, where the tight prepuce is producing irritation,
either through pressure or adhesions, or retained sebaceous matter, do I
ever resort to dilatation; always, however, even then, not as a final
operation, but merely as preparatory procedure toward a future operation
of a more efficient order.

In cases of timid adults, who refuse all kinds of operative
interference, good results may be obtained by the use of a mild
lead-wash or cold tea-baths and the introduction of flat layers of dry
lint interposed between the prepuce and the glans; this has a very good
effect in keeping the parts apart and dry, and may in time produce a
certain amount of dilatation; but even when this is done, unless it will
render the foreskin sufficiently loose to allow of its being kept
finally back of the corona, it is, after all, but a temporary makeshift.
The corona should be exposed and kept clear of the preputial covering;
anything short of this will not give all the good results to be desired.
I have more than once performed a secondary operation on Jews, who had
been imperfectly circumcised by not having the prepuce removed
sufficiently, and in whom the subsequent contraction of the preputial
orifice had re-covered part of the glans, and only lately visited a
four-year-old boy, circumcised when eight days old, in whom the prepuce
covered half of the glans, the corona acting as a tractive point from
which the penile integument was being drawn forward. In this case the
simple pierced-lint Maltese cross was used, with an adhesive band to
hold the tails down behind and around the penis just back of the corona.

These means, although not circumcision either in a surgical or in the
Hebraic religious sense, are, nevertheless, sufficient in a medical
sense for all desired purposes; provided, however, that there is no
resulting constriction, or a mild condition of paraphimosis, back of
the corona, and that the whole of the glans is sufficiently uncovered,
and that no abnormal dog-ears are left to garnish each side of the penis
like an Elizabethan frill or collar; although Agnew holds that, in
slitting, the practice adopted by many of rounding off the corners is
mostly superfluous, as nature will do so itself in time.

The ordinary way of performing the operation by modern surgeons is by
what is known as the Bumstead circumcision. It was not an invention of
Bumstead, but was adopted by him in preference to all others. The
requisites are a sharp-poi