ondition of chronic
inflammation only is present, and upon this the cancerous process
becomes ingrafted. Phimosis and the consequent balanitis lead to cancer
of the penis.... A general acceptance of the belief that cancer usually
has a pre-cancerous stage, and that this stage is the one in which
operations ought to be performed, would save many hundreds of lives
every year.... Instead of looking on whilst the fire smouldered, and
waiting till it blazed up, we should stamp it out on the first
suspicion.... What is a man the worse if you have cut away a warty sore
from his lip; and, when all is done, a zealous pathologist demonstrates
to you that the ulcer is not cancerous, need your conscience be
troubled? You have operated in a pre-cancerous stage, and you have
probably effected a permanent cure of what would soon have become an
incurable disease. I do not wish to offer any apology for carelessness,
but I have not in this matter any fear for it."

In view of the great frequency of the occurrence of cancer of the penis,
and the facts pointed out by Roux, that, after the removal of the
cancerous prepuce or a portion of the penis for cancer, in case of a
recurrence the disease does not do so in the penis, but that it attacks
the inguinal glands, showing conclusively that the prepuce is the
inciting cause as well as the initial point of attack, the sentiments in
the foregoing paragraph, taken from the words of Hutchinson, are worthy
of our most careful consideration.

M. Roux, Surgeon to the Charite, during the second decade of the present
century, first called the attention of the French profession to the
intimate relation or dependence that cancer of the penis bears to
phimosis. In England he was preceded in this field of surgical
investigation by William Hey, whom Roux met in London in 1814. Hey had
then operated by amputation of the penis on twelve cases of cancer, nine
of whom had had phimosis at the time of the development of the cancer.
Wadd at this time also published a work on the subject, but, although he
noticed that phimosis was a cause of cancer, he did not fully grasp the
subject as Hey and Roux had done, as he believed a cancerous diathesis a
primary necessity, and did not then recognize that the primary cause was
fully to be found in the prepuce itself.

Roux was probably the first to point out the peculiarly local character
of penile cancer, as there is no locality wherein a timely operation is
less apt