,,! ,,b>b>ity ,,( ,,circumcision ,,z ,a ,,rem$y ,,= ,,cong5ital ,,abnormality ,,by ,,h]b]t ,,sn[1 ,m4,d4 ,,lond4 c4 ,,surgeon ,,to ,,! ,,canc] ,,hospital ,illu/ration3 ,logo ,,london ,j4 ,a4 ,,*ur*ill #aa ,,new ,,burl+ton ,,/reet #ahij ,,prefatory ,,note ,to /ate t ! object ( ?is little "w is to 'put d[n ,circumcision' "u ! circum/ances indicat$1 w\ld1 besides sav\r+ ( unp>donable arrogance1 irresi/ibly sugge/ analogy to ! example ( a too fam\s ald]man1 :o 0 det]m9$ to 'put d[n ,suicide4' ,if1 h[ev]1 ! facts & argum5ts !re9 set =? contribute 9 "s small measure t[>ds ! abolition ( an antiquat$ practice involv+ ! infliction ( v consid]able suff]+ ^u helpless infants2 & sanction$1 on extremely que/ionable gr\nds1 by m5 ( em95t au?ority2 ! foll[+ pages w n h be5 writt5 9 va94 ,m evil is wr\ght by want ( ?\ght1 ,?an comes f want ( he>t4 ,,gl\ce/] ,,place1 ,,portman ,,squ>e3 ,octob] #ahij4 ,,! ,,b>b>ity ,,( ,,circumcision ,,z ,a ,,rem$y ,,= ,,cong5ital ,,abnormality4 ,i ,,circumcision ,,z ,a ,,religi\s ,,rite4 ,! e>lie/ hi/orical or quasi-hi/orical notice ( circumcision is to be f\nd 9 ,g5esis xvii42 :]e ,jahve enjo9s ^u ,abraham ! p]sonal p]=mance ( ?is mutilation1 z a sign ( ! cov5ant h5ce=w>d to subsi/ betwe5 !m4 ,abraham1 8 son ,i%mael1 & all 8 male slaves =?) und]w5t ! prescrib$ op]ation2 :i* !nce-=w>d rema9$ obligatory ^u _! po/]ity1 ?\gh n )\t transi5t p]iods ( desuetude4 ,x 0 suff]$ to lapse dur+ ! passage ( ! ,israelites ?r\gh ! wild]ness1 & 0 subsequ5tly reviv$ by ,jo%ua 7v4 #e72 aga9 9 ! reign ( ,antio*us ,epiphanes1 :5 "s ( ! ,jews seem to h submitt$ to a pla/ic op]ation 9 ord] to oblit]ate its effects4#a ,! compulsory p]=mance ( circumcision 0 re-enact$ = ! la/ "t by ,matta?ias1 9 ! age ( ! ,maccabees2 & ! law to ?is effect has rema9$ 9 =ce until ! pres5t day4#b ,! t]ms 9 :i* ! ,deity addresses 8 comm&s to ,abraham presuppose an already exi/+ famili>ity ) ! ritual c]emony on ! "p ( ! latt]4 ,accord+ly we f9d t x previ\sly prevail$ among ! ,col*ians1 ?iopians1 & anci5t ,egyptians ( bo? ! ,upp] & ,l[] ,prov9ces 7,g>dn] ,wilk9son74 ,among ! latt] x appe>s to h become re/rict$1 by ! dawn ( ! hi/orical p]iod1 to ! prie/ly ca/e1 & to ^? :o desir$ initiation into ! sacr$ my/]ies4 ,9 ! temple ( ,*unsu at ,k>nak is a del9eation ( ! rite z p]=m$ on two "y *ildr51 probably sons ( ,rameses ,,ii41 ! f\nd] ( ! build+4 ,x 0 app>5tly connect$ ) ! wor%ip ( ,ra1 ! ,sun ,god2 & a seem+ allusion to x 9 ?is connection is to be f\nd 9 *apt] xvii4 ( ! ',book ( ! ,dead4' ,notices ( circumcision also appe> 9 anci5t ,pho5ician my?ology4 ,!re c be no "q ( its v great antiquity1 or ( its wide preval5ce among anci5t nations4 ,traditional desc5t f a primval ,/one ,age is betray$ by casual notices 9 ,holy ,writ4 ,?us1 9 ,exodus iv4 #be1 a %>p /one is ! in/rum5t ( mutilation2 & 9 ,jo%ua v4 #b1 ! m>g9al r5d]+ is 'knives ( fl9ts4'#c ,! ,hivites1 ! ,canaanites 7,pho5ician71 & _m if n mo/ ( ! nations ) :om ! ,israelites 7 br\ght into contact aft] settlem5t 9 ! ,promis$ ,l&1 appe> to h practis$ circumcision at "s p]iod 9 _! hi/ory4 ,9 ! ,old ,te/am5t we accord+ly f9d ! designation ( '! uncircumcis$' specially res]v$ = ! ,phili/9es1 & appli$ to ^! z a t]m ( opprobrium4 ,! li/ ( peoples by :om ! circumcision ( males has be51 or is /ill1 an e/abli%$ cu/om is suffici5tly long4 ,among su* races at ! pres5t day1 'an almo/ unbrok5 l9e may be trac$ f ,*9a to ! ,cape ( ,good ,hope1' & unless p]haps 9 ,europe 7:]e comp>atively slight traces ( aborig9al mann]s & cu/oms survive71 we f9d ! c]emony *>act]i/ic n only ( savage tribes1 b ( nations rank+ fairly high 9 ! scale ( civilisation2 = in/ance1 ! ,mexicans1 & ! anci5t ,aztec races ( ,c5tral ,am]ica4 ,! ,teanas & ,manaos on ! ,amazon2 ! ,salivos1 ,guamos1 ,otamocos1 on ! ,or9oco2 ! negroes ( ! ,congo1 ) _m o!r tribes on bo? ! we/ & ea/ coa/s ( ,africa1 notably ! ,kaffirs1 ,be*uanas1 & ,hott5tots2 ! ,abyss9ians 7,*ri/ian71 ,nubians & mod]n ,egyptians2 ! natives ( ,madagasc>2 mo/ ( ! ,au/ralian aborig9es2 ! ,papuans1 ,new ,cal$onians1 inhabitants ( ! ,new ,hebrides1 ( ,java1 ( ! ,philipp9es1 & ( ,fiji1 are only a few t may be indicat$4 ,an approximation to ! rite 9 ! =m ( a slitt+ up ( ! prepuce 0 notic$ among ! ,fri5dly ,isl&]s by ,capta9 ,cook4 ,al?\gh n enjo9$ 9 ! ,koran1 x is a univ]sal practice among ! ,mohamm$ans1 z a tradition f ! ante-,mohamm$an p]iod4 ,a cognate op]ation ^u females obta9s among ! mod]n ,egyptians1 ! ,nubians1 ! ,abyss9ians1 z well z 9 _m o!r p>ts ( ,africa among ! negro races2 also among ! ,malays on ! %ores ( ! ,p]sian ,gulf 7,c>/5 ,niebuhr71 & on ! banks ( ! ,or9oco4 ,z an anci5t cu/om 9 ,arabia & ,egypt1 x is notic$ by ,/rabo4 ,local v>iations ( detail are f\nd2 z 9 ! case ( ! ,fri5dly ,isl&]s j cit$2 & ( ! ,madagasc>ians1 :o cut ! fle% at ?ree sev]al times2 ! excis$ prepuce be+ ev5tually swall[$ by "s relative or o!r4 ,! date at :i* circumcision is p]=m$ v>ies consid]ably4 ,among ! ,jews1 ! eigh? day is1 ( c\rse1 ! select$ p]iod2 probably f consid]ation = ! sacr$ numb] sev51 = ! sev5 days ( uncleanness prescrib$ = ! p>turi5t "m 7,lev4 xii4 #b71 & = an idea t ) ! second cycle ( sev5 days ! infant !n prop]ly comm5c$ its e>?ly life4 ,among ! ,arabs1 x is def]r$ till ! ?irte5? ye>2 ! age at :i* _! reput$ ance/or1 ,i%mael1 0 submitt$ to x4 ,& e race seems to h select$ = itself :at 0 consid]$ ! mo/ suitable "t4 ,! ,turks1 = example1 h *os5 ! sev5? or eigh? ye>2 ! ,p]sians circumcise boys at ?irte51 girls1 betwe5 ! n9? & ! fifte5? ye>2 & s on4 ,x is ?us evid5t1 n only t ! rite is extremely anci5t1 b t x is impossible to ref] ! practice ( circumcision to any s+le s\rce2 or to d\bt t x orig9ally arose among _m widely-sund]$ peoples1 z ! result ( a c]ta9 /age 9 man's m5tal evolution4 ,! once widely-spread cu/om ( ! ,,c\vade1 & o!r /range aborig9al practices1 af=d an illu/rative analogy4#d ,h]odotus seems to h be5 ! au?or1 or at lea/ ! introduc]1 ( ! cleanl9ess !ory2 accord+ to :i* ! c]emony 0 inv5t$ f motives ( hygi5e4 ,philo ,judu ascribes ! cu/om to f\r causes3 #a4 ,cleanl9ess2 #b4 ,! avoidance ( c>buncle 7,qu4 canc]872 #c4 ,! symbolisation ( purity ( he>t2 #d4 ,! atta9m5t ( num]\s (fspr+4 ,( ^!1 x ne$ h>dly be said t ! la/ has no f\ndation 9 fact2 & ! two prec$+ require no rem>k4 ,! idea1 h[ev]1 t circumcision 0 initiat$ = purposes ( cleanl9ess has la/$ to ! pres5t day1 & /ill appe>s to h consid]able curr5cy4 ,:atev] may h be5 ! social condition ( ! anci5t ,egyptians & ,arabians1 on behalf ( bo? :i* races1 z hav+ be5 ! s\rce :5ce ,abraham d]iv$ 8 evid5t famili>ity ) ! cu/om1 plausible pret5sions h be5 put =?2 x is simply prepo/]\s to imag9e = a mom5t t ! num]\s savage tribes 7witness ! ,hott5tots & ! ,au/ralian aborig9es7 :o practise x1 c\ld ev] h be5 actuat$ by any su* consid]ations4 ,its _w-wide diffusion1 aga91 totally =bids ! supposition1 ei!r ( its introduction into ^! tribes by contact ) o!r nations m highly civilis$2 or ( its adoption1 by ! =m]1 :ile 9 a high] /age ( sociology1 f :i* !y h subsequ5tly become degrad$4 ,& ?is explanation is put f9ally out ( c\rt by ! ph5om5on ( an analog\s rite appli$ 9 suffici5tly num]\s qu>t]s to ! p]sons ( females4 ,9 ord]1 !re=e1 plausibly to acc\nt = ! g5]al preval5ce ( ?is /range mutilation1 we are compell$ to look else:]e2 & an exam9ation ( ! religi\s ideas :i* are kn[n to actuate primitive man1 w af=d a clue4 ,copi\s illu/rations ( ! work+ ( su* ideas among peoples em]g+ f b>b>ism c be trac$ 9 almo/ e page ( ! e>li] books ( our ,old ,te/am5t2 &1 ev5 9 classical my?ology1 al?\gh ov]laid by ! lat] developm5ts ( a high civilisation1 _! influ5ce is /ill n entirely effac$4 ,! pr9ciple ( sub/itution 0 famili> to all ! nations ( antiquity1 to ! ,israelites n ! lea/4 ,witness ! univ]sal resort to sacrifices1 ! !ory ( :i* is well indicat$ by t ( ,isaac 9 ,g5esis xxii4 ,fur!r illu/rative examples are af=d$ by ! law ( ! scapegoat1 9 ,leviticus xvi42 by ! (f]+ ( *ildr5 to ,mole* 7,lev4 xx4 #b72 & by ! leg5d ( ,jeph?ah's daught] 7,judg4 xi474 ,) ?is1 v>i\s c]emonies1 involv+ ei!r mutilation or ! %$d+ ( blood1 7 9 vogue--= example1 ! prie/s ( ,baal 7#a ,k+s xviii4 #bh72 ev5 cutt+ (f ! hair seems to h be5 9 ! nature ( a repres5tative sacrifice4#e ,h5ce _m ,g]man au?orities cit$ 9 ,keil's ,biblical ,ar*ology 7vol4 i4 p4 #dae7 consid] circumcision z a relic ( anci5t sacrifice3 ! consecration ( a "p ( ! body = ! :ole4 ,! diff]5t grades 9 ! process ( humanisation may be assum$ to h be5 successively atta9$ z foll[s4 ,9 ! e>lie/ p]iods1 human sacrifice 0 probably univ]sal2 9 ! ,bible1 we h ! episode ( ,jeph?ah's daught]1 above ref]r$ to2 & 9 ! n>rative ( ,abraham's purpose to (f] ,isaac !re is n ! slighte/ indication ( surprise on ! "p ( ! patri>* :5 he receiv$ ,jahve's comm&s2 :5ce may be argu$ evid5t acqua9tance ) su* de$s4 ,besides :i*1 we he> ( human sacrifice among ! tribes contigu\s to ! ,israelites1 until a mu* lat] date4 ,ev5 ! ,greeks & ,romans occasionally resort$ to ?is dur+ ! hi/orical p]iod2 9 ! ,hom]ic age1 x appe>s to h be5 a n infrequ5t practice4 ,z1 h[ev]1 m5 progress$ 9 culture & 9 humanity1 su* b>b>ity became impossible4 ,in/ead ( putt+ _! fir/born *ildr5 7(t5 by cruel me?ods1 z 9 ! sacrifices to ,mole*7 to dea?1 !y propitiat$ ! deity by an (f] ( ! mo/ preci\s memb]4 ,inde$1 9 ! ,g5esis acc\nt ( ,abraham's circumcision1 ,mr4 ,moncure ,conway consid]s 7,demonology & ,devil ,lore1 ii4 #hc7 t ! leg5d1 subsequ5tly obscur$ by lat] traditions1 orig9ally po9ts to ! p]=mance ( a mu* m sev]e op]ation4 ,& :5 /ill m advanc$1 ev5 ?is became impossible2 ! excision ( a v small portion ( ! organ1 n ( indisp5sable necessity to ! fulfilm5t ( its functions1 be+ sub/itut$4 ,aft] _m g5]ations _h !n pass$ ov]1 ! cu/om _h become s firmly implant$ 9 ! m9d & habits ( ! p1 t its eradication 0 r5d]$ a matt] ( extreme difficulty2 ev5 by new religi\s disp5sations & m elevat$ modes ( ?