d to have originated from a perineal
fistula. The pathological investigation in the case, however, by Mr.
Quekett, who submitted the mass to a microscopical examination,
confirmed Mr. Brett in his original opinion that the disease had the
same pathological conditions as the similar disease found in India,
where it originates from local inflammatory causes. In this case the
preputial irritation was, in all probability, the precursor of the
conditions that led to the perineal fistula, the patient having had a
stricture for some twelve years. Mr. Brett states that the man had been
abandoned by his wife on account of his previous sexual disability, and
on account, as well, of his having been incapacitated from following any
vocation. After the operation all his functions were restored and his
organs were sound.

Nelaton records a case reported by Wadd, in 1817, of an African negro so
affected, whose penis measured fourteen inches in length and twelve and
a half inches in circumference; also the case reported by Gibert, of
Hospital St. Louis, of a subject "with a penis the size of a mule's."

Mr. Brett attributes the recovery of his case as being due in a great
measure to the moral support given to the patient from the knowledge
that his procreative organs were not interfered with, and on the same
grounds he attributes the great fatality previously attending the
operation to the fact that it previously had been the custom in many
cases to make a clean general _taille a fleur de ventre_, sacrificing
all the genital organs. In simple hypertrophy, he considers that the
body of the penis and the testicles will always be found to be in a
normal condition; a careful dissection of the parts will invariably save
not only the man's sexual functions, but his moral stamina, which he
sadly needs in such an emergency. In the discussion on this subject
heretofore mentioned as taking place in the London Medical Society, Mr.
Pye, Mr. John A. Morgan, and others insisted on the necessity of
retaining the testicles, whenever possible, in all these sweeping
operations upon the genitals, they being actually necessary for the
moral and physical support of man, Mr. Morgan observing that their
removal would depress parts controlled by the sympathetic system.

CHAPTER XXIII.

REFLEX NEUROSES AND THE PREPUCE.

We have seen in the previous chapters what the immediate effects of the
prepuce may lead to; we have followed its local effects i