strength in the bladder frequently renders the formation of stricture so insidious that the urethra at the affected part is very narrow before the individual is aware of the existence of any contraction whatever; the bladder, however, at length becomes unable to empty itself, and the abdominal muscles and diaphragm powerfully act as coadjutors, so that each effort to make water is accompanied by a straining which is very distressing, and the complete evacuation of the bladder is often not accomplished even by these combined forces. The straining which accompanies stricture, and which seems necessary to evacuate the bladder, although it be occasionally exceedingly annoying to the patient at the time, is more important with reference to the results which are its consequence. I am firmly of opinion that there are a great number of patients laboring under hernia which has been produced by no other cause. I must confess that I had seen a great number of instances of stricture in ruptured patients before I drew any inference from the observation of their co-existence." The foregoing observations of Macilwain, made in 1830, are here reproduced for their clearness of expression and explanation, as well as to show what injuries can be produced on the young child afflicted with phimosis. We are, as surgeons, familiar with the anatomical and pathological changes there are undergone by the bladder and its lining membrane, as well as in the ureters and kidneys, in many cases of stricture, as well as of the great amount of prostatic irritability and enlargement that is due to the same cause. How similarly these results can be and are actually produced by phimosis is undeniably expressed by the post-mortem appearances in the poor infant described by Golding Bird to the London Medical Society, and mentioned in the London _Lancet_ of May 16, 1846. The bladder and ureter were like those of a man who had long suffered from stricture. From the remarks of Dr. J. Lewis Smith, that phimosis may be productive of inguinal hernia and prolapsus of the rectum, and the observations of Edmund Owens and Arthur Kemp, both high authorities on children's diseases, being both connected with children's hospitals, as well as the remarks of Mr. Bryant in his "Surgical Diseases of Children," who all concur in looking upon phimosis as a great factor in hernia, Bryant having observed thirty-one in fifty consecutive cases of phimosis, we are certainly warranted in assuming that phimosis is not only a mere local timely inconvenience that will disappear with the