ndition. So that even in such a case as above reported as being due to
rheumatic phlebitis, or the case reported in the fortieth volume of the
"Dictionaire des Sciences Medicales" by Patissier, wherein a man lost
penis and scrotum through gangrene, induced by urinous infiltration, may
all in the origin be due, if not to the immediate, to the remote effects
of the presence of the prepuce.

In the first volume of the _Journal of Venereal and Cutaneous Diseases_
the writer reported a case of the complete loss of penis in a young man
as a result of phagedena due to syphilis. The man had had a long and
pendulous prepuce; in his case, had circumcision been performed in early
childhood, it would have lessened the chances of primary infection, and
had it been performed after his infection, it would have removed one
cause--if not the principal cause--of the ease with which the phagedenic
action was inaugurated. The case already mentioned as an example of
spontaneous and natural circumcision belongs to the gangrenous results
following phimosis, ending with the loss of the prepuce. In Maclise's
"Surgical Anatomy" several specimens of deformity are figured, showing
the results of this mildest of the effects of a phagedenic action. The
beginning of the interference in the return preputial circulation
undoubtedly always takes place over the superior aspect of the corona,
where the pressure of the glans is most sharply defined against the
inner fold of the prepuce.

There are milder conditions, wherein the circulation of the prepuce is
materially interfered with, both through the lax tissues of the parts
and the peculiar anatomical construction and shape of the neighboring
parts, wherein, without going as far as gangrenous breakdown, the person
suffers considerably nevertheless, and is placed in danger of losing his
penis; for, as observed by Patissier, whenever a person affected with a
gonorrhoea is attacked by a putrid or any low-grade fever, he runs the
greatest danger of losing his virile member through gangrene.

Even where phimosis does not exist, but only the long, lax, and
retractable prepuce, that is considered a perfectly physiological
condition, the prepuce is liable to cause very distressing and
complicating annoyances during the progress of other diseases. The
writer has noticed that cases with a thick, leathery, and redundant
prepuce, even when perfectly retractable, are more liable to require the
use of the catheter d