Each one of these circumstances is of special importance in relation to circumcision and may be commented on as follows. 1) The slightest departure from scrupulous cleanliness either on the genitals of the infant, on the instruments or dressings used, or on the hands of the Mohel enormously increases the number of microbes which may possibly infect the wound. _Hence the necessity for absolute ordinary cleanliness before resorting to antiseptic measures._ 2) It is well known that these organisms exist in a very virulent form in unhealthy wounds, in boils and in abscesses, and the worst cases of blood poisoning have resulted from the direct infection of a healthy wound from an unhealthy one. For this reason all the precautions in regard to the disinfection of the hands, which will be referred to subsequently, must be carried out with rigorous care, when there has been any possibility of their having come in contact with such sources of infection. 3) The natural protective power of the body against infection is diminished when the general health is below the normal standard. This occurs in infants mainly, when they are premature, or suffering from jaundice, sickness or diarrhœa, congenital disease of the heart or other organs. In these circumstances the circumcision must be delayed. When the parts are unduly bruised, the local resistance is considerably lowered; hence the paramount necessity of the operation being performed neatly and dexterously. If these micro-cocci have already found access to the body in other parts, as evidenced by _purulent ophthalmia_ (i.e. matter discharging from the eye lids) or _suppuration about the navel_, it is important that these conditions be cured before the circumcision is undertaken, because experience shows that in their presence the risks of a general blood infection are increased. 4) There is a special liability for the skin of an infant, particularly in the region of the scrotum, to become irritated by its excretions and to present the eruption known as _eczema_. The folds of the groin occasionally suffer in the same way, the skin becoming reddened and peeling. These cases demand medical attention before operation, owing to special risks of infection. _No infant presenting a rash of any kind should be circumcised without previous examination by a doctor, because it may indicate constitutional disease._ 5) Cold always indicates that the bodily processes are deficient in activity. Infants are especially liable to cold, and hence the necessity to supply them with abundant artificial warmth. This is especially required during the exposure which a circumcision involves, and therefore due attention must be paid to the temperature of the room where the operation takes place, draughts must be avoided, and adequate protection of the infant when carried from and to the bedroom, must be ensured. [Illustration] CHAPTER II. _Results of the Infection of Wounds._