There are two causes of phimosis; for sometimes the prepuce so covers the glans that it cannot be retracted; and sometimes when drawn behind, it cannot be brought forward, which last species is properly called paraphimosis. The first variety is occasioned either from a cicatrix formed in the prepuce, or from an adhesion by flesh. But the second variety takes place in inflammations of the genital organs when the skin being brought back, the glans swells, and it cannot longer allow of being drawn forward. If it is the first species of phimosis we may operate upon it in this manner. After having placed the patient properly, and drawn the prepuce forwards, and having fastened three or four hooks into its extremity and giving them to assistants to hold, we direct them to stretch and open it; and then if the external adhesion be from a cicatrix, we divide the prepuce from the internal parts with a lancet or sharp knife in three or four places, making the divisions at the inner parts direct and equally distant from one another. The prepuce at the glans is double, wherefore we divide the mouth of the inner part; for having thus opened the contraction formed by the cicatrix, we are enabled to retract the prepuce. But if a preternatural adhesion of the flesh of the internal parts occasion the phimosis we may make scarifications in all the flesh, drawing back the prepuce and scraping away the fleshy prominences between the incisions, and afterwards apply a tube of lead to the whole glans, having wrapped it in dried paper (papyrus), the tube having its opening the same everywhere; for thus, by the application of the tube, the prepuce, when brought forwards again, is prevented from forming adhesions, being kept separate by the lead and the paper wrapped round it; for by getting swelled with the moisture it separates the skin still more. This we may do whether we operate upon a phimosis occasioned by a cicatrix, or one from a preternatural adhesion of flesh. But if the complaint called paraphimosis take place, and become chronic, adhesions take place, and the complaint is incurable, unless one choose to submit to the operation for deficiency of prepuce. But if it has not yet formed adhesions, we may make three, four, or more direct incisions circularly, and having bathed with much tepid oil, draw the prepuce outwards. * * * * * COMMENTARY. Celsus describes the operation as follows: “Subter a summâ orâ, cutis inciditur recta linea usque ad frænum; atque ita superius tergus relaxatum, cedere retro potest. Quod si parum sic profectum est, aut propter angustias, aut propter duritiem tergoris, protinus triangula forma cutis ab inferiore parte excidenda est, sic ut vertex ejus ad frænum, basis in tergo extremo sit. Tum superdanda linamenta sunt alia que medicamenta quæ ad sanitatem perducant. Necessarium autem est, donec cicatrix sit, conquiescere: nam ambulatio, atterendo ulcus sordidum reddit.” (vii, 25.)