himosis that is acquired by old men, he found dilatation
with a two-bladed instrument to be sufficient, provided the indurated
circle was made to yield. For the circumcision of adults he has invented
an adjustable shield, something like the Jewish spatula, with which he
protects the glans.

Gross (the elder) used both slitting on the dorsum and circumcision. He
found neither objection nor deformity in the flaps left by the dorsal
incision, as they were only temporary; in some cases, he simply followed
the practice of Cullerier, of making multiple slits in the constricting
and inelastic mucous membrane.

Agnew believes in circumcision in the treatment of reflex troubles. He
relates a case, in the second volume of his "Surgery," of eczema
extending over the abdomen, of over a year's standing, cured in a child
by circumcision; he operates by incision on the dorsum, in which he
leaves nature to make away with the flaps, or he circumcises by the
Bumstead method.

Van Buren and Keyes recommend both the incision on the dorsum and the
operation of Ricord; where the mucous membrane alone is tight and
constricted, they follow Cullerier's method of either single or multiple
incisions of the inner coat. They lay great stress on the necessity of
keeping the patient quietly in bed to insure rapid and complete union.

My friend, Dr. Robert J. Gregg, of San Diego, has lately operated on a
number of cases, the operation being perfectly painless, the little
patients submitting to it and feeling no more pain than if it were
having its toe-nails trimmed, the local anaesthesia being produced by the
hypodermatic injection of cocaine. This procedure is now used to a
considerable extent throughout the country, and it is a far safer and
more comfortable performance than either etherizing or chloroforming, as
the sudden and spasmodic filling of the lungs of young children--who
will resist and hold their breath for a long time, then suddenly
inhale--with anaesthetic vapor is almost unavoidable, having in two
instances nearly lost two children from such an accident.

Dr. G. W. Overall, in a late _Medical Record_, which is quoted in the
_Journal of the American Medical Association_ of February 21, 1891,
gives the description of a very good and painless method of producing
this local anaesthesia; for it need hardly be said that with a nervous,
irritable child the introduction of the hypodermatic needle is as
formidable an operation as either sl