XI. In the event of disease, the operation of circumcision is not devoid of risk, and should be reserved as far as possible for extreme cases, in which removal of the whole prepuce is obviously a matter of necessity.[29] XII. In healthy children the operation seems to be rarely fatal in this country. Many cases of death directly traceable to circumcision have, however, been reported on the Continent. XIII. The immediate effects of circumcision, especially when performed on young infants, involve considerable and protracted suffering. XIV. The most conspicuous _remote_ result is that of an extremely contracted _meatus urinarius_, as the consequence of subsequent inflammatory processes, due to the exposure and continual friction of the unprotected glans. XV. The compulsory enforcement of local cleanliness procured by circumcision seems hardly a sufficient argument for the general adoption of the practice by peoples not utterly indifferent to all laws of hygiene; and has little weight even in individual cases. XVI. The superior chastity and purity of mind and body supposed to be procured for its recipients by ritual circumcision, lie open to very considerable question, in the face of abundant well-known facts. XVII. The advantage of circumcision in obviating future venereal contagion is restricted by its principal advocate to one form (albeit the most important) of such disease. Even in this limited field the facts adduced appear open to dispute, and greatly to need confirmation by independent observers. XVIII. In the hands of careless or inexperienced operators the surgical operation of circumcision has been followed by the most disastrous permanent consequences. XIX. In face of the facts here set forth, it is NOT advisable to apply the operation of circumcision, as a remedy for congenital phimosis, to Christian infants; much less to extend this, as a routine custom, to the whole male population. FOOTNOTES: [27] The word 'adhesion' in the previous pages is employed solely as a term of convenience, to denote this imperfect separation, and does not imply any analogy to inflammatory processes. [28] The writer first drew attention to the advantages of this method of treatment in the _British Medical Journal_, Nov. 15, 1874. Having instituted a tolerably extensive search through the medical literature of the preceding three or four decades, he is unable to find any account of a case in which the procedure failed to effect a permanent cure, unless there had existed previous disease. [29] A fatal case, after circumcision for gonorrhoeal inflammation, in a youth of 17, is reported in the _Lancet_, Feb. 25, 1882. Death took place on the eighth day apparently from septicæmic pneumonia. _BIBLIOGRAPHY._ PUBLISHED WORKS. I.--MEDICAL.