Gross does not mention this affection in his work on surgery, but Agnew devotes considerable space to its description, dividing the disease into two forms: the inflammatory, such as may follow venereal primary sores or operations on the penis, not excepting circumcision; and the obstructive variety, such as may follow embolism or any mechanical obstruction, either purposely or accidentally applied. Of the latter he gives a number of quoted instances; he only admits seeing one case, that of an aged man in the Pennsylvania Hospital, in whom the disease was caused by embolism of the dorsal artery. J. Royes Bell, in the "International Encyclopaedia of Surgery," pays more attention to it than any of our American authors; mentioning, among the causes which may give rise to it, the exanthemata, especially small-pox, and the poisoning by ergot of rye and erysipelas. Among the local causes lie mentions phimosis, paraphimosis, and balano-posthitis. Bell quotes the case reported by Mr. Partridge, in the sixteenth volume of the "Transactions of the Pathological Society of London," wherein a sober man, aged forty, lost the whole of his penis up to the root, during the course of a typhus fever. Also the case reported by Mr. Gay, in the thirtieth volume of the same "Transactions," wherein a cabinet-maker, aged thirty-one, lost his penis through the probable results of rheumatic phlebitis, and due to the presence of a plug in the internal iliac vein. In the twelfth volume of the "Transactions" of the same society he finds the record of the case of a soldier who lost his penis through gangrene induced by syphilitic phagedena. In the consideration of the subject of the prepuce as connected with penile gangrene, it must not be overlooked that the presence of a prepuce may be the inciting cause of some rheumatic affection (the writer has repeatedly seen such), just as such cases are often the result of stricture; as cases of rheumatism that have resisted all remedial means, but that have readily given way to the dilatation of a stricture, are by no means uncommon; not a mere muscular reflex rheumatic pain, but even when accompanied by a rheumatic blood condition. 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.