n inflammatory
condition of the prepuce, with painful dysuria.... This is also true of
the occasional adhesion of the labia minora in little girls, like the
similar adhesion of the foreskin in boys. It is almost constant in the
first period of life, but sometimes persists to the end of the first
year; can usually be torn by the handle of the scalpel, and rarely
requires an incision. In a few cases this adhesion appeared to me to be
the cause of the dysuria, which disappeared after the separation of the
labia from one another."

Henoch, however, does not seem to have grasped the full relation that
the natural phimosis of young children bears to dysuria, as he here
follows the prevailing opinion, that where by dint, push, hauling, and
hard work the prepuce can be pushed back phimosis does not exist, as
well as the general apathy to the fact that a prepuce can exert a very
injurious influence by its pressure, even when not adherent and very
retractable; such a prepuce is often attended by balanitis and
posthitis, with an accompanying difficult, frequent, and painful
urination. In a case which will be related farther on, in the discussion
of the systemic effects of a long, contracted prepuce, as it induces
diseased action by continuity of tissues, there is an account of a death
of a two-year-old child which we can assume to have had its original
starting-point in a condition of phimosis. Henoch, however, rather
attributes the death in that case to what may well be considered the
result of a cause, leaving the original cause more to appear as a final
accessory condition.

My reasons for this view of the subject are simply owing to the fact
that I do not believe that a child can long be afflicted with the
_ischuria phimosica_ of Sauvages without having the urinary organs
beyond more or less seriously affected from the mere retention alone,
irrespective of any reflex irritation from the pressure on the glans or
of any from the irritation of the peripheral nerves; the dilatation of
the adjacent cavities or channels and the deposit of calcareous matter
being facilitated by the retention of urine and its naturally altered
condition owing to that retention. So that dysuria in young children,
beginning in a slightly phimosed condition, or in the irritability of
the glans and meatus, due to its preputial covering, it is safe to
assume, may produce a train of symptoms ending in permanently-injured
health, or even death. The irritat