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 irritating urine of a slight access of fever may, by its passage over the irritable mucous lining of the prepuce, be the initial starting-point of a serious or fatally-ending disease. In all of these, it must be admitted, the presence of the prepuce is either actively or passively the cause of the most serious disease processes that may follow.