will follow.

I give here a few cases, taken from my note-book, which I trust may prove interesting:

Case 1.-Young man, nineteen years of age, of good family history; pale and effeminate looking. The leader in his class at school, he suddenly became the subject of a hysterical form of mania. He would laugh and cry alternately, make speeches, etc., and at times became melancholy and listless. He slept but little, ate but little. He had been treated a few weeks by the family physician, when he came under my care. After gaining his confidence, I found upon examination a tight, long prepuce, which I decided the whole chain of nervous symptoms came from. He stated, he had suffered from frequent erections and practiced onanism that he might study and

rest. These erections were no doubt at the outset irritative. I advised circumcision as the best means of relief, to which he consented. After doing the operation, I prescribed absolute rest, nourishing food, opium and camphor, for the double purpose of rest and as antiaphrodisiac. In a few days he was decidedly better. He continued to improve and in three months was entirely well and stronger than ever before, and has remained so.

Case 2-Boy, seven or eight years of age; thin and pale; had weak facial expression. Family history very good. Quite nervous. His lower limbs were small and he complained of pain in his joints. He had been treated for rheumatism. I suspected the trouble at once, and upon making an examination found long, pointed prepuce, with phimosis. Operated on him, and removed quite an accumulation of smegma around corona and under prepuce. I put him upon tonics, massage and faradism to lower extremities, and in two months he was well and a nice looking, active boy.

Case 3.-Baby boy, eight months old. Was quite ner

vous and fretful, slept badly. Had an eruption over his body and face, which was annoying. Had long prepuce, with pinhole opening, ballooning, as it were, when he urinated. I circumcised him, and in a week he was well, and the mother took him home happy.

Case 4-Boy, nine years old; of neurotic history; appearance very good and healthy. He had been well and all right until recently, when he became frightened at seeing a crazy negro handcuffed, and ran away from home. When found he was sitting down, playing on the ground. When taken hold of to carry him home he fought and resisted, but finally became quiet and went along. He appeared rather subdued and listless until the next day, when he had a nervous spell, as the father termed it, in which he would bite his hands, and if let alone would run. The family physician was summoned and after treating him for these spells, which came every day, for about a week, sent the boy to my office for diagnosis of his case.

After carefully examining him I found he had a long, tight prepuce, and that the trouble was reflex, and most likely incipient epilepsy, in which phimosis was the exciting cause, with a hereditary predisposition.

I advised circumcision as the best means of treatment. Being some distance from me I have not kept up with the boy, but presume he is doing well.

There is no doubt but that many cases of reflex nervous troubles similar to the above come from this cause, and unless one is careful in his investigation he will fail in properly locating the cause, and hence in a correct diagnosis. I have seen a number of cases of incipient epilepsy in which there was only a facial movement or smacking of the lips, and again several in which there was no other symptom excepting a disposition to run.

As soon as the wave or paroxysm passed, the patient would be himself again. Often they are irritable and drowsy and fall asleep, and on waking never realize what has happened.

My object in presenting this paper is to show the importance of a closer investigation along these lines and the importance, too, of circumcision as a means of treatment and relief in such conditions.

X-RAYS IN EXTERNAL TREATMENT.

BY M. B. HUTCHINS, M.D., ATLANTA.

Mode of action of X-rays: McLeod (24) quotes Pusey as expressing the belief that while the rays have no bactericidal effects in the laboratory, the disappearance of pus in certain cases and the cleaning of lesions seem to indicate some such action in vito. The more probable explanation is that they set up a reaction in the tissues and a flow of serum which themselves act as germicides.

McLeod further says that the rays cause devitalization, degeneration and destruction. Sometimes the cell toxins. produced seem to set up, in the ray-weakened tissues, ulceration, necrosis and sloughing, healing with vascular and imperfect scars. He very correctly states that mild doses of the rays have a stimulating effect upon the healthy elements of the skin. Large doses and long exposures, nearness to the tube, etc., devitalize the elements, interfere with regeneration, cause degeneration. The more highly differentiated structures, as hair follicles, glands, both sweat and sebaceous, the nails and the bloodvessels are more readily and intensely affected than the less distinct element.

Pathologically altered cells, of epiblastic or mesoblastic origin, are far less resistant than healthy cells. He states (truly) that while these are being destroyed the healthy cells may be stimulated to actual repair service.

Action of cell toxins from cumulative effects of X-rays may cause the train of severe symptoms above mentioned,