These irritations from the preputial irritability are not always so slow moving as to span over either months or years in their fell work. Instances of their sudden action have been sufficiently recorded as to warrant them as being classed as causative agents in acute affections that instantly threaten life. In the London _Lancet_ of May 16, 1846, there is a record of a very peculiar case reported to the London Medical Society by Dr. Golding Bird: "The case was that of a child seven or eight weeks old only, an out-patient of Guy's Hospital. The child had become almost lifeless immediately after nursing, and to all appearances looked as if under the influence of some narcotic. It had not, however, had anything of the kind given to it, nor had it sustained a fall, nor was the head so large as to lead to suspicion of congenital hydrocephalus. On inquiring if the child passed water, the answer led to an examination of the prepuce, which was found to be elongated, and had an aperture only of the size of a pin-hole, like a puncture in the intestines. The urine was dribbling out; it was evident that the child had never completely emptied its bladder. Mr. Hilton slit up the prepuce, and all the symptoms were immediately relieved and soon entirely removed." Dr. Bird referred to a case which he had related to the Society some years before, which was reported in the _Lancet_ at the time, of a child who fell a victim to a malformation of this kind, and after death the bladder and ureter were found like those of a man who had long suffered from stricture. Mr. Hilton has seen many cases similar to the one mentioned by Dr. Bird. The greatest benefit resulted from slitting up the prepuce. In this case the benefit was very remarkable, a partial paralysis of the left side, under which the little patient labored, being quite removed in twenty-four hours.
In this case the difficulty was evidently both the result of mechanical pressure and reflex irritation. A somewhat similar case as to its results is given by Dr. Sayre, to whom the case was reported by Dr. A. R. Mott, Jr., of Randall's Island, in January of 1880: "John English, aged 46, native of England, widower, clerk; admitted to workhouse hospital. Patient had been at work for a week as a prisoner; on the 23d of December was noticed to be restless and uneasy, and finally, in the evening, he fell from his bunk in a fit. During the next forty-eight hours he had several convulsions, and during the intervals lay in a semi-comatose condition, showing no consciousness except to stir a limb when pinched. Pulse, 120; temperature, 101½°; respiration, 18. Swallowed nothing, and passed fæces in bed. Continued in this condition until December 25th (temperature having fallen to 100°), when a string was discovered passed twice around the penis behind corona and tied, the long prepuce serving to conceal it from observation. While not sufficiently tight to occlude the urethral canal, still a firm, indurated band remained after the string was cut, and did not disappear for four or five days.