\ght4 ,h5ce we f9d ! rite among ! ,israelites made an exception to ! fi]ce d5unciation ( mutilations 9 g5]al1 utt]$ by ,jahve or by 8 mess5g]s2 & h5ce also1 we see x 7?\gh n prescrib$ 9 ! ,koran7 an ord9>y mod]n cu/om ?r\gh\t ! :ole ( ,islam1 z well z among ! ,*ri/ian ,abyss9ians4 ,! practice ( self-emasculation 9 hon\r ( a div9ity 0 a common feature 9 ! wor%ip ( ,*ronos1 ( ,cybele1 & d\btless ( _m o!r among ! e>li] recipi5ts ( religi\s adoration2 x is ref]r$ to 7& n 9 t]ms ( reprobation7 at ,mat!w xix4 #ab4 ,x has desc5d$ to mod]n times--witness ! fanatical sects 9 ,russia2 & ev5 p]sons ( high intellectual calibre 7z1 = in/ance1 ,orig57 h submitt$ to x4 ,:at m5 reg>d$ z hon\rable & m]itori\s 9 !mselves1 !y w\ld be n unlikely to impose also on _! *ildr54 ,! exi/5ce ( su* ascetic practices among p>tially civilis$ nations mu/ n be lo/ sight ( 9 ! pres5t connection2 z help+ u to compreh5d ! m5tal religi\s attitude ( primval man4 ,!re c be little "q t "h we f9d our correct explanation ( ! orig9 & wide preval5ce ( circumcision4 ,we are1 h[ev]1 no long] p]mitt$ to reg>d ?is z a hygi5ic cu/om1 b simply & solely z a relic ( b>b>ism2 dat+ f an immemorial antiquity1 long ant]ior to ! fir/ hi/orical records1 & :5 man 0 little1 if at all1 remov$ f savag]y4 ,! v5]able age ( ! prescriptive rite1 z well z ! v>i\s social & religi\s phases ?r\gh :i* ! peoples adopt+ x h s9ce successively pass$1 h effectually spiritualis$ x & h %$ ar\nd x a c]ta9 halo ( s5tim5talism2 b %\ld n be suff]$ to obscure ! only rational conception ( its prim>y significance4 ,! sacrificial "* ( ! act among ! ,israelites 0 indicat$ by a =m] cu/om ( plac+ a pot ( du/ 9 ! room :]e ! c]emony 0 to take place2 t1 z we read 9 ! ?ird *apt] ( ,g5esis1 be+ ! allott$ food ( ! s]p5t4 ,! practice seems to h cont9u$ d[n to a rec5t p]iod1 b n[ to h fall5 into disuse4 ,we ?us cle>ly see t1 beside be+ ! sign ( ! cov5ant ) ! tribal deity1 !re 0 also involv$ ! idea ( a propitiatory sacrifice to ! awful evil demons4 ,! mo/ cle> in/ance ( circumcision z an act int5d$ to conciliate an (f5d$ div9ity1 or malignant _s1 appe>s 9 ! /range /ory ( ,zipporah at ,exodus iv4 #bd2 :]e ! vic>i\s nature ( ! rite is also pla9ly set =?4 ,!re is no app>5t reason = id5tify+ ! ,"l 7',adonai'72 :o s\ght to slay ,moses1 ) ,jahve2 f :om ,moses _h j p>t$ ^u excell5t t]ms4 ,& !re c be little d\bt t ,samael1 to :om ! scapegoat 0 subsequ5tly (f]$ 7,lev4 xvi4 #bj71 or "s simil> dread p[] ( d>kness1 is "h meant4#f ,if ! writ] is n greatly 9 error1 an impression prevails 9 "s qu>t]s t ,moses ei!r in/itut$ anew or effectually p]petuat$ ! rite ( circumcision among ! ,israelites2 z a useful measure ( sanitation4 ,h[ev] des]v$ly high ! reputation ( ! great ,hebrew lawgiv] z a sanit>ian1 he does n seem entitl$ to cr$it 9 ?is connection2 & alludes b casually to ! c]emony1 z to an already well-e/abli%$ cu/om1 among c]ta9 directions = ! treatm5t ( ! p>turi5t woman at ,leviticus xxii4 #c4 ,!re is pla9ly no "q ( hygi5e "h involv$4 ,dr4 ,a%] 7,! ,jewi% ,rite ( ,circumcision7 consid]s t ,,*a/ity 0 ! ma9 purpose aim$ at 9 ! ,div9e injunction to ,abraham2 b1 = reasons subsequ5tly adduc$1 su* a !ory w be se5 to h no f\ndation 9 fact4#g ,z ! pres5t is n an antiqu>ian treatise1 only a v cursory hi/oric or e?nic acc\nt ( ritual circumcision is "h ins]t$2 _m o!r curi\s & int]e/+ p>ticul>s may be f\nd 9 ! au?orities cit$ at ! end ( ?is volume1 z well z 9 ! copi\s ,g]man lit]ature on ! same subject4 ,all t has be5 attempt$ 9 ! prec$+ pages is to exhibit ! cu/om 9 its orig9al "*2 & 79 s f> z ! pret5sions advanc$ ^u its behalf z a surgical proc$ure are conc]n$71 dive/$ ( ! traditional sanctity :i* is possibly l>gely answ]able = "s ( ! views promulgat$ by m$ical au?ors2 :]eby ! g5]al habit & practice ( ! m$ical pr(ession become also ( necessity deeply t+$4#h ,,footnotes3 #a ,an acc\nt ( ! op]ation 7seem+ly !n n infrequ5tly resort$ to7 p]=m$ at a mu* lat] date = ! above purpose1 is to be f\nd 9 ,celsus1 lib4 vii4 cap4 xxv4 #b ,accord+ to ,keat+'s ,cyclopdia ( ! ,diseases ( ,*ildr51 #ahij1 vol4 iii41 "s ( ! rabb9s n[ omit x2 9 ! tee? ( a /rong & gr[+ popul> prejudice4 ,i am in=m$1 h[ev]1 by ! ,rev4 ,s4 ,s+]1 to :om ,i am greatly indebt$ = a c\rte\s reply to inquiry on ! subject1 t ^! congregations w\ld n be reg>d$ z or?odox2 & t ! innovation is unkn[n 9 ! ,old ,_w4 #c ,9 ! ,lancet ( ,april #bj1 #ahhi1 is figur$ a curi\s circumcis+ ,in/rum5t us$ by ! ,malays1 :o p]=m ! rite ^u boys at ! age ( eight ye>s2 & also ^u females1 ab\t #a_/h? in* be+ nipp$ (f ! extremity ( ! clitoris4 ,9 ! c]emony p]=m$ on female *ildr51 v>iations exi/2 o!r tribes remove ! nymph4 #d ,la ,c\vade 0 ! designation ( ! unwritt5 law1 accord+ to :i*1 directly an infant 0 br\ght into ! _w1 ! husb& retir$ to b$ & 0 s$ul\sly nurs$ = a c]ta9 prescrib$ p]iod2 ! "m1 on ! o!r h&1 gett+ up & att5d+ to ! affairs ( ! h\sehold4 ,tylor speaks ( x z ?is once _w-wide cu/om 7,primitive ,culture1 i4 #gf74 #e ,examples ( ! sub/itution pr9ciple among v>i\s mod]n races are to be f\nd 9 ,tylor's ,primitive ,culture1 vol4 ii4 p4 #cf et seq4 #f ,! imposition ( circumcision by ! ,jews ^u vanqui%$ enemies1 z ! ,idumeans & ,itureans 7,josephus1 ,antiq4 ,b4 #ac7 s\nds ! l note2 !re c\ld h>dly be any "q ( proselytism4 ,at an e>li] date ^! p w\ld h be5 ru?lessly massacr$ en masse1 l ! ,amalekites 7#a ,sam4 xv4 #h72 slaught]$ 9 great "p1 l ! ,moabites 7#b ,sam4 viii472 or sacrific$1 l ,agag 7#a ,sam4 xv4 #c71 to ! deity ( ! conqu]ors4 #g ,accord+ to ! same writ]1 x is absolutely impossible to say1 9 any giv5 case among ! ,mohamm$ans1 :e!r circumcision has be5 p]=m$ or n2 =1 z ! muco-cutane\s membrane has n be5 divid$1 '! s(t ela/ic sk9 ( ! p5is easily comes =w>d & re-cov]s ! glans4' ,he /ates t ! p]=mance ( t p>ticul> portion ( ! c]emony :i* consi/s 9 te>+ & remov+ ! membrane 9 "q1 completely di/+ui%es ! ,jews f all ! o!r nations ( ! _w :o practise ! op]ation z a religi\s rite4 #h ,two cases ( int]e/ 9 ?is connection may be "h notic$4 ,dr4 ,levy1 a ,jew d5ti/ ( ,/ett91 /ates 7,m$ical ,record1 ,may #c1 #ahij7 t1 l 8 fa!r be=e him1 he 0 born )\t a =esk92 fur!r1 t 8 f\r bro!rs1 :o di$ 9 *ildhood1 7 simil>ly circum/anc$4 ,! late ,dr4 ,a%] 7op4 cit471 :o mu/ be consid]$ a high au?ority 9 su* a matt] 7s f> at lea/ z conc]ns 8 co-religioni/s71 says3 ',no "p ( ! human body is subject to s _m v>ieties & irregul>ities z ! p5is & =esk94' ,he believes total abs5ce ( ! prepuce to be extremely r>e1 & d\bts :e!r su* a ph5om5on has ev] occurr$2 b seems to reg>d a p>tial defici5cy z no?+ unusual4 ,he /ates t 9 mo/1 if n all1 in/ances ( suppos$ cong5ital abs5ce ( ?is /ructure1 a small portion ( ! sk9 w be f\nd prolong$ to ! glans across ! int]v5+ fossa2 :i* morsel1 h[ev] small1 mu/ be excis$ by ! ,mohel1 ) ! usual =malities4 ,a note in=ms u t1 accord+ to ,jewi% tradition1 ! foll[+ p]sonages nev] _h =esk9s3 ,adam1 ,se?1 ,noah1 ,%em1 ,mel*iz$ek1 ,jacob1 ,joseph1 ,job1 ,moses1 ,balaam1 ,samuel1 ,david1 ,j]emiah1 ,z]ubbabel4 ,! second case be>s ^u ! v het]odox !ory ( mat]nal impressions1 & is report$ 9 ! same p]iodical1 ( dates ,nov4 #c1 #ahhh1 & ,m>* #bc1 #ahhi4 ,x is t ( a *ild born accurately circumcis$1 sev5 mon?s & tw5ty days aft] ! l op]ation on 8 eld] bro!r 7presumably 9 pres5ce ( ! "m1 al?\gh ?is is n /at$74 ,! local appe>ances 9 ! two *ildr5 are affirm$ by ,dr4 ,h>vey1 ( ,ill9ois1 to h be5 exactly alike2 '! cong5ital case ev5 %[+ ! m>ks ( ! sutures4' ,bo? ( ! above cases1 toge!r ) ,dr4 ,a%]'s exp]i5ces1 may be respectfully comm5d$ to ! notice ( ,pr(essor ,weismann4 ,,ii ,,nature ,,( ,,cong5ital ,,phimosis--,,physiological ,,importance ,,( ,,! ,,prepuce4 ,! ^w 'phimosis' 7,greek3 phimo1 ,i b9d7 signifies t condition ( ! p5is 9 :i* ! prepuce _c be retract$ beyond ! corona gl&is2 & :i* may be ei!r cong5ital or factiti\s4 ,! latt] is a pa?ological ph5om5on1 ! product ( injury or ( disease4 ,to apply ! t]m 'abnormal' to ! =m] is1 h[ev]1 h>dly p]missible1 except :5 ! difficulties 9 retraction are p]man5t & extreme2 :5 !y _c be ov]come by judici\s p]sev]ance1 & by c>eful manipulation 9 ! e>ly weeks ( infant life4 ,a c]ta9 am\nt ( adhesion betwe5 ! two contigu\s surfaces ( muc\s membrane is almo/ con/antly pres5t at bir?1 z a cont9uation ( ! normal intra-ut]9e agglut9ation 7,keat+'s ,cyclopdia ( ! ,diseases ( ,*ildr51 #ahij1 vol4 iii42 article by ,dr4 ,de ,=e/ ,will>d74 ,! radical defect 9 cong5ital phimosis is ?us ! adhesion or imp]fect sep>ation ( two muco-cutane\s surfaces1 normally develop$ 9 close contact4 ,z a rule1 ^! are s slightly connect$ t a v slight degree ( =ce is suffici5t to "p !m2 b 9 a consid]able m9ority ( in/ances ! defect ev5tually becomes p]man5t2 ) ! natural gr[? ( ! organ m difficulty is exp]i5c$ 9 procur+ retraction2 & v>i\s disagreeable1 or ev5 dang]\s1 symptoms are prone !n to make _! appe>ance4 ,! compla9t1 h[ev]1 is simply "o ( degree4 ,if ! adhesions at ! m>g9 ( ! ure?ral meatus are s tight t !y fail to be quickly sep>at$ by ! /ream ( ur9e direct$ aga9/ !m--! =ce ( :i* necess>ily v>ies 9 diff]5t infants--consid]able imp$im5t to micturition results2 &1 p]haps usefully1 s]ves to direct e>ly att5tion to ! /ate ( ! p>ts4 ,9 r>e cases1 no op5+ at all into ! ure?ra has be5 discov]able2 & complete ret5tion has necess>ily ensu$4 ,v (t51 h[ev]1 no?