_1st._ In some cases the penis is sunken into the pubic skin, so that on grasping the prepuce the whole integument of the penis is pulled up leaving the organ itself buried in the skin behind. It will be found that in many of these cases the testicles have not descended into the scrotum. The first stage of the operation, in these instances, is all important. The root of the penis is embraced between the second and third fingers of the right hand as previously explained and firm pressure backwards is made until a definite erection is made. The amount of skin to be amputated must be very accurately estimated, the shield carefully adjusted in an oblique direction, as in these cases the inclusion of some of the skin of the scrotum is very easy. The mucous membrane often proves to be very thick, but whatever its consistence may be it should be cut away with scissors after reflection as this proceeding helps to prevent the glans sinking back into the skin. A careful examination of the infant must be made in these cases because they frequently denote immature development, and call for postponement of the performance of the circumcision. _2nd._ The prepuce is sometimes deficient. The upper portion of the glans may be exposed and project beyond the short prepuce. The amount of the latter which should be removed is so small, that on pulling it forward there is not sufficient in the small circle of skin for the fingers to obtain a firm grasp. In this case forceps should be employed to hold the foreskin. _3rd._ Some infants are born apparently circumcised. On examination it will be found that a considerable amount of prepuce still remains on the upper surface of the penis, while the under surface may be quite free. In these cases the whole of the remaining prepuce is grasped between the fingers and the operation is performed in the usual manner. Here also the underlying mucous membrane should be entirely cut away after it has been torn through. [Illustration] CHAPTER VI. _Repair of the Wound._ As the whole difference between a scientific operator and a merely mechanical Mohel lies in an appreciation of the process of repair in the wound inflicted, it becomes necessary to consider this in detail. The area of the circumcision wound extends between the corona of the glans and the circular cut edge of the skin. The skin of the penis always retracts, so that if the shield has been placed in the position previously indicated, the skin will not after the circumcision reach quite up to the corona; the neck of the glans will be well exposed. This is the condition to be attained in ritual circumcision.