uring the course of a continued fever. Such a
condition is also a very frequent accompaniment of prostatic
obstruction. So often has this been noticed that its association with
prostatic trouble or disease tends to the belief that the irritation
produced by this condition of prepuce often lays the foundation for
prostatic disease in not a few cases.[100] In elderly people, with the
atrophied penis and elongating prepuce, the constant moisture from the
urine on the inner fold and glans adds greatly to the irritation as well
as to the discomfort of the patient.

A number of affections are accompanied by oedema, especially toward the
latter stages of the disease; such, for instance, as the ending of cases
of mitral insufficiency. In these, the distension of the prepuce and the
resulting balano-posthitis is at times a source of great distress, and
at times the resulting engorgement produces a retention of urine. It was
after an attendance on one such case that required daily and frequent
puncturings for its relief, but which, in spite of all care, finally
became gangrenous, that a fellow practitioner cheerfully submitted to
circumcision, to avoid the possibility of any such complication
occurring to embitter his closing illness.[101]

The prepuce is the starting-point of many of the cases of penitis and
retention of urine that often accompany attacks of gonorroea; especially
can this result be anticipated where the prepuce is long, pendulous, and
with its veins in a varicose condition. Why it should be so is
self-evident. Anything that will add to the interference of the return
circulation only exaggerates the tendency to penis engorgement; this
increases the difficulty of urination, which, by the retention that
results, in turn increases the constriction at the root of the penis,
and adds to the already difficult return circulation. The bladder by its
urine, and the penis by its blood, actually form, by their mutual
pressures, an impassable dam at the root of the organ. That this is the
true condition has been more than once verified from the instant relief
given to the whole condition by the prompt employment of the supra-pubic
puncture or aspiration, as catheterization in such cases is altogether
out of the question, and should never be attempted or employed unless a
soft catheter can be inserted.

A person laboring under a continued fever has his blood in a condition
to favor sphacelus; with the slow-moving current of