+ ( ?is sort happ5s = sev]al weeks1 mon?s1 or ev5 ye>s2 & ! exi/5ce1 or r p]si/5ce1 ( ! disability may n be notic$ at all until adolesc5ce ( adult life4 ,! majority ( in/ances lie betwe5 ^! extremes2 n seldom unpleasant symptoms beg9 to be obs]v$ :5 ! boy is a few mon?s old2 b !re is a wide range ( v>iation4 ,! p5ile & preputial lay]s ( muc\s or quasi-muc\s membrane be+ firmly adh]5t1 & gr[? ( ! glans p5is proce$+ apace1 c]ta9 consequ5ces necess>ily foll[4 ,! prepuce be+ 79 extreme cases7 tightly fix$ to ! m>g9s ( ! ure?ral orifice1 ! meatus ur9>ius /ill reta9s ! same calibre z :5 bir? took place1 & becomes f> too small = ! ne$s ( ! rapidly gr[+ *ild4 ,a difficulty 9 effectually void+ ! bladd] is exp]i5c$1 & may ev5tually result 9 complete ret5tion4 ,! little pati5t tugs at ! seat ( unpleasant s5sation2 & ?is elongates ! folds ( sk9 at ! extremity ( ! p5is1 normally some:at r$undant1 & extremely di/5sile4 ,! muscul> =ce ( ! bladd] be+ sp5t ^u ov]com+ ! ob/ruction at ! n>r[ meatus1 ! ur9e trickles out feebly1 & 'balloons' 9 ! s(t p\*es beyond1 :i* cont9u\sly reta9 a few drops4 ,h5ce great local irritation & excoriation4 ,x is n w>rantable1 h[ev]1 to speak ( contraction ( ! p5ile muc\s membrane4 ,no contraction takes place1 except z a consequ5ce ( inflammatory attacks2 & ^!1 9 ! infant1 are r>ely suffici5t to cause any mat]ial %r9k+4 ,! ph5om5on is simply "o ( natural developm5t "u a rigid re/ra9+ envelope2 & ?\gh ev5tually ! ap]ture is f\nd n>r[ en\gh1 ! 'contraction' is relative only4 ,s also1 9 e male *ild !re is m or less seem+ r$undancy ( sk9 at ! end ( ! p5is2--= natural physiological reasons4 ,! condition is apt1 z fir/ /at$1 to become factiti\sly enhanc$ "u ! pressure ( ur9>y ob/ruction4 ,b !re is seldom or nev] a real sup]fluity ( integum5t 9 ?is locality ab initio2 9 excess ( :at ! subsequ5t ne$s ( ! full-develop$ organism may be reasonably suppos$ to w>rant4 ,x is requisite to lay "s /ress on ^! two po9ts1 z t5d+ mat]ially to influ5ce our conceptions ( ! practice condemn$ 9 ?is pamphlet4 ,al?\gh pla9ly n absolutely ess5tial to ! due increase 9 bulk ( ! p5is1 or to ! subsequ5t p]=mance ( its functions1 x is prima facie obvi\s t ! prepuce mu/ be int5d$ to subs]ve "s useful purpose4 ,t1 accord+ to ,dr4 ,will>d 7,keat+'s ,cyclopdia71 'is to protect ! head ( ! organ1 dur+ ! ye>s :5 ! p5is is b a portion ( ! ur9>y app>atus2 & lat]1 by its friction ov] ! s5sitive corona1 to enhance ! ejaculatory orgasm4' ,! latt] half ( ?is /atem5t may fairly be que/ion$1 z ! prepuce is completely retract$ dur+ coition2 & s no friction ov] '! corona' c well take place "u ord9>y conditions4 ,! fir/ "p1 h[ev]1 is unimpugnable2 & to x may be add$ "s consid]ation ( ! protection af=d$ dur+ ! fir/ ef=ts at functional use4 ,"s measure ( ! degree 9 :i* ! glans p5is is %ield$ f ext]nal irritat+ ag5cies is af=d$ by ! s5sations ( ! adult = ! fir/ "t depriv$ ( ?is app5dage2 or 9 :om ! latt] is kept retract$ = any l5g? ( "t1 contr>y to prec$+ habit4 ,extreme discom=t1 inde$ consid]able sor5ess & actual pa91 are compla9$ (2 until tol]ance becomes e/abli%$1 & until ! delicate membrane has by exposure & friction become s h>d5$ t ! abs5ce ( its =m] cov]+ is no long] notic$1 a p]iod occupy+ commonly sev]al weeks4#i ,9 ! case ( "y *ildr51 ! unpleasant s5sations involv$ mu/ be relatively f> great]2 consid]+ _! physical helplessness & _! m impressionable n]v\s sy/em4 ,accord+1 moreov]1 to ! au?ority previ\sly cit$1 e>ly removal ( ! prepuce is apt to be foll[$ by progressive scl]osis1 ) att5dant evils ( contract$ meatus1 balanitis1 c4 ,&1 fail+ ?is1 '! exposure ( ! t5d] sk9 to ! friction ( ! clo?+1 c4 t5ds to keep up a /ate ( abnormal excitem5t dur+ ! e>ly ye>s ( life4' ,x ?us becomes app>5t t1 ap>t f any risks involv$ by op]ative proc$ures1 ablation ( ! prepuce1 :e!r 9 infant or 9 adult1 is n a measure to be und]tak5 lightly1 or )\t satisfactory evid5ce ( positive necessity4 ,,footnote3 #i ,! fact t _m adults1 ( n too s5sitive organisation1 gradually acquire a habit ( reta9+ ! =esk9 p>tially or ev5 entirely retract$1 is ( c\rse n lo/ sight (4 ,b ?is 9 no way affects ! "q ( its sudd5 removal1 or ( ! protection af=d$ by ! /ructure 9 "q to infants ( t5d] ye>s4 ,,iii ,,dang]s ,,& ,,results ,,( ,,cong5ital ,,phimosis--,,acquir$ ,,phimosis4 ,a p]fectly heal?y condition ( ! male g5]ative organs is compatible only ) p]fect mobility ( ! prepuce ov] ! gl& :i* x envelopes4 ,s1 9 ! abs5ce ( ?is1 we enc\nt] a numb] ( ill consequ5ces1 "s local only2 "s affect+ ! well-be+1 & ev5 ! life1 ( ! entire organism4 ,! p>ts be+ extremely vascul>1 & 9 v intimate relation ) ! c5tral n]v\s sy/em2 we v naturally f9d t cong5ital phimosis1 int]f]+ ) ! normal gr[? ( ! glans p5is1 is prone to develop v>i\s reflex neurotic disord]s or diseases2 ( :i* "s h be5 m9utely describ$ by ,dr4 ,sayre4#aj ,?us =ms ( p>alysis may ensue2 ei!r conf9$ to a s+le gr\p ( muscles1 & simulat+ club-foot1 or ( a m g5]al "*4 ,epilepsy1 reflex c\gh1 convulsions1 *oreic movem5ts ( ! limbs1 are extreme examples2 b a mild] in/ance ( ! same causes 9 op]ation %[s itself 9 "y infants1 z nocturnal re/lessness ) defective nutrition4 ,hip-jo9t disease & sp9al c>ies may be simulat$1 & ! mal-assimilation ( food may ev5tually produce su* gross de=mities z b[+ ( ! legs4 ,*ronic priapism is a n uncommon occurr5ce4 ,ob/ruction to ! free dis*>ge ( ur9e may produce symptoms ( sev]e vesical irritation1 occasionally suppos$ to indicate /one 9 ! bladd]4 ,! /ra9+ ef=ts at micturition may cause h]nia or prolapse ( ! rectum2 ! nocturnal incont95ce ( *ildr5 is n unfrequ5tly traceable to ! same s\rce4 ,epi/axis has be5 describ$4 ,ret5tion ( ur9e 9 ! folds ( ! elongat$ =esk91 toge!r ) ! *ild's habit ( pull+ ?is1 induce a condition ( sor5ess :i* causes great sm>t+ :5ev] micturition takes place1 & induces ! pati5t to def] t act z long z possible4 ,h5ce may 9 "t result dilatation ( ! bladd]1 cy/ic kidneys1 & dea?4 ,ev5 eczema ( ! abdom9al wall has be5 ?us produc$2 & has disappe>$ :5 ! cause 0 remov$1 z 9 a case cit$ by ,dr4 ,hayes ,agnew 7,pr9ciples ( ,surg]y1 #ahha74 ,:5 ! pati5t is all[$ to rea* adult life ) ! disability unreliev$1 he becomes subject to attacks ( balanitis2 & ! p>ts may ulc]ate or ev5 sl\gh4 ,9 a case se5 by ! writ]1 :]e at ! "t no symptoms ( inflammation 7 pres5t1 ! reta9$ deposits ( smegma _h ulc]at$ ?r\gh ! prepuce at v>i\s po9ts--project+ f ?is exactly l *alk-/ones f ! f+]s ( a g\ty p]son4 ,9 a unique case cit$ by ,eri*s51 ',dr4 ,wi%am1 ( ,fyzabad1 remov$ no few] ?an #dbf calculi1 v>y+ 9 size f a p9's head to a small bean1 f ?is situation1 9 ! p]son ( a native ( ,india1 sixty ye>s ( age1 :o came "u treatm5t = :at appe>$ to be a l>ge tum\r at ! end ( ! p5is1 ! true nature ( :i* 0 n detect$ until1 on remov+ x1 ! knife grat$ aga9/ ! conta9$ calculi4' ,! defect con/itutes a s]i\s imp$im5t to impregnation2 9 ! ev5t ( an acquir$ local disord]1 its pres5ce s]i\sly h9d]s diagnosis1 & altoge!r precludes appropriate treatm5t4 ,x has be5 suppos$1 & n )\t plausibility1 to pr$ispose to epi!lioma4 ,a case is giv5 by ,mr4 ,oliv] ,pemb]ton2 & o!rs h be5 report$4 ,!re c be no "q t1 "u su* circum/ances1 ! pres5ce ( malignant disease ab\t ! glans w\ld mu* long] rema9 undetect$ ?an 9 a normal /ate ( ! p>ts2 & t ! prospects ( cure by op]ative removal w\ld be proportionately less5$4 ,only comp>atively mild examples ( phimosis1 9 :i* ! adhesions produc$ little or no con/riction1 & did n at all int]f]e ) ur9ation1 c\ld ?us h be5 suff]$ to pass unreliev$ until ! subjects 7 f> pa/ maturity4 ,phimosis1 z an acquir$ condition1 is ( frequ5t occurr5ce 9 an acute =m2 z ! result ( inflammatory o$ema ( ! prepuce 9 y\?s & adults4 ,?is1 aga91 may be a consequ5ce ( simple balanitis1 ! result ( want ( cleanl9ess1 comb9$ ) disord]$ g5]al heal? & a cat>rhal /ate ( all ! muc\s membranes2 9 :i* ev5t x usually yields to mild measures1 su* z ! injection ( w>m fluids "u ! =esk94 ,9 by f> ! great] numb] ( in/ances x is produc$ by v5]eal infection2 & imp]atively ne$s prompt op]ation1 usually 9 ! guise ( slitt+ up ! /ructure on a director4 ,9 a *ronic =m1 sl[ly & gradually com+ on1 & v intractable to rem$ial measures1 x is n seldom se5 9 old m5 ( g\ty habit2 & ( consequ5tly unheal?y & irritable muc\s membranes4 ,! pa?ology & treatm5t ( ,,acquir$ phimosis d n fall )9 ! scope ( ! pres5t "w1 b x is necess>y to po9t out t ^! are ess5tially diff]5t f ^? ( ! cong5ital2 & t ! latt] ne$s consid]ation ^u pr9ciples totally div]se4 ,9 ! cong5ital we h to deal ) tissues p]fectly heal?y1 & ) sk9 peculi>ly ela/ic & di/5sile4 ,9 ! factiti\s1 all ! p>ts are m or less alt]$ by disease1 acute or *ronic2 & z a sequel to ! latt]1 or to repeat$ attacks ( ! =m]1 true contraction takes place2 ! prepuce (t5 atta9+ a h>d & gri/ly consi/5ce1 "u :i* condition simple dilatation is difficult or impossible4 ,! ph5om5on is r>ely1 if ev]1 se5 9 association ) cong5ital phimosis2 b>r+ g\t or v5]eal ta9t 9 addition4 ,,note4--,! infrequ5cy ( canc]\s disease attack+ ! p5is1 r5d]s x unsafe to dogmatise ^u any suppos$ causal relation%ip betwe5 t malady & ! pres5ce or abs5ce ( ! =esk91 & does n appe> to w>rant any /rong] ass]tion on ?is po9t ?an t :i* is record$ on ! previ\s page4 ,,footnote3 #aj ,or?opdic ,surg]y1 p4 #ad4 ,see also ,hilton1 ,re/ & ,pa91 p4 #bgf4 ,,iv ,,cutt+ ,,op]ations ,,= ,,! ,,relief ,,( ,,cong5ital ,,phimosis2 ,,_! ,,suppos$ ,,advantages4 ,f ! prec$+1 ! evils or dang]s incurr$ by p]mitt+ a male *ild to rea* adult life2 or1 9 ! ev5t ( press+ symptoms1 to pass ev5 a few weeks or mon?s ) ?is disability unreliev$2 are suffici5tly obvi\s4 ,al?\gh1 z ,dr4 ,will>d 7op4 cit47 /ates1 ! adhesions betwe5 prepuce & glans c ne>ly always be brok5 d[n ) suffici5t read9ess dur+ ! fir/ few weeks aft] bir?1 !re c be little d\bt t1 )\t conspicu\s necessity1 ! m$ical practition] w seldom c>e to 'make ! baby cry1' & ?us draw d[n ^u himself vigor\s mat]nal reproa*es4 ,x seems1 moreov]1 h>dly judici\s to enc\rage any tamp]+ by nurses or midwives1 probably m or less ignorant & unskill$4 ,we may take x = grant$1 !re=e1 t no?+ w usually be done until ! *ild is sev]al mon?s old2 :5 "s m en]getic treatm5t w be requisite to rem$y ! condition 9 "q4 ,9 mild] cases no notice w probably be tak5 ( ! abnormality = at lea/ sev]al ye>s1 & its pres5ce may be detect$ only by accid5t2 ! adhesions 9 su* are trivial1 & d n int]f]e ) normal gr[?2 h5ce are1 z a rule1 easily ov]come4#aa ,al?