ss burning,
smarting, itching, excoriations, and swelling, which, affecting the
little glands situated about the corona and sulcus, induces them to
secrete an altered and vicious secretion. In this manner a simple
elongation of the prepuce will produce an inflammation of the surface of
the glans (balanitis), or that of the prepuce itself (posthitis), or the
two conjoined (balano-posthitis), complicated possibly with phimosis. By
an extension to the mucous membrane of the urethra of the same condition
of the inflammatory process, we have blennorrhagia; blennorrhagia is
liable to be followed by inguinal swellings or tenderness, orchitis,
stricture, and prostatic disease; the formation of preputial calculus,
from retention of the urine in the prepuce; and cancer is apt to be the
end of any of these conditions."[98]

J. Royes Bell, in Ashhurst's "International Encyclopaedia of Surgery,"
observes as follows: "Carcinoma attacking the genital organs usually
assumes the form of epithelioma; the other kinds are rarely met with.
Epithelioma may invade the prepuce, or the whole penis, or any part of
it. The most common age for it is fifty years or over. In the great
majority of cases there has existed a congenital or acquired phimosis. A
contusion or a urinary fistula may be the exciting cause. With a
phimosis the parts are not kept clean, but the gland is macerated and
rendered tender and excoriated by retained secretions, and the
irritation causes an epithelioma to grow in those predisposed to the
disease, as is found to be the case when the tongue is irritated by a
broken tooth, or the scrotum by the presence of soot in its folds.
Syphilis has no direct influence in inducing the disease, but a
syphilitic chap or ulcer may be the starting-point of an epithelioma.
Two kinds of epithelioma affect the penis,--the indurated and the
vegetating, or cauliflower growth.... The nature of the disease, in
either the prepuce or the glans, is masked by a phimosis.... The
prognosis in these cases is much more hopeful than in epithelioma, in
other situations.... Sir William Lawrence operated on a patient who was
quite well years afterward, and Sir William Ferguson amputated the penis
of a man of note in the political world, who lived many years after the
operation, and died at an advanced age."

Agnew, of Philadelphia, describes an epithelioma of the prepuce
occurring in persons past middle life, beginning as a tubercle, crack,
or wart, for