Note 97 — Chapter XX · The Prepuce, Phimosis, and Cancer.

“Pertes Seminales.” In the fourth American edition of the English translation of McDougall of Lallemand we find that he fully appreciated the dangers that lurk in a prepuce. At page 216 he says: “Such is the condition which the parts present in cases of recent balanitis, and these are the inflammations and ulcerations that cause more or less extensive adhesions of the prepuce to the glans. Such adhesions are generally cellular, but sometimes fibrous or even cartilaginous, according to the severity and frequent repetition of the inflammation. Various degrees of induration also results according to the intensity, the duration, and the frequency of the phlogosis. Thus, I have often found a mucous membrane hardened, thickened, and covered with numerous papillæ, sometimes fibrous or cartilaginous, with three times its natural thickness. I have also met with cases in which the prepuce has become cancerous. I have operated in several cases of cancer of the penis, too, which certainly arose from no other cause. The patients were generally peasants between fifty and sixty years of age, who had never known other than their own wives, but who had frequently suffered from balanitis attended by abundant discharge, swelling of the prepuce, and excoriation of its opening, which was so contracted as to prevent the passage of the glans. I have seen one case, also, in which balanitis, irritated by a forced march and the abuse of alcoholic stimulants, passed into gangrene, by which the greater part of the glans was destroyed. Such have been the accidents which I have observed on those whose prepuce was too narrow to permit the glans being uncovered; accidents which I can only attribute to the long retention of the sebaceous matter in a kind of cul-de-sac, into which a certain quantity of urine passes every time the patient makes water.”