\gh less sev]e measures h be5 f "t to "t br\ght =w>d & advocat$1 ! op]ation ( circumcision is1 to all int5ts & purposes1 ! only proc$ure 9 g5]al use = rem$y+ cong5ital phimosis2 & z ! latt] is v common1 s also is ! p]=mance ( ?is anci5t sacrificial rite among t l>ge majority ( ! population :o are o!rwise 9 no way committ$ to x4 ,!re is a simplicity & ?or\ghness ab\t ! little amputation :i* may p]haps comm5d x to ! surgical m9d2 & !re are unque/ionably c]ta9 sup]ficial advantages ( a hygi5ic nature ab\t ! pati5t's subsequ5t condition2 ?\gh x may be d\bt$ :e!r ^! are by any means s consid]able z has be5 made to appe>4 ,h[ev] ?is may be1 x goes )\t say+ t no o!r curative proce$+ has s f> met ) any wide fav\r 9 ! m$ical pr(ession2 &1 if "o may judge f _! publi%$ op9ions1 ! lead+ expon5ts ( m$ical practice & op9ion1 9 ?is c\ntry at lea/1 are s pleas$ ) circumcision & its results t !y w\ld will+ly see ! ,mosaic ,laws 9 ?is p>ticul> ext5d$ to ! :ole ,*ri/ian population1 :e!r affect$ by phimosis or n4 ,witness ,mr4 ,jona?an ,hut*9son3 ,x is surely n ne$ful to seek any recondite motive = ! orig9 ( ! practice ( circumcision4 ,no "o :o has se5 ! sup]ior cleanl9ess ( a ,hebrew p5is c h avoid$ a v /rong impression 9 fav\r ( ! removal ( ! =esk94 ,x con/itutes a h>b\r = fil?1 & is a con/ant s\rce ( irritation4 ,x conduces to ma/urbation1 & adds to ! difficulties ( sexual cont95ce4 ,x increases ! risk ( syphilis 9 e>ly life1 & ( canc] 9 ! ag$4 ,i h nev] se5 canc] ( ! p5is 9 a ,jew1 & *ancres are r>e4--,ar*ives ( ,surg]y4 ,argum5ts by ?is di/+ui%$ surgeon1 9 fav\r ( ext5sion ( ! cu/om z a matt] ( ord9>y r\t9e to e male ,g5tile1 are to be f\nd 9 ! ,m$ical ,times & ,gazette1 ,decemb] #a1 #ahee2 toge!r ) a ref]5ce to previ\s utt]ances 9 an id5tical s5se4 ,eri*s5 7,surg]y1 ,n9? ,edition1 #ahhh1 vol4 ii4 p4 #aahh7 says3 ,e *ild :o has a cong5ital phimosis ought to be circumcis$2 & ev5 ^? :o1 )\t hav+ phimosis1 h an abnormally long & lax prepuce1 w\ld be improv$ greatly 9 cleanl9ess1 heal?1 & morals by be+ subject$ to ! same op]ation4 ,x w\ld be well if ! cu/om ( ,ea/]n nations1 :e!r x be reg>d$ z a religi\s rite or only z a "t-hon\r$ obs]vance1 7 introduc$ among/ u4 ,9 ,holmes's ,sy/em ( ,surg]y1 #ahhc1 we read3 ,circumcision is ! op]ation requir$ 9 *ildr52 & x is be/ adapt$ = adults also :5 ! sk9 is r$undant1 & ! m>g9s ( ! preputial op5+ are ?ick5$4 ,mr4 ,w4 ,h4 ,jacobson 7,op]ations ( ,surg]y1 #ahhi7 says3 ,?is op]ation is /ill n practis$ (t5 en\gh1 especially among poor] pati5ts2 among/ :om _m practition]s /ill treat phimosis z a matt] ( b little importance4 ,"s ( ! pret5sions set =? above on behalf ( circumcision w be subsequ5tly ref]r$ to2 b on ! plea = a g5]al ext5sion ( ! rite to nations n impell$ !reto by special ,div9e comm&1 x may be rem>k$ t sev]al ,jewi% surgeons :o h writt5 ^u ! topic by no means reg>d ?is ) an eye ( fav\r2 & h1 9 fact1 gone ev5 s f> z to d5\nce 9 ! /ronge/ t]ms its compulsory p]=mance among _! co-religioni/s4#ab ,= _! dislike1 !y advance :at appe> to be v adequate reasons2 &1 9 su* a matt] !y mu/ h enjoy$ a f> wid] special exp]i5ce ?an any practition] )\t ! ,hebrew pale4 ,! foll[+ extract f ,eri*s5's ,sci5ce & ,art ( ,surg]y 7,n9? ,edition1 #ahhh7 may be reg>d$ z a typical acc\nt ( ! ord9>y surgical op]ation 9 vogue at ! pres5t day4 ,! italics are ! pres5t writ]'s3 ,circumcision 9 boys or adults may be mo/ conv5i5tly p]=m$ 9 ! foll[+ way4 ,! surgeon re/ra9s hmorrhage dur+ ! op]ation by ty+ a tape tightly ar\nd ! root ( ! p5is1 or by compress+ ! organ 9 ,clov]'s circumcision t\rniquet1 a mo/ useful in/rum5t1 :i* c be slack5$ or tight5$ at any "t4 ,he next draws ! elongat$ prepuce slightly =w>ds1 until ! portion ( x :i* corresponds to ! back ( ! glans is br\ght j 9 front ( t /ructure4 ,he !n seizes ! project+ prepuce imm$iately 9 front ( ! glans ) a pair ( n>r[-blad$ polypus-=ceps1 :i* he gives to an assi/ant1 :o mu/ hold !m tightly2 or he grasps x & protects ! glans by means ( a plate :i* ,i h _h con/ruct$ = ?is purpose4 ,) "o sweep ( ! bi/\ry he cuts (f all t portion ( ! integum5t :i* projects beyond ! =ceps1 :i* are !n tak5 away4 ,x w n[ be f\nd t he has remov$ only a circle ( sk91 b t ! muc\s membrane l9+ x /ill tightly embraces ! glans2 ?is he slits up1 by introduc+ ! po9t ( a pair ( scissors at ! preputial orifice2 & !n1 trimm+ (f ! angles ( ! flaps1 he turns back ! muc\s membrane & atta*es x to ! edge ( ! cutane\s incision by a suffici5t numb] ( f9e catgut sutures4 ,be=e introduc+ ^!1 he w g5]ally f9d x necess>y to ligature a small art]y on ea* side ( ! p5is1 & "o or two 9 ! frnum4 ,! be/ dress+ 9 *ildr5 w be "s simple o9tm5t1 su* z boracic acid o9tm5t1 or ! glans may be simply sme>$ ) a little vasel9e4 ,aft] e act ( micturition ! p>ts %\ld be well spong$ ) boracic acid lotion or ,condy's fluid & wat]4 ,9 ! adult1 union by fir/ int5tion may (t5 be obta9$ by a dry dress+ ( iod(orm-wool ?ickly cov]$ ) collodion1 s z to protect x f ! ur9e4 ,?is may be left un*ang$ = f\r or five days4 ,!re is usually a good deal ( swell+ ( ! muc\s membrane ab\t ! frnum1 & "s solid o$ema usually rema9s = "s weeks aft] ! op]ation4 ,?is gradually subsides1 & a l9e> cicatrix rema9s1 :i* causes ! pati5t no inconv5i5ce4444 ,! *ief po9ts to be att5d$ to 9 ! p]=mance ( ?is op]ation1 & on :i* its aft]-success is mo/ dep5d5t1 are--#a4 ,t too mu* sk9 be n remov$2 #b4 ,t ! muc\s membrane be slit up to ! base ( ! glans2 #c4 ,t too mu* ( x be n remov$2 #d4 ,t all ble$+ vessels be ti$ ) catgut ligatures1 :i* mu/ be cut %ort2 #e4 ,t ! muc\s membrane be well turn$ back1 s z to cov] ! gap left by ! retract$ sk92 #f4 ,t all sutures be ( catgut1 :i* w be absorb$1 & ?us save ! pa9 ( tak+ !m out4 ,! modus op]&i ( diff]5t surgeons v>ies 9 p>ticul> details1 usually ( a slight & unimportant "*4 ,! pi?y description conta9$ 9 ,maund]s ,op]ative ,surg]y may be appropriately quot$3 ,! extremity ( ! =esk9 be+ seiz$ ) =ceps is drawn well =w>ds2 ! :ole prepuce is embrac$ ) ! blades ( dress+-=ceps1 imm$iately ant]ior to ! glans p5is1 & cut (f 9 front ( ! latt] in/rum5t4 ,z soon z ! =ceps are remov$1 ! sk9 w become retract$1 leav+ ! muc\s membrane /ill ab\t ! glans2 ?is is slit up longitud9ally z f> z ! corona1 :5 x may be turn$ back1 & its edge w come into apposition ) ! circul> w\nd 9 ! sk94 ,! op]ation is n[ complete2 b 9 ! adult x w be well to introduce a few int]rupt$ sutures4 ,! prepuce has sometimes be5 slit up longitud9ally on a director4 ,al?\gh well suit$ to cases ( adv5titi\s phimosis 9 ! adult1 ! me?od is 9 no way adapt$ to ! cong5ital =m1 & has nev] f\nd g5]al fav\r ) ! m$ical pr(ession4 ,x has no advantages ov] circumcision2 al?\gh reta9+ ! prepuce1 x /ill leaves ! glans l>gely uncov]$2 & ! %>p corn]s ( ! divid$ sk91 unless trimm$ & r\nd$ (f1 produce a v unsightly aft]-appe>ance4 ,9 p]=m+ circumcision _m surgeons hold ! clamp or dress+ =ceps :i* protect ! glans incl9$ obliquely d[nw>ds & =w>ds1 s z to leave a portion ( ! prepuce 9 ! neighb\rhood ( ! frnum unremov$4 ,z "o ( ! ma9 advantages claim$ = ! op]ation is ! prev5tion ( future infection by ret5tion ( morbid mat]ial 9 ! preputial folds1 su* a practice w\ld seem to indicate a lurk+ disbelief 9 ! validity ( ?is pret5sion4 ,if x be reasonable & "r to excise ! /ructure on ^! gr\nds1 & if t proce$+ be att5d$ by su* salut>y effects2 x is only logical n to d ?+s by halves1 b to make ! excision z complete z possible4 ,?us ,li/on made 8 section ne> ! frnum1 's z to reta9 ! sk9 on ! glans1 :i* is ( advantage4' ,! use ( ! ela/ic ligature1 & ( ! craseurs1 bo? ord9>y & galvanic1 = ! p]=mance ( circumcision1 are cruel & fanta/ic modes ( effect+ t object1 :i* h>dly ne$ any expression ( condemnation2 & :i* x is difficult to believe c ev] h be5 s]i\sly advocat$4 ,keyes 7,diseases ( ! ,ur9>y ,organs1 #ahhh71 aft] break+ up adhesions ) an oil$ probe1 m>ks an anil9e l9e ar\nd ! =esk91 & amputates ! sk91 c41 9 front ( ?is m>k2 ?us previ\sly e/imat+ ! am\nt ( tissue to be remov$4#ac ,= op]ations involv+ ! amputation ( ! :ole1 or ne>ly ! :ole prepuce1 ! foll[+ advantages are claim$3-- 7a7 ,greatly enhanc$ local cleanl9ess ?r\gh\t aft]-life4 7b7 ,great] *a/ity2 & ! preclusion ( immoral p]sonal habits4 7c7 ,a small] liability to v5]eal contagion 9 aft]-life4 7d7 ,a dim9i%$ pron5ess to ev5tual canc]\s disease4 ,9 respect ( ! fir/ ( ^! x may be conc$$ t1 among a p naturally ( uncleanly habits1 ab/raction ( ! prepuce w\ld at any rate prev5t mis*ief result+ f compulsory ret5tion ( ! smegma4 ,:e!r x w\ld lead to m frequ5t ablutions is p]haps d\btful2 z also :e!r ! plea has any valid efficacy 9 reg>d ( p]sons belong+ to ! bett] classes1 or to nations n specially di/+ui%$ 7l ! ,ori5tal7 = _! disreg>d ( ! mo/ elem5t>y laws ( p]sonal hygi5e4 ,) savage tribes or ) su* races z ! ,*9ese 7_m ( :om are said to be completely wa%$ f head to foot on two occasions only--:5 !y ent] ! _w1 & :5 !y h quitt$ x71 any?+ conduc+ to m complete bodily cleanl9ess 9 aft]-life is c]ta9ly wor?y ( consid]ation2 & probably ( approval1 ev5 :5 x necessitates a surgical op]ation4 ,b to apply ?is reason+ to m civilis$ peoples seems h>dly w>rantable on ! facts 9 view4 ,%av+ ! head1 or pluck+ out ! nails w\ld mat]ially conduce to subsequ5t fre$om f dirt2 b no "o w\ld s]i\sly advocate ei!r ( ^! z habitual cu/oms2 & ! practice "u discussion 9 no way diff]s f !m1 s f> z ! pr9ciple involv$ is conc]n$4 ,! second ( ! reasons above assign$ is "o :i* has probably great weight 9 det]m9+ ! practice ( _m surgeons2 & x has ev5 be5 gravely cont5d$ by "o ( ! ,jewi% communion t ! ,deity in/itut$ ! rite among ! ,israelites 9 ord] to promote _! great] purity & cont95ce4#ad ,?is sugge/s ! irrepressible comm5t>y t1 :atev] ! case 9 bygone ye>s1 ! op]ation seems n[ to h :olly lo/ its salut>y effects 9 ! direction indicat$1 z ,mr4 ,jona?an ,hut*9son 7,m$ical ,times & ,gazette1 loc4 cit47 himself te/ifies4 ,d\btless any?