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, touching on the subject of reflex nervous diseases or neuroses due to preputial adhesions, was one prepared by Dr. M. F. Price, of Colton, California, and read at the semi-annual meeting of the Southern California Medical Society, at its Pasadena meeting in December, 1889. In the course of the paper he gives a considerable number of examples, of which some extracts are herewith given: One case was a boy aged seven, who for two years had had frequent attacks of palpitation of the heart; when seen by Dr. Price the little heart was laboring hard, beating at a furious rate (far beyond counting), with a loud blowing or splashing sound, and the pulse at the wrist a mere flutter. The breath was inspired in a series of jerks, the face flushed and somewhat swollen. The chest-wall was visibly moved at every thump of the heart. The doctor attended the child for a month without the little patient making any appreciable improvement. Some time during this period of observation the father happened to mention that the boy sometimes complained of his penis hurting him at the time of an erection. This led the doctor to examine the parts, when he found a long prepuce, with a mucous membrane adherent to the glans, about a line beyond the corona, the whole circumference of the organ. With the use of cocaine and a blunt instrument the adhesions were removed, with an immediate amelioration of all the reflex symptoms. The very next paroxysm was lighter and less exhausting; the improvement was continuous. The child soon went to school and had no further trouble; but, in the doctor's opinion, the two years' hard struggle have not