A case of hypospadias through five generations / by T.J. Strong.

  • Strong, T.J.
Date:
1906
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Licence: In copyright

Credit: A case of hypospadias through five generations / by T.J. Strong. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    ploded this theory. It has been frequently observed that complete suppression of the urine is not necessarily followed by symp- toms of uremia, and that symptoms of uremia make their appearance when an excess of urea does not exist in the blood. That urea in ex- cess in the blood is productive of no deleteriius results while the kidney is in active opera- tion, is a fact well established by experiments on animals. And it is only when the functions of the kidney are interfered with or abolished that death takes place. It is not my intention to detain you with the numerous theories which have from time to time been advanced concerning this train of symptoms, but to search with you for the cause of headache, blindness, nausea, anemia, and general debility attendant upon chronic nephritis. It would appear that poisoning by urea alone is not the solution of this problem. It is a very popular and recent theory that the above symptoms are caused by an interference with the functions of the kidney, which lead to a disturbance of the regular chemical changes in all parts of the body. These changes are followed by a change in the nutrition of the tissues, which is manifested by a loss of weight and strength, anemia, and disordered func- tions of the brain. While this explains, in a general way, it avoids a direct issue, and leaves us still hunting for the specific cause of these distressing and dangerous symptoms. By reason of the loss of albumin and the thinning of the blood stream, hypertrophy of the left ventricle is said to increase the blood pressure in the arteries. It has been sug- gested, and appears consistent with these symptoms, that if by any accidental circum- stance the blood pressure is suddenly increased, or the blood stream further thinned, edema is increased, which edema may involve brain tis- sue, as well as lungs, serous cavities, or cellu- lar tissue. The form of the attack will vary according to the portion of the brain which be- comes edematous. If the cerebral hemispheres alone are involved, the patient becomes com- atose, convulsions without coma, if the central portions are involved, and both convulsions and coma, if central and cortical portions are involved. Wanted:—By a young physician, an opportunity to substitute for a few months. Dr. C. E. Buchanan, West Lebanon, N. H. A CASE OF HYPOSPADIAS THROUGH FIVE GENE^TIONS. By T. J. Strong, M. D., of Burlington. During five years’ service in the U. S. Army, both in the tropics and this country, the writer saw several cases of hypospadias among sol- diers, all more or less interesting and all com- ing under observation for treatment for specific urethritis either acute or chronic. The history of these cases was of no par- ticular interest, the abnormality being con- genital, and as far as can be remembered now, extending over not more than one or two gen- erations. All cases refused operative interfer- ence. The location of the meatus was different in all cases—in some posterior to the coronal sulcus and in others on the glans penis at vary- ing distances from the end. The openings were small in some and larger in others. No great difficulty was experienced in urinating (except the “ardor urinae” attendant upon the acute cases of urethritis), and the one disagreeable feature presented itself in the treatment, it be- ing somewhat more difficult to give an irriga- tion or injection than in a normal penis. How- ever the cases progressed favorably, one neces- sitating a meatotomy, the opening kept dilated by straight conical steel sounds. As above stated, these cases presented noth- ing of a particular interest beyond the fact that there was no opening in the penis in any one of them in its normal situation and if the writer remembers correctly, no sign or in- dentation where the meatus should have opened normally. A case has recently been seen which presents an interesting family history showing' heredity through five generations of this abnormalit}^ A careful perusal of litera- ture relating to abnormalities of this kind does not reveal any such length of time. The case is herewith presented in its entirety; R. P., soldier. Fort Ethan Allen, Vt., age 21, unmarried. Called at office for treatment for gonorrhoea. Previous History. Diseases incident to childhood, no serious illness. About one year ago contracted gonorrhoea and claimed he was cured in ten days. Closer questioning elicited the fact that he noticed once in a while a “morning drop.” Seven or eight months ago after sexual intercourse he had a profuse puru- lent discharge from his penis and took “cap-