+ :i* might t5d to enhance ! *a/ity ( _m mod]n nations w\ld be well wor?y ( s]i\s consid]ation2 ) a view to its univ]sal adoption4 ,/range to say1 h[ev]1 c]ta9 ( ^? m$ical m5 :o h inve/igat$ ! "q ) opportunities ( special exp]i5ce1 l>gely base _! opposition to ! practice ( ritual circumcision ^u ! gr\nd t removal ( ! =esk9 9 e>ly life leads to premature sexual excitem5t1 & a correspond+ disposition to onanism4 7,levit1 ,allg4 ,wi5] m$4 ,zeit41 ,novemb] #ag1 #ahgd47 ,9 ! ,lancet ( ,april #d1 #ahfi1 two cases mat]ially be>+ ^u ?is po9t are report$4 ,"o is t ( a ,jew1 ag$ ?irty-five1 suff]+ f 'sp9al p>alysis1' :i* he attribut$ to a habit ( p]si/5t ma/urbation 9 *ildhood or y\?4 ,& allusion is made to a y\ng] bro!r ( ! same pati5t2 :o1 z a consequ5ce ( ! same1 _h acquir$ sp]matorrhoea1 ,dr4 ,will>d 7,keat+'s ,cyclopdia7 says3 ,i h fail$ to f9d any /ati/ics prov+ t ! circumcis$ ma/urbate less frequ5tly1 or are m virtu\s ?an o!rs2 & ! exposure ( ! t5d] sk9 to friction ( clo?+ c41 t5ds to keep up a /ate ( abnormal excitem5t dur+ ! e>ly ye>s ( life4 ',:]e doctors diff]1 :o %all decide8' ,& 9 face1 !re=e1 ( su* directly contradictory op9ions f pr(essional witnesses1 x is difficult to believe t ablation ( ! prepuce is ( mat]ial avail1 ei!r 9 preclud+ ma/urbation1 or 9 promot+ ! subsequ5t *a/ity ( ! adult individual4 ,on ! ?ird ( ! reasons assign$ = advocat+ circumcision--! prev5tion ( v5]eal disease :5 manhood is atta9$--,mr4 ,jona?an ,hut*9son1 ^: te/imony _c b receive consid]able weight1 rem>ks t *ancres are r>e 9 ! ,jew4 ,! obs]vation has n be5 controv]t$2 b mu/ be receiv$ ) a c]ta9 am\nt ( hesitancy1 9 consequ5ce ( an evid5t bias 9 fav\r ( radical measures ( op]ative treatm5t4 ,x seems r to ne$ confirmation by surgeons ( ! ,jewi% race1 practis+ especially among _! co-religioni/s4 ,! pres5t writ] has be5 unable to discov] any evid5ce 9 support f su* a qu>t]4 ,! au?ority la/ cit$ po9ts out t cicatricial tissue is ( all o!rs lea/ resi/5t to infection2 & 9 ! writ]'s own confess$ly few opportunities = rese>* 9 ?is p>ticul> field ! numb] ( ,jews :o h display$ remote b unmi/akable indications ( previ\s syphilitic ta9t has n appe>$ small4 ,x is n improbable t a ,hunt]ian sore develop$ ^u sc>-tissue1 or ^u ! h>d5$ integum5t ( a d5ud$ glans1 w\ld be f> m trivial 9 "*1 m transi5t1 less productive ( inconv5i5ce1 & less easily recognisable1 ?an ! same 9 a normal /ate ( ! p>ts2 ! aft]-effects be+1 ( c\rse1 id5tical4 ,su* prim>y lesions 9 a p notori\sly r neglig5t ( _! p]son w\ld seldom come "u ! notice ( ! m$ical practition]4 ,s1 fail+ fur!r evid5ce1 ! provisional v]dict ^u ?is "q mu/ be ! ,scot* "o1 ',n prov54' ,b ev5 if ! above ass]tion be accept$ 9 respect ( true syphilis1 x assur$ly fails to hold good ) ref]5ce to o!r v>ieties ( v5]eal disease4 ,?us ,mr4 ,jona?an ,hut*9son's (t-quot$ /ati/ics#ae 7,m$ical ,times & ,gazette1 ,decemb] #a1 #ahhe71 9 8 own words1 'prove t1 ?\gh 9 proportion ( ne>ly a ?ird to ! o!r pati5ts1 !y 7,jews7 furni% ne>ly half ! cases ( gonorrhoea4' ,! la/-nam$ motive = circumcision1 al?\gh1 9 ! passage quot$ at ! beg9n+ ( ?is section1 x has be5 /amp$ ) ! approval ( ! same high au?ority1 ne$s b transi5t allusion4 ,x is a priori probable t cong5ital phimosis prolong$ into adult life r5d]s ! subject !re( some:at m likely to develop local malignant disease ?an any "o n s circum/anc$2 ! result+ attacks ( inflammation & ( unheal?y ulc]ation1 c41 may be naturally expect$ to lead to ! gr[? ( papillomata1 z well z to ma9ta9 a *ronic condition ( l[]$ vitality4 ,b ! comp>ative r>ity ( epi!lioma 9 ?is p>ticul> locality w\ld deprive ! allegation1 ev5 if ?is 7 positively e/abli%$ z an indisputable fact1 ( any weight z an argum5t = ! removal ( ! prepuce4 ,moreov]1 x is obvi\sly a reason n = ! r\t9e p]=mance ( circumcision1 b = ! relief ( phimosis2 by :atev] means attempt$ or propos$4 ,,footnotes3 #aa ,9 ,druitt's ,surgeon's ,vade-,mecum1 #i? edition1 p4 #ffb1 are ! notes ( a case ( 'cong5ital phimosis ( ! tighte/ k9d' 9 an adult ( tw5ty-?ree4 ,circumcision 0 ?reat5$2 b ! affection readily yield$ to ! injection ( w>m wat] daily4 ,!re are probably _m simil>4 #ab ,dr4 ,a%] 7op4 cit47 does n disapprove ( circumcision1 b 8 evid5tly /rong religi\s bias1 & ! fact t 8 :ole "w is compos$ f an ecclesia/ical po9t ( view1 ) ! express sanction & co-op]ation ( ecclesia/ical dignit>ies1 con/itutes him a f> f indep5d5t 7negative7 witness4 #ac ,an imm5se v>iety ( op]ative proc$ures = phimosis1 or ev5 ( details 9 ! p]=mance ( ord9>y circumcision1 might be quot$4 ,quot hom9es1 tot op]ationes4 ,_! multiplicity1 & ! v contradictory nature ( ! advantages claim$ = ea*1 /rongly indicate t nei!r ! results ( slitt+ op]ations1 nor ^? ( entire or p>tial excision ( ! prepuce1 are f\nd uni=mly satisfactory4 ,?us1 9 addition to ! me?ods describ$ 9 ! text1 x may be not$ t ,job]t de ,lamballe & o!rs divide ! =esk9 on bo? sides ( ! frnum )\t excision2 ,van ,bur5 makes two cuts1 "o on ! dorsum & "o ne> ! frnum1 subsequ5tly remov+ ! two flaps2 ,dr4 ,r4 ,w4 ,taylor 7,am]ican ,j\rnal ( ,syphilis & ,d]matology1 ,octob]1 #ahgb7 makes two lat]al incisions ) scissors4 ,:ile1 z above /at$1 "s surgeons pref] to hold ! =ceps :i* gu>d ! glans obliquely1 f above d[nw>ds & =w>ds1 s z to leave a c]ta9 portion ( ! sk9 ab\t ! frnum2 ,mr4 ,h[se 7,guy's ,hospital ,reports7 advocates ! c>eful removal ( ! frnum1 9 ord] to prev5t subsequ5t o$ema4 ,simple incision on a director 0 =m]ly pref]r$ by _m1 ?\gh = cong5ital phimosis x has n[ probably fall5 into disuse4 ,9 contra/ ) ! c>eful devices = reta9+ "p ( ! prepuce1 or = ensur+ t too mu* be n cut away1 ,sir ,w4 ,f]gusson & ,pr(essor ,humphrey f9d x be/ to amputate ! /ructure z radically z possible4 ,on ?is po9t see cases by ,mr4 ,reg9ald ,h>rison1 ref]r$ to at page #ci4 #ad ,see ! ,lancet1 ,decemb] #ab1 #ahgd4 ,dr4 ,a%] 7op4 cit47 also takes ! same view4 #ae ,! foll[+ is ,mr4 ,hut*9son's /ati/ical table d]iv$ f 8 practice at ! ,out-pati5t dep>tm5t ( ! ,metropolitan ,hospital3 ---------------------------------------- ---------------- ,cases ,gonorrhoea ,syphilis,proportion ( gonorrhoea to syphilis ---------------------------------------- ---------------- ,n ,jews #bgb #ajg #afe #jf to #a ,jews #eh #dg #aa #dc #a ---------------------------------------- ---------------- ,on ^! figures a plausible inf]5ce might p]haps be f\nd$1 t :at ! ,jew saves 9 immunity f syphilis he1 to a c]ta9 ext5t1 loses 9 increas$ proclivity to gonorrhoea2 c]ta9ly ! lea/ ( ! two evils4 ,mr4 ,hut*9son goes on to /ate t ( #beb *ildr5 "u ! age ( five ye>s1 #bg out ( #agi ,*ri/ians exhibit$ symptoms ( cong5ital syphilis 9 a well-m>k$ =m2 :ile only #c out ( #gc ,jews 7 ?us affect$1 ! proportion ?us be+ #a 9 #f among ! ,*ri/ians1 :ile only #a 9 #bd among ! ,jews4 ,aga91 ( #ig wom5 7two-?irds be+ m>ri$71 ( :om #ib 7 ,*ri/ians & #e ,jews1 #fa ( ! =m] 7 syphilis$2 aga9/ a blank return among ! latt]4 ,^u ! evid5ce ( ^! /ati/ics1 ,mr4 ,hut*9son advocates a g5]al adoption ( ! rite ( circumcision by ,we/]n nations6 ,^u 8 own %[+1 h[ev]1 ! b5efit to be d]iv$ f su* a sweep+ innovation1 suppos+ t ?is 7 practicable1 is n s v l>ge2 = #aa syphilis$ ,jews out ( a total ( #eh ) v5]eal disease1 is a tol]ably respectable proportion4 ,! inf]5ces "h drawn1 moreov]1 d n appe> to h be5 confirm$ by c>eful /ati/ical obs]vation c>ri$ out by o!r m$ical practition]s2 among :om ^? ( ,jewi% bir? %\ld be able to give specially valuable te/imony4 ,! field ( inquiry 0 comp>atively small2 /ati/ics drawn f ! out-pati5t dep>tm5t ( a g5]al hospital are1 = obvi\s reasons1 n always ( ! mo/ reliable "*2 & ! conclusions may be vitiat$ by ! facts sugge/$ 9 ! text4 ,h5ce1 al?\gh !y ref] to b "o v5]eal malady1 x is h>dly possible to acquiesce 9 !m implicitly1 ev5 9 ?is limit$ respect2 )\t "s confirmation drawn f a mu* m ext5d$ field ( rese>*4 ,v ,,disadvantages ,,& ,,dang]s ,,( ,,circumcision4 ,z a surgical op]ation1 circumcision is commonly p]=m$ ) s mu* impunity t _m surgeons w probably n be dispos$ to admit ! possibility ( its be+ att5d$ by any dang] to life2 & !re c be no d\bt t x is b seldom foll[$ by a fatal result4 ,/ill1 ) any brea* ( surface :atev]1 !re mu/ be a *ance ( blood-poison+ & ( ! absorption ( septic mat]ials2 &1 9 ! case ( a *ild liable to hmophilia1 x _c be d\bt$ t s]i\s consequ5ces might readily ensue4 ,?us1 9 ! ?ird c5tury x 0 enact$ by ! rabb9s 7,talmud1 ,treatise ,jebamo?1 #fdf7 t1 aft] two dea?s 9 ! same family f ?is cause1 ! c]emony 0 to be omitt$2 & ! prohibition has cont9u$ 9 =ce ev] s9ce4 ,maimonides inculcates ! utmo/ caution 9 ! p]=mance ( ! rite1 & insi/s t '9 case ( d\btful sickness1 a *ild mu/ n be circumcis$2 s9ce dang] to life ov]rides ! :ole c]emonial law4' 7,maimonides on ,circumcision1 *4 i474 ,at ! pres5t date x is always effect$ by an exp]t 7,mohel71 :o is n infrequ5tly a qualifi$ m$ical man2 & accid5ts are gu>d$ aga9/ ) jeal\s c>e4#af ,! anci5t plan1 accord+ to :i* ! op]ator receiv$ 9 8 m\? 