reckoned as among the chief
etiological factors of chronic interstitial nephritis (page 227). The
condition of the kidneys in cases of strictures of long standing is
known not to be a reliable one, and any incentive to dysuria or to
retention, no matter how slight, is apt to lead, eventually--and that
even in very young subjects--to that toxic condition mentioned in a
former part of this chapter as one of von Jaksch's subdivisions of
toxaemia, the ammoniaemia of Frerichs; this condition being the fatal
ending of the case of the two-year-old child mentioned by Henoch, who
died after the relief of a retention due to phimosis and calculi
resulting from the phimotic occlusion. Having seen so many cases wherein
the conditions described in this chapter were so apparently--whether
from ammoniaemia due to infection, or toxaemia from the urinary tract, or
uraemic toxaemia from the intestinal tract--all due to some preputial
interference or irritation, I cannot help but feel that in these
conditions--which, singularly, are not so prevalent with the Hebrews as
with Christians--we have one factor in the cause of the shorter and more
precarious vitality of the latter.

Morel, in his "Traite des Degenerescences Phisiques," ably discusses the
degenerative and morbific influences and results of toxaemia, as well as
he clearly defines their sources. The connection between toxaemia and
mental affections has already been shown, and Prof. Hobart A. Hare, in
his instructive and interesting prize essay on "La Pathogenie et la
Therapeutique de l'Epilepsie (Bruxelles, 1890)", mentions that
convulsive disorders resulting from the presence of some toxic substance
are of frequent occurrence. How much this may enter as a partial factor
into many of the cases of epilepsy which are classed in the order of
"reflex" may well challenge our consideration. Hare lays great stress on
the necessity of circumcision wherever there is an indication of
preputial local irritation. "If practicable, circumcision should be
performed; it is an operation with but small risk or danger, and easy of
performance. In such circumstances it is always permissible to
circumcise, were it for no other end than an acknowledged attempt to
reach a cure."

CHAPTER XXVI.

SURGICAL OPERATIONS PERFORMED ON THE PREPUCE.

In operative interference there is one point which should not be lost
sight of, this being that the length and bulk of the prepuce in a great
measure depe