In view of the great frequency of the occurrence of cancer of the penis, and the facts pointed out by Roux, that, after the removal of the cancerous prepuce or a portion of the penis for cancer, in case of a recurrence the disease does not do so in the penis, but that it attacks the inguinal glands, showing conclusively that the prepuce is the inciting cause as well as the initial point of attack, the sentiments in the foregoing paragraph, taken from the words of Hutchinson, are worthy of our most careful consideration.
M. Roux, Surgeon to the Charité, during the second decade of the present century, first called the attention of the French profession to the intimate relation or dependence that cancer of the penis bears to phimosis. In England he was preceded in this field of surgical investigation by William Hey, whom Roux met in London in 1814. Hey had then operated by amputation of the penis on twelve cases of cancer, nine of whom had had phimosis at the time of the development of the cancer. Wadd at this time also published a work on the subject, but, although he noticed that phimosis was a cause of cancer, he did not fully grasp the subject as Hey and Roux had done, as he believed a cancerous diathesis a primary necessity, and did not then recognize that the primary cause was fully to be found in the prepuce itself.
Roux was probably the first to point out the peculiarly local character of penile cancer, as there is no locality wherein a timely operation is less apt to be followed by a recurrence. He records a number of cases where the prepuce alone was affected when first seen, but none wherein the glans was attacked and where the prepuce was exempt, giving ample evidence of the original starting-point of the disease.[94]
Erichsen also remarks on the little liability to recurrence of cancer of the penis after a timely operation; he divides the cancer to which the penis is subject to as being of two distinct kinds,--scirrhus and epithelioma. The latter variety commences as a tubercle in the prepuce, and, according to Erichsen, does not occur in the body of the penis except as a secondary infiltration or deposit.[95] Travers states that Jews who are circumcised are not subject to either form of cancer.[96]