7previ\sly fill$ ) w9e7 ! extremity ( ! lac]at$ memb]1 is n[ :olly or 9 great "p aboli%$ among ! ,jewi% community2 x be+ f\nd t bo? syphilis & tub]culosis 7 ?us communicat$ to ! infant4#ag ,! ,lancet ( ,octob] #a1 #ahgj1 quotes f ! ,wi5] ,m$4 ,presse ! p>ticul>s ( two cases1 report$ by ,dr4 ,s*w>tz1 ( boys circumcis$ at ! usual p]iod2 :o subsequ5tly di$ f phlegmon\s inflammation & sl\gh+ ( ! "p1 "o five & ! o!r tw5ty-five days subsequ5tly to ! op]ation4 ,9 ! same p]iodical = ,decemb] #e1 #ahgd1 may be f\nd allusion to ! exp]i5ce ( ,dr4 ,kohn1 himself a ,jew2 :o /at$ at a m$ical society 9 ,vi5na1 t dur+ a practice ( ?irty-five ye>s he _h kn[n six dea?s f ?is s\rce 7,allg4 ,wi5] ,m$4 ,zeit4 ,novemb] #ag1 #ahgd74 ,he himself _h ?us lo/ a *ild ( 8 own4 ,h[ev] su* fatality may be attribut$ to ! neglect ( all hygi5ic rules among ! poor] classes ( ,jews2 x c h>dly be d\bt$ t1 "u ev5 ! mo/ fav\rable conditions1 septic poison+ or uncontrollable hmorrhage mu/ occasionally happ51 albeit extremely r>e2 & ?is :e!r ! op]ation has be5 p]=m$ f ritual or f surgical motives4 ,to ! abs5ce ( su* cases report$ 9 m$ical lit]ature1 too mu* weight mu/ n be attribut$4#ah ,x is r ^u ! m9or consequ5ces1 imm$iate or subsequ5t1 t ^? :o object to ! practice h f\nd$ _! opposition2 & ( su* !re has be5 no lack1 especially among m$ical m5 :o h be5 !mselves ,jews1 & :o h ?us necess>ily enjoy$ ! fulle/ exp]i5ce ( its effects4 ,?us ! ,lancet ( ,decemb] #e1 #ahgd1 m5tions a pamphlet by ,dr4 ,levit1 demon/rat+ ! evils ( ! cu/om4 ,he speaks ( ! premature beg9n+ ( sexual excitem5t 9 boys depriv$ ( _! prepuce1 & ! disposition to onanism s common to ,ea/]n nations2 he reg>ds circumcision z a crim9al manipulation2 & calls ^u ! m$ical pr(ession to oppose ! practice1 ev5 at ! risk ( los+ fav\r at ! h&s ( ! ,jewi% families !y att5d4 ,& 8 argum5ts are effectually su/a9$ by ,dr4 ,kohn4 ,dr4 ,s*w>tz1 9 record+ ! fatal cases above quot$1 'deprecates ! cu/om ) great w>m?1 & expresses ! wi% t x may be laid aside4' ,mr4 ,r4 ,w4 ,p>k] 7,briti% ,m$ical ,j\rnal1 ,july #ai1 #ahgi7 ref]s to a *ild 7"o ( a family ( ble$]s7 :o1 be+ circumcis$1 ne>ly bl$ to dea?4 ,he also says3 ',diffuse cellulitis ( ! p5is is n an uncommon complication aft] ?is op]ation 9 unheal?y1 ill-f$1 & badly-c>$-= *ildr54' ,dr4 ,ma/91 9 ,gaill>d's ,m$ical ,j\rnal1 speaks ( ! great frequ5cy ) :i* he has be5 consult$ by ,jews = *ronic ure?ral dis*>ges1 irritable ure?ra1 & o!r affections ( ! g5ito-ur9>y organs4 ,he describes '! pret]naturally small meatus :i* results f e>ly removal ( ! prepuce by circumcision4' 7,m$ical ,record1 ,decemb] #aj1 #ahhe47 ,else:]e 9 ! same p]iodical 7,m$ical ,record1 vol4 xxi47 we are in=m$ t #ie p] c5t4 ( "y male ,jew adults h ?is contract$ meatus4 ,%orn ( its natural protective cov]+1 ! muco-cutane\s cov]+ ( ! glans soon becomes true d]moid tissue4 ,mr4 ,j4 ,hut*9son 7loc4 cit47 speaks ( 'e "o :o is acqua9t$ ) ! effects ( circumcision 9 r5d]+ ! delicate muc\s membrane ( ! glans h>d & sk9-l4' ,contact ) ! clo?+1 c41 necess>ily induces a *ronic inflammatory condition ( ! "p1 foll[$ commonly by contraction & cond5sation4 ,we _c ) impunity ra%ly int]f]e ) any ( ,nature's dispositions1 h[ev] seem+ly insignificant4 ,?is h>d sk9like condition ( ! integum5t ^u ! glans p5is1 ) its concomitant ( n>r[$ ure?ral ap]ture1 may be reg>d$ z ! normal result ( circumcision4 ,9 ! h&s ( bungl+ op]ators1 h[ev]1 f> worse consequ5ces may foll[4 ,?us ,j4 ,bell 7,manual ( ,op]ations 9 ,surg]y1 #ahff7 'has kn[n ! glans p5is includ$ 9 ! incision 9 at lea/ "o in/ance4' 7,! italics are 8 own47 ,mr4 ,reg9ald ,h>rison 7,diseases ( ,ur9>y ,organs1 #crd ,edition1 #ahhg7 has treat$ two v>ieties ( ure?ral /ricture aft] circumcision :i* h n turn$ out well2 9 two cases1 ! extremity ( ! glans p5is1 includ+ ! meatus1 _h be5 w\nd$ 9 mak+ ! section ( ! prepuce2 9 a ?ird1 ow+ to 'o$ema & difficulty ( asc]ta9+ :]e ! glans 01 amputation _h be5 p]=m$1 & ! end ( ! glans includ$4' ,! second v>iety ( /ricture 0 caus$ by ! prepuce be+ divid$ too high up1 or1 :at am\nts to ! same ?+1 be+ drawn d[n too mu* ov] ! glans p5is1 be=e be+ includ$ 9 ! =ceps = ! purpose ( mak+ ! necess>y section4 ,on br++ toge!r ! p>ts ) sutures1 ! t5sion on !m 0 s great z to cause ulc]ation1 & to leave beh9d a broad cicatrix1 capable ( ex]cis+ a contractile pressure on ! "u surface ( ! ure?ra2 suffici5t to imp$e micturition & to cause o!r discom=t4'#ai ,dr4 ,hyde 7,bo/on ,m$ical & ,surgical ,j\rnal1 ,june #bf1 #ahij7 has se5 disa/r\s results f circumcision2 & ,dr4 ,will>d 79 ,keat+'s ,cyclopdia ( ! ,diseases ( ,*ildr57 says t1 aft] circumcision1 h>d5+ ( ! glans occurs2 & ! evils ( contract$ meatus1 balanitis1 c4 foll[1 z po9t$ out by ,otis1 ,ma/9 & o!rs4 ,s f>1 !re=e1 z ! remote consequ5ces ( circumcision are conc]n$1 !re is /rong evid5ce t ! op]ation is by no means an unmix$ bless+ to its recipi5t4#bj ,turn+ to ! m imm$iate effects & consequ5ces1 ! italicis$ passages 9 ,mr4 ,eri*s5's elaborate description concur ) ! exp]i5ce s9ce cit$ ( o!r writ]s1 to %[ ! ne$ ( consid]able caution 9 ! p]=mance ( ?is surgical proc$ure4 ,septic infection1 hmorrhage1 & subsequ5t sl\gh+ ( ! "p h to be s$ul\sly gu>d$ aga9/2 & on ! ,cont95t1 at lea/1 ! res\rces ( mod]n antiseptic surg]y h be5 specially invok$4 ,)\t c>eful ligature ( ! art]ies1 ^! may1 we are told1 give rise to tr\blesome & long unnotic$ hmorrhage :5 ! pati5t is put back to b$4 ,! examples above quot$1 & ! v>y+ practice ( diff]5t surgeons1 %[1 moreov]1 t discrim9ation & judgm5t are ess5tial z to ! excision ( ei!r too mu* or too little ( ! =esk92 bo? ( :i* ev5ts may be disadvantage\s4 ,mr4 ,w4 ,h4 ,jacobson 7,op]ations ( ,surg]y1 #ahhi7 says t aft] circumcision 'an adult %\ld lie 9 b$ = =ty-eight h\rs1 & keep on ! s(a = a week1 alt]nate /it*es be+ remov$ at int]vals4 ,if he insi/ on gett+ ab\t too e>ly1 he mu/ run ! risk ( ! p>ts rema9+ long o$emat\s & t5d]4 ,& = ?is reason1 ) hospital pati5ts1 :o h to come backw>ds & =w>ds1 e>ly & complete heal+ is n to be expect$4 7,! italics are ! pres5t writ]'s47 ,x may be reasonably assum$ t no sane man1 :o possess$ ! advantages ( a s\nd & entire prepuce1 w\ld will+ly sacrifice x )\t j & suffici5t cause be+ %[n4 ,& 8 natural repugnance to su* a deprivation w\ld probably be 9 no wise less5$ by a p]usal ( ! passage la/ cit$4 ,x w\ld be )\t d\bt 9 ! highe/ degree edify+ 9 ! pres5t connection1 7 ! s5sations ( "s educat$ adult ( av]age s5sitiv5ess1 :o _h submitt$ to ! op]ation1 plac$ on record2 toge!r ) a /atem5t ( ! "t :i* elaps$ be=e p]fect tol]ance became e/abli%$2 & be=e ! 'h>d sk9like condition1' s mu* approv$ ( by ,mr4 ,j4 ,hut*9son1 & ! o!r m or less en?usia/ic advocates ( circumcision1 0 satisfactorily atta9$4 ,9 ! abs5ce ( su* a del9eation1 h[ev]1 we c only surmise ! feel+s ( ! pati5t2 & conclude t1 z ) ca!t]isation1 & o!r manipulations address$ to a delicate muc\s membrane1 !y w\ld 9 "s in/ances be almo/ nil2 b t 9 ! man ( highly s5sitive organisation1 !y w\ld am\nt to ke5 & long-protract$ torture4 ,infants ( t5d] ye>s mu/ ( necessity be class$ 9 ! latt] ( ^! two categories2 9 _! case1 !re are also c]ta9 circum/ances :i* t5d to enhance ! b>b>ity ( ! proc$ure2 & l>gely to aggravate ! suff]+ involv$4 ,?us an ,am]ican op]ator 7at ! association meet+ ( g5ito-ur9>y surgeons1 report$ 9 ! ,bo/on ,m$4 & ,surg4 ,j\rnal1 ,june #bf1 #ahij7 speaks ( ! difficulty ( keep+ *ildr5's knees out ( ! way aft] removal ( ! prepuce1 & ( ! consequ5t torture to !m4 ,ev5 aft] heal+1 contact ) flannel napk9s1 & o!r clo?+1 mu/ long be v pa9ful4 ,!re c be little d\bt :at w\ld be ! v]dict--c\ld !y only give x utt]ance--^u ! imm$iate results ( ! op]ation 9 "q2 return$ by ^! in>ticulate 7if f> f mute7 victims ( hygi5ic or?odoxy4#ba ,,footnotes3 #af ,! mo/ scrupul\s & m9ute precautions = obviat+ any dang] to life are enjo9$ by ! ,talmud4 ,! c]emony is n p]mitt$ to take place at all unless ! *ild is 9 p]fectly s\nd heal?2 & t ,mohel1 ^: consci5ce may convict him ( hav+ caus$ ! dea? ( an infant by 8 neglig5ce1 is =bidd5 ev] to (ficiate aga94 #ag ,a case ( tub]culosis ?us contract$ is report$ 9 ! ,briti% ,m$ical ,j\rnal ( ,m>* #e1 #ahhg2 & twelve o!r in/ances are also m5tion$ 9 ! same p>agraph4 #ah ,! writ] has be5 unable to discov] any mortality /ati/ics ( ritual circumcision1 & app>5tly none exi/4 ,dr4 ,a%] 7op4 cit47 makes a rem>k to ! same effect4 #ai ,9 ! same "w its au?or /ates t an unnatural smallness ( ! ure?ra is a n infrequ5t cause ( incont95ce ( ur9e 9 *ildr54 ,9 "s cases !re=e ascrib$ to cong5ital phimosis1 may n ! incont95ce be m]ely a concomitant1 & n an effect1 ( ! latt] condition8 #bj ,dr4 ,keyes 7,diseases ( ,ur9>y ,organs1 #ahhh7 has be5 'twice call$ ^u to relieve by op]ation a phimosis result+ f a =m] op]ation4' #ba ,an objection to circumcision1 ( :olly s5tim5tal "*1 yet n ! less wor?y ( practical consid]ation1 may1 9 addition to ^? set =? 9 ! text1 be "h not$4 ,! p>5ts ( any *ild1 9 :om ! necessity ( "s rem$ial measure = cong5ital phimosis has become app>5t1 usually express consid]able relief :5 told t x is n necess>y to make ! infant 'a little ,jew4' ,,vi ,,abs5ce ,,( ,,necessity ,,= ,,circumcision ,,9 ,,cases ,,( ,,cong5ital ,,phimosis--,,! ,,rational ,,treatm5t ,,( ,,! ,,latt]4 ,f :at has be5 already set =?1 x is suffici5tly evid5t t no male %\ld be suff]$ to rea* adult life ) ?is cong5ital disability unreliev$2 & t 9 ! majority ( in/ances radical treatm5t is requisite at a f> e>li] date4 ,!re c be no d\bt t x is inf9itely bett] = an infant to be subject$ to circumcision1 ?an to pass _m mon?s or ye>s ) ! unpleasant or ev5 dang]\s symptoms previ\sly detail$4 ,! po9t n[ to be consid]$1 !re=e1 is :e!r ^! symptoms c be obviat$ by any less h]oic measure1 & :e!r ! suff]+ ?us incurr$ is a matt] ( absolute necessity2 :e!r1 inde$1 x is "r & prop] to subject ! *ild to mutilation = ! b5evol5t purpose indicat$4 ,= by no less t]m c ! proc$ure 9 "q be *>act]is$4 ,x consi/s 9 ! ab/raction ( a /ructure1 n inde$ ( p>am\nt importance to ! organism1 b obvi\sly evolv$ by ,nature = wise ends z a protective cov]+4 ,7 !re no necessity = its pres5ce1 x w\ld n occur2 & )\t ov]:elm+ evid5ce t su* mutilation is unavoidable & b5eficial1 x mu/ be held e?ically crim9al ?us to lay r\gh h&s ^u a p]fectly normal organ4 ,z indicat$ above1 cong5ital phimosis may be said 9 "s slight degree to occur 9 e new-born male *ild4 ,two lay]s ( muco-cutane\s membrane are develop$ 9 close contact1 & are commonly agglut9at$ 9 a measure2 b x is only :5 ! sep>ation is v incomplete t any defect produc+ consequ5ces ( importance is f\nd4 ,!re is no de=mity or defici5cy ( p>ts2 &1 except z a consequ5ce ( long-cont9u$ inflammation1 no contraction occurs4 ,:at is commonly spok5 ( z 'a contract$ prepuce' simply signifies ! natural gr[? ( ! glans "u a rigid envelope1 prim>ily ( normal proportions4 ,all1 !n1 t is requisite to rem$y ?is condition 9 ! fir/ in/ance1 is ! due sep>ation ( ! two contigu\s lay]s ( muco-cutane\s membranes1 :i* 9 ! new-born may g5]ally be effect$ ) ease4 ,z ! infant gr[s1 h[ev]1 !re is apt to sup]v5e relative disp>ity ( size2 ! tissues _c be suffici5tly exp&$ to all[ ( ! ideal /ate ( ! organ--a prepuce movable freely & loosely ^u its includ$ glans--)\t "s lac]ation4 ,&1 unless c>e be tak51 ! w\nds 9 ! p>ietal lay] ( muco-cutane\s membrane aga9 quickly heal2 ! new cicatricial tissue und]goes1 p]haps1 a little real contraction2 & matt]s rema9 z !y 7 be=e4 ,h5ce1 probably1 ! disfav\r ) :i* proc$ures1 involv+ dilatation ( ! prepuce1 seem to h be5 hi!rto reg>d$ by mo/ surgeons4#bb ,"s am\nt ( reunion betwe5 ! two surfaces may also take place at ! spots :]e ! adhesions h be5 ruptur$4 ,! pr9ciple to be aim$ at1 h[ev]1 is simply ! sep>ation ( two contigu\s & adh]5t lay]s ( muc\s or muco-cutane\s membrane4 ,few m$ical m5 are probably aw>e ( ! natural di/5sibility ( ! p>ts2 ( ! ease ) :i* 7:5 ! pati5t is r5d]$ passive & unconsci\s by means ( an an/hetic7 ! glans c be br\ght completely into view1 & ! prepuce p]fectly retract$ beh9d ! corona4 ,all t is !n necess>y is1 by ! use ( emolli5ts & by daily retraction = a v brief p]iod1 to prev5t reunion ( adhesions or ( fissures 9 ! muco-cutane\s membrane2 until a suffici5t degree ( dilatation has be5 secur$ to preclude all fe> ( any future difficulty4 ,c]ta9 precautions are1 ( c\rse1 necess>y4 ,! pati5t %\ld be an/hetis$2 ! tissues involv$ are extremely s5sitive1 & ! adm9i/ration ( e!r 7or ( *lor(orm 9 ! case ( a "y *ild71 besides relax+ ! p>ts1 enables ! measure to be c>ri$ out mu* m effici5tly ?an w\ld o!rwise be ! case4 ,al?\gh ! necess>y dilatation c usually be v spe$ily effect$1 x (t5 takes "s little "t ?or\ghly to remove ! adh]5t smegma1 n seldom ( gritty & calc>e\s consi/5ce4 ,?is1 besides be+ ! longe/1 is ! mo/ pa9ful "p ( ! manipulation4 ,! use ( coca9e z a local an/hetic = su* a purpose1 preclud+ ! adm9i/ration ( e!r or *lor(orm1 is n to be recomm5d$4 ,! wide surface involv$ r5d]s its influ5ce incomplete2 & x is ( consid]able advantage to h ! pati5t1 p>ticul>ly :5 ( t5d] ye>s1 oblivi\s to :at is go+ on4#bc ,if ! di/5sion be too timidly effect$1 s t ! =esk9 c be retract$ ov] ! glans only ) difficulty2 an equal difficulty w be f\nd 9 pull+ x =w>ds aga91 & tempor>y p>aphimosis may result4 ,"u an/hesia1 h[ev]1 ?is _c b prove transi5t2 b if free dilatation be procur$ 9 ! fir/ in/ance1 !re is n ! lea/ fe> ( its occurr5ce at all4 ,on ! o!r h&1 c>e is requisite n to lac]ate unnecess>ily ! delicate membrane2 aft] :i* m or less inflammatory tr\ble sup]v5es1 & ! necess>y daily retraction ( ! =esk91 to be subsequ5tly insi/$ on1 becomes difficult & pa9ful4 ,%\ld mu* o$ema ?us occur1 x is be/ to discont9ue = a few days ! retraction1 until ! inflammation has subsid$2 sub/itut+ ! daily injection ) a syr+e "u ! prepuce ( w>m c>bolis$ oil1 9 su* a mann] t 7! orifice be+ clos$71 ! fluid is made to di/5d & 'balloon' t envelope z mu* z possible4 ,! ideal dilatation-proc$ure is h[ to effect ! maximum ( dilatation ) ! m9imum ( lac]ation4 ,9 boys ( sev5 or eight & upw>ds1 x is (t5 easy to /ret* ! p>ts suffici5tly to all[ ( easy retraction & ( free movem5t backw>ds & =w>ds )\t a s+le r5t 9 ! membrane1 & )\t ! loss ( a s+le drop ( blood4 ,9 y\ng] *ildr51 h[ev]1 ?is /ructure is necess>ily mu* m delicate1 & easily torn1 especially if !re be /ruggl+4 ,9 ! latt] case complete an/hesia1 pl5ty ( delib]ation1 & ! use ( n too l>ge an in/rum5t1 are elem5ts ( importance4 ,! foll[+ is ! usual me?od ( p]=m+ ?is manipulation--'op]ation' is mu* too grave a ^w3 ,! only in/rum5t ne$$ is an ord9>y dress+-=ceps ( av]age size 9 ! case ( an adult or boy ( age above indicat$2 proportionately small] ) "y infants1 9 :om1 inde$1 a probe w sometimes effect all t is requisite4 ,! pati5t be+ well an/hetis$1 ! surgeon1 tak+ ! organ 9 8 left h&1 retracts z f> z possible ! =esk94 ,) 8 "r he introduces ! clos$ dress+-=ceps z f> z x w ent]2 mak+ sure1 ( c\rse1 t he has n pass$ x into ! meatus4 ,he !n widely exp&s ! two limbs ( ! h&le1 hold+ ^! ap>t = a few seconds4 ,complete retraction ( ! =esk9 beh9d ! corona gl&is is !n usually at once easy2 adh]5t spots be+ sep>at$ ) ! ?umb-nail4 ,%\ld !re be any difficulty ! tissue is gradually peel$ (f by manipulation ) ! f+]s2 & ! collections ( inspissat$ smegma scrap$ (f ) ! nail or ) an e>-scoop4 ,f9ally1 ! op]ator pulls ! prepuce backw>ds & =w>ds two or ?ree times1 mak+ sure t x is p]fectly loose2 ano9ts ! glans well ) vasel9e1 & leaves x cov]$ by ! =esk9 z 9 ! normal /ate4 ,subsequ5tly1 complete retraction is necess>y on ea* ( ! fir/ f\r or five days2 aft] :i* x may be gradually int]mitt$1 be+ subsequ5tly resort$ to only = purposes ( cleanl9ess4 ,! daily wa%+ recomm5d$ by "s ,am]ican writ]s seems :olly unnecess>y2 &1 z be=e rem>k$1 ! less tamp]+ ) ^! organs 7except :5 absolutely unavoidable7 ! bett]4 ,:5 free movem5t ( ! =esk9 on ! glans has be5 atta9$1 toge!r ) heal+ ( any excoriation or sore1 !re is no fe> ( subsequ5t contraction4 ,any seem+ r$undance ( ! prepuce is 9 no way detrim5tal2 x %\ld only s]ve to induce a m c>eful habit ( cleanl9ess1 & ! habitual use ( ^? ablutions to :i* e man naturally resorts ^u atta9+ ye>s ( discretion4 ,dilatation ?us effect$ c at ! lea/ d no h>m1 & _c possibly place ! subject 9 a worse position ?an he 0 previ\sly2--:i* ! examples 9 previ\s *apt]s %[ to be f> f ! case1 ) ! op]ation ( circumcision4 ,if c>ri$ out z "h indicat$1 x w be f\nd ?or\ghly effectual2 ! reasons :y x appe>s to h fail$ 9 "s h&s app>5tly be+3 7a7 neglect ( aft]-treatm5t1 & ( c>e to retract ! prepuce daily ?r\gh\t ! fir/ few days2 7b7 insuffici5t dilatation at ! "t1 s t retraction has nev] be5 p]fectly easy2 7c7 avoidable & unnecess>y lac]ation ( ! muco-cutane\s /ructures1 foll[$ by inflammatory mis*ief4#bd ,! adoption ( a special in/rum5t = ! above purpose has be5 advocat$ f "t to "t by sev]al writ]s1 :o speak 9 gl[+ t]ms ( ! fav\rable results !y h ?us atta9$4 ,a r =midable-look+ "o1 us$ by ,nlaton1 is depict$ 9 ! ,gazette des ,hpitaux1 #ca1 #ahfh2 ?is has ?ree blades at "r angles to ! /em1 & is some:at on ! model ( an ord9>y ure?ral dilator4 ,sev]al successful cases are describ$1 ) "o ( failure4 ,9 ! latt]1 a y\? ( sev5te51 incision _h to be resort$ to1 z ! prepuce c\ld n be /ret*$ suffici5tly ) ! in/rum5t2 & 9 ?is !re 0 d\btless true contraction1 probably z a result ( v5]eal infection4 ,9 ! ,dubl9 ,qu>t]ly ,j\rnal1 ,no4 xlviii4 p4 #dhb1 ,dr4 ,cruise1 ( ,dubl91 figures a some:at analog\s in/rum5t ) two blades1 & speaks ( num]\s cases 7'9 :i* ) due c>e ! result has be5 p]fect'7 9 8 own h&s & 9 ^? ( 8 fri5ds4 ,he1 h[ev]1 kept ! =esk9 subsequ5tly retract$ = tw5ty-f\r to =ty-eight h\rs1 a proce$+ :i* entails ^u ! pati5t v consid]able discom=t1 & is unnecess>y4 ,dr4 ,hayes ,agnew 7,pr9ciples ( ,surg]y7 figures a special 'phimosis-=ceps1' :i* appe>s 9 no ess5tial p>ticul> to diff] f ord9>y dress+-=ceps2 ! only noticeable peculi>ity be+ t ! blades are a little long] ?an usual4 ,levis's dilatation-in/rum5t1 describ$ 9 ,keat+'s ,cyclopdia1 vol4 iii4 p4 #fdc1 is work$ by screw-p[]1 & is /at$ to be 'v effective2' x resembles an ord9>y pair ( dissect+-=ceps1 ) a screw plac$ close to ! h&le1 :i* effects sep>ation ( ! two blades4 ,?is is1 no d\bt1 satisfactory 9 its results1 b seems to be unnecess>ily sev]e = ! purpose to :i* x is appli$2 9 :i* v little =ce is usually ne$$1 or1 inde$1 is desirable1 = obvi\s reasons4 ,mr4 ,r4 ,w4 ,p>k]'s dilatation-in/rum5t has be5 ref]r$ to on ! previ\s page2 & !re are d\btless _m o!rs4 ,dr4 ,f4 ,h4 ,/u>t1 ( ,brooklyn 7,m$ical ,record1 ,decemb] #d1 #ahhf71 9 advocat+ a manipulation v simil> to ! "o "h describ$ 7he introduces fir/ a probe to break d[n adhesions1 !n ! dress+-=ceps1 turn+ ! latt] r\nd72 comes to ! conclusion t '! numb] ( cases :i* really require circumcision is extremely small4' ,& x may be g5]ally rem>k$ t no "o :o has really tri$ ! dilatation plan ) due c>e & )\t prejudice1 appe>s to h subsequ5tly rel9qui%$ x2 or to h be5 o!rwise ?an highly satisfi$ ) its effects1 :atev] ! precise me?od adopt$4 ,^? surgeons :o speak ( hav+ se5 unsatisfactory results g5]ally convey ! idea t ^! h tak5 place 9 o!r h&s2 & h nev]1 9 any publication se5 by ! pres5t writ]1 condesc5d$ to details4#be ,to ! case ( boys pa/ ! e>ly ye>s ( *ildhood1 & /ill m to t ( adults1 ! argum5ts 9 fav\r ( ! sub/itution ( a simple dilatation-process = ! unnecess>ily sev]e op]ation ( circumcision1 apply ) r$\bl$ =ce4 ,z 9 ^! no symptoms direct+ att5tion to ! phimosis h previ\sly exi/$ = any l5g? ( "t1 x may be tak5 at once = grant$ t1 h[ev] tight ! s-call$ 'contraction' may seem on inspection1 ! condition is pres5t 9 only a m9or degree2 t "u an an/hetic ! adhesions w yield to v slight =ce1 & satisfactory retraction1 ) subsequ5t free mobility1 be procur$ )\t ! slighte/ difficulty4 ,) adults1 moreov]1 ! avoidance ( any ne$ = conf9em5t to b$1 ( ev5 to ! h\se1 is an important consid]ation4 ,9 su* ! tissues are necess>ily m ela/ic & less fragile ?an 9 "y infants2 !re is mu* less prospect ( lac]ation1 ) consequ5t t5d]ness & swell+4 ,an op]ation = ! relief ( cong5ital phimosis advocat$ by ,mr4 ,furneaux ,jordan 7,briti% ,m$ical ,j\rnal1 ,may #b1 #ahfc7 may be "h allud$ to4 ,mr4 ,jordan passes "o blade ( a small r\nd-po9t$ scissors 7,crit*ett's /rabismus-scissors answ] well7 ?r\gh ! orifice2 sk9 & muc\s membrane are divid$ to ! l5g? ( a qu>t] ( an in* on "o side1 ! same be+ repeat$ on ! o!r4 ,! prepuce is n[ retract$ z f> z possible2 ?is exposes m l9+ membrane betwe5 ! lips ( ! w\nd1 & ?is aga9 is divid$ by a second incision on