per noticed. The expulsive efforts accompanying
urination sometimes cause prolapsus of the rectum, and frequently
produce inguinal hernia. In a lecture before the Harveian Society
(_British Medical Journal_, February 28, 1880), Edmund Owen, Surgeon to
St. Mary's Hospital and to the Hospital for Sick Children, says:
"Perhaps the commonest cause of hernia in childhood is a small preputial
or urethral orifice, and next to that I would put the smegma-hiding or
adherent prepuce." Arthur Kemp (London _Lancet_, July 27, 1878), Senior
House-Surgeon to the Children's Hospital, says: "Phimosis is a common
occurrence, and numerous ill effects can undoubtedly be attributed to
it;" and he alludes to the observation of Mr. Bryant, as published in
his book on the "Surgical Diseases of Children": "In fifty consecutive
cases of congenital phimosis, thirty-one had hernia, five had double
inguinal hernia, and many had umbilical hernia besides. In no one was
the hernia congenital, its earliest occurrence being at three weeks.
Circumcision was performed in these cases, and all were much
benefited."[103]

During the session of the Ninth International Congress, where the above
paper was read and remarks made, which appear in the third volume of its
"Transactions," another paper was also presented by Dr. Saint-Germain,
of Paris. The Doctor fully recognized the dangers from a narrow or
adherent prepuce, but did not think that more than one case in three
hundred really required circumcision; he believed in dilatation, as
employed by Nelaton, with the exception that, whereas Nelaton employs
three branches to his dilator, Saint-Germain preferred only a two-branch
dilator.

Dr. Lewis, the president of the Section, related a number of cases where
the use of uncleanly instruments had resulted disastrously. But, for
that matter, the same objection can be offered against dilatation, as a
filthy instrument is as liable to infect the patient as a knife. There
is no earthly excuse why a knife that has been used on a case of
diphtheritic croup should be used some hours afterward to circumcise a
child. As to the operation of dilatation practiced by Dr. Holgate, it
can really be said to answer the _immediate_ demands, but how far its
utility is efficient as to _permanent_ results Dr. Holgate has not
given the profession any information.[104]

One of the most interesting and instructive papers that it was ever the
fortune of the writer to listen to, touchi