Ralfe observes, in his "Kidney Diseases," that long-standing disease of the genito-urinary passages must be 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 toxæmia, the ammoniæmia 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 ammoniæmia due to infection, or toxæmia from the urinary tract, or uræmic toxæmia 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 "Traité des Dégénérescences Phisiques," ably discusses the degenerative and morbific influences and results of toxæmia, as well as he clearly defines their sources. The connection between toxæmia and mental affections has already been shown, and Prof. Hobart A. Hare, in his instructive and interesting prize essay on "La Pathogénie et la Thérapeutique de l'Épilepsie (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."