ea* side4 ,! op]ation is n[ complete1 & ! =esk9 may easily be retract$4 ,! incisions :i* 7 made 9 ! long axis ( ! p5is aft] retraction become l9e> 9 a v]tical direction1 & almo/ imp]ceptible 9 ! circul> folds ( retract$ =esk94 ,9 ! aft]-treatm5t ! prepuce %\ld be kept back1 or frequ5tly retract$4 ,9 *ildr5 retraction once daily = a week or t5 days1 till ! w\nds h heal$1 is q suffici5t4 ,! ext5t ( ! incisions %\ld1 ( c\rse1 be a little less 9 *ildr51 a little great] 9 ! adult4 ,! pres5t writ] has se5 ?is op]ation p]=m$ 9 "o in/ance1 & ! aft]-results 7 9 ! highe/ degree satisfactory4 ,z contra/$ ) circumcision1 ! proc$ure m]its w>m comm5dation2 pres]v+ ! useful =esk91 & foll[$ by a mu* m spe$y recov]y ?an may be expect$ f ! =m]4 ,= ! lac]ations :i* may result f =cible dilatation1 small nicks ) a pair ( scissors are sub/itut$4 ,! only objection is t ev5 ?is op]ation1 trivial z x appe>s1 is seldom necess>y2 & t suffici5t di/5sion ( ! =esk9 may (t5 be procur$ )\t any brea* ( surface :atev]4 ,moreov]1 "s conf9em5t to b$ or to ! s(a is subsequ5tly requisite2 :]eas1 aft] ! effects ( ! an/hetic h pass$ (f1 ! pati5t1 "y or old1 ^: =esk9 has be5 dilat$1 c behave exactly z usual4#bf ,mr4 ,jordan's op]ation is1 h[ev]1 a v useful coroll>y to ! dilatation-me?od 9 ! *ronic phimosis 7(t5 associat$ ) g\t7 ( m5 9 advanc$ life2 :5 ! p>ts are usually 9 a v gri/ly condition2 & :51 if x be f\nd impossible to procure retraction by /ret*+1 ! contract$ tissues may be advantage\sly nick$ ) scissors 9 ! mode "h indicat$4 ,,footnotes3 #bb ,= in/ance1 ,mr4 ,eri*s5 7op4 cit47 dismisses ! measure ) ! cursory allusion ( a brief p>agraph2 aga9/ ! long & elaborate acc\nt1 previ\sly detail$1 ( circumcision2 x is n m5tion$ at all 9 ! e>li] editions ( 8 "w4 ,a%by & ,wright speak ( x ) great disfav\r4 ,mr4 ,jacobson 7,op]ations ( ,surg]y1 #ahij7 does n introduce x at all2 possibly because h>dly wor?y to be dignifi$ by ! title 'op]ation4' #bc ,9 adults1 or 9 boys approa*+ manhood1 gradual dilatation by ! daily introduction ( a sponge t5t has be5 recomm5d$4 ,x might be resort$ to 9 ! case ( an exceptionally timid & pati5t individual1 b h>dly = any o!r4 #bd ,mr4 ,r4 ,w4 ,p>k] 7,brit4 ,m$4 ,j\rnal1 ,july #ai1 #ahgi7 recomm5ds gradual dilatation ) a special screw-=ceps1 :i* he has us$ 9 a consid]able numb] ( cases at ! ,*ildr5's ,hospital1 'always ) good results4' #be ,9 ! pap] above quot$1 by ,dr4 ,cruise1 ( ,dubl9 7#ahfh71 t surgeon speaks ( ,dr4 ,hutton hav+ us$ dress+-=ceps = ! cure ( phimosis fifte5 ye>s previ\sly4 ,v probably ! adoption ( t in/rum5t = ! same purpose w\ld be f\nd on inquiry to date back /ill fur!r2 & no pret5sion ( orig9ality c be "h put =? = ! advocacy ( a simple common-s5se practice1 :i* mu/ h be5 repeat$ly resort$ to by _m practition]s ( ! pa/4 #bf ,m4 ,faure has also describ$ a some:at analog\s 'nick+' op]ation4 ,,vii ,,summ>y4 ,i4 ,circumcision z a sacrificial rite has be5 practis$ by v num]\s races ( div]se orig91 & dates f an extremely remote antiquity2 probably f ! ,/one ,age1 z sugge/$ by ! int]nal evid5ce ( ,biblical records4 ,,ii4 ,?is fact1 toge!r ) t ( its application by _m tribes to ! p]sons ( female *ildr51 deprives ! religi\s c]emony ( any title to ! hygi5ic "* & purpose1 :i* h be5 frequ5tly attribut$ to x4 ,,iii4 ,! surgical op]ation ( circumcision1 especially :]e infants are conc]n$1 has !re=e to be discuss$ solely on its own m]its1 :olly ap>t f any !ory ( ,div9e int5tions1 bas$ ^u !ological consid]ations4 ,x appe>s to be errone\s 9 pr9ciple4 ,,iv4 ,x consi/s 9 a mutilation2 9 ! removal ( a p]fectly normal /ructure1 ) :i*1 = pat5t physiological reasons1 e male *ild is end[$ by nature4 ,! morality ( su* a practice1 )\t grave necessity1 is op5 to "q4 ,v4 ,unless z ! result ( subsequ5t disease1 no de=mity1 & inde$ no actual abnormality1 exi/ z factors productive ( ! condition designat$ ',cong5ital ,phimosis4' ,almo/ e male *ild suff]s at bir? f "s degree ( ! same ph5om5on--! imp]fect sep>ation ( two muco-cutane\s surfaces1 develop$ 9 contiguity4#bg ,,vi4 ,symptoms ascrib$ to a 'contract$ prepuce' are due to natural gr[? ( ! glans p5is1 :5 ?is physiological sep>ation is v incomplete1 & :51 !re=e1 a rigid con/rict+ envelope prev5ts developm5t4 ,no true contraction exi/s1 except z ! result ( sup]add$ inflammation2 & is r>ely ( mu* importance1 unless an elem5t ( contagion has be5 introduc$4 ,,vii4 ,! rational treatm5t ( cong5ital phimosis prim>ily consi/s 9 ! effici5t execution ( ! process orig9ally int5d$ by nature1 b imp]fectly c>ri$ out4 ,&1 second>ily1 9 precautions to ensure ! p]man5tly free mobility ( ! prepuce ^u ! glans p5is4 ,,viii4 ,su* complete sep>ation ( ! two contigu\s lay]s ( membrane may almo/ inv>iably be effect$ by v simple means2 &1 ) "s slight att5tion to aft]-treatm5t1 w p]man5tly secure all t is desir$1 )\t risk & )\t ev5 transi5t disability4 ,,ix4 ,! treatm5t ( cong5ital phimosis by dilatation is ! common-s5se rem$y = ?is condition4 ,x has be5 c>ri$ out by _m practition]s ) diff]5t in/rum5ts & v>iations ( detail2 & all :o h ?us attempt$ x ) ord9>y c>e 7includ+ ! pres5t writ]7 seem em95tly satisfi$ ) ! results4#bh ,x4 ,:5 diseas$ processes co-exi/ ) cong5ital phimosis1 ! case mu/ necess>ily be treat$ on its own m]its4 ,simple dilatation1 ev5 if practicable1 is n always suffici5t1 b %\ld be comb9$ ) incisions ( z limit$ a nature z possible4 ,mr4 ,furneaux ,jordan's op]ation is !n useful4 ,,xi4 ,9 ! ev5t ( disease1 ! op]ation ( circumcision is n devoid ( risk1 & %\ld be res]v$ z f> z possible = extreme cases1 9 :i* removal ( ! :ole prepuce is obvi\sly a matt] ( necessity4#bi ,,xii4 ,9 heal?y *ildr5 ! op]ation seems to be r>ely fatal 9 ?is c\ntry4 ,_m cases ( dea? directly traceable to circumcision h1 h[ev]1 be5 report$ on ! ,cont95t4 ,,xiii4 ,! imm$iate effects ( circumcision1 especially :5 p]=m$ on "y infants1 involve consid]able & protract$ suff]+4 ,,xiv4 ,! mo/ conspicu\s remote result is t ( an extremely contract$ meatus ur9>ius1 z ! consequ5ce ( subsequ5t inflammatory processes1 due to ! exposure & cont9ual friction ( ! unprotect$ glans4 ,,xv4 ,! compulsory en=cem5t ( local cleanl9ess procur$ by circumcision seems h>dly a suffici5t argum5t = ! g5]al adoption ( ! practice by peoples n utt]ly indiff]5t to all laws ( hygi5e2 & has little weight ev5 9 individual cases4 ,,xvi4 ,! sup]ior *a/ity & purity ( m9d & body suppos$ to be procur$ = its recipi5ts by ritual circumcision1 lie op5 to v consid]able "q1 9 ! face ( abundant well-kn[n facts4 ,,xvii4 ,! advantage ( circumcision 9 obviat+ future v5]eal contagion is re/rict$ by its pr9cipal advocate to "o =m 7albeit ! mo/ important7 ( su* disease4 ,ev5 9 ?is limit$ field ! facts adduc$ appe> op5 to dispute1 & greatly to ne$ confirmation by indep5d5t obs]v]s4 ,,xviii4 ,9 ! h&s ( c>eless or inexp]i5c$ op]ators ! surgical op]ation ( circumcision has be5 foll[$ by ! mo/ disa/r\s p]man5t consequ5ces4 ,,xix4 ,9 face ( ! facts "h set =?1 x is ,,n advisable to apply ! op]ation ( circumcision1 z a rem$y = cong5ital phimosis1 to ,*ri/ian infants2 mu* less to ext5d ?is1 z a r\t9e cu/om1 to ! :ole male population4 ,,footnotes3 #bg ,! ^w 'adhesion' 9 ! previ\s pages is employ$ solely z a t]m ( conv5i5ce1 to d5ote ?is imp]fect sep>ation1 & does n imply any analogy to inflammatory processes4 #bh ,! writ] fir/ drew att5tion to ! advantages ( ?is me?od ( treatm5t 9 ! ,briti% ,m$ical ,j\rnal1 ,nov4 #ae1 #ahgd4 ,hav+ in/itut$ a tol]ably ext5sive se>* ?r\gh ! m$ical lit]ature ( ! prec$+ ?ree or f\r decades1 he is unable to f9d any acc\nt ( a case 9 :i* ! proc$ure fail$ to effect a p]man5t cure1 unless !re _h exi/$ previ\s disease4 #bi ,a fatal case1 aft] circumcision = gonorrhoeal inflammation1 9 a y\? ( #ag1 is report$ 9 ! ,lancet1 ,feb4 #be1 #ahhb4 ,dea? took place on ! eigh? day app>5tly f septicmic pneumonia4 ,,bibliography4 ,,publi%$ ,,works4 ,i4--,,m$ical4 ,eri*s5's ,surg]y1 ,n9? ,edition2 ,holmes's ,sy/em ( ,surg]y1 ,?ird ,edition2 ,maund]'s ,op]ative ,surg]y2 ,joseph ,bell's ,manual ( ,surgical ,op]ations2 ,jacobson's ,op]ations ( ,surg]y2 ,reg9ald ,h>rison's ,diseases ( ,ur9>y ,organs1 ,?ird ,edition2 ,keyes's ,diseases ( ,ur9>y ,organs2 ,keat+'s ,cyclopdia ( ! ,diseases ( ,*ildr52 ,a%by & ,wright's ,diseases ( ,*ildr52 ,jaff's ,die rituelle ,circumcision im ,li*te d] antiseptis*5 ,*irurgie2 ,a%]'s ,! ,jewi% ,rite ( ,circumcision2 ,wund]b>'s ,biblis*-,talmudis*e ,m$ic92 ,gideon ,bir*]'s ,die ,bes*neidung d] ,israelit52 ,dr4 ,hayes ,agnew's ,pr9ciples ( ,surg]y2 ,sayre's ,or?opdic ,surg]y2 ,hilton's ,re/ & ,pa92 ,int]national ,encyclopdia ( ,surg]y1 #ahhf2 ,guy's ,hospital ,reports2 ,am]ican ,j\rnal ( ,syphilis & ,d]matology1 ,octob] #ahgb2 ,wal%am's ,!ory & ,practice ( ,surg]y1 c4 c4 ,,ii4--,,hi/orical ,,& ,,miscellane\s4 ,! ,te/am5ts1 ,old & ,new2 ,! ,talmud2 ,maimonides on ,circumcision2 ,tylor's ,primitive ,culture2 ,moncure ,conway's ,demonology & ,devil ,lore2 ,keil's ,biblical ,ar*ology2 ,smi?'s ,diction>y ( ! ,bible2 ,calmet1 ,diction>y ( ! ,bible1 ,encyclopdia ,am]icana1 ,encyclopdia ,britannica2 ,h[>d1 ,royal ,encyclopdia2 ,p5ny ,cyclopdia2 ,*amb]s's ,encyclopdia2 ,encyclopdia ,metropolitana2 ,w9]'s ,realwr?2 ,brew/]1 ,ed9burgh ,encyclopdia2 ,engli% ,cyclopdia2 ,wilkes's ,encyclopdia ,lond95sis2 ,globe ,encyclopdia1 c4 ,,p]iodicals4 ,! ,lancet1 ,briti% ,m$ical ,j\rnal1 ,m$ical ,times & ,gazette1 ,m$ical ,record1 ,dubl9 ,j\rnal1 ,bo/on ,m$ical & ,surgical ,j\rnal1 ,*icago ,m$ical ,/&>d1 ,gazette des ,hpitaux1 ,allgeme9e ,wi5] ,m$4 ,zeitung1 ,wi5] ,m$4 ,presse1 c4 ,,by ,,! ,,same ,,au?or4 ,,! ,,palliative ,,treatm5t ,,( ,,incurable ,,canc]4 7,) ,app5dix on ! ,opium ,pipe47 #bs4 #f;d4 ,,! ,,reappe>ance ,,( ,,canc] ,,aft] ,,op]ation4 #es4 #f;d4 ,,! ,,g5]al ,,!ory ,,( ,,canc]-,,=mation4 #as4 ,,cl9ical ,,notes ,,on ,,canc]4 #cs4 #f;d4 ,j4 ,a4 ,,*ur*ill1 ,new ,burl+ton ,/reet4