BY JACOB SNOWMAN, M.D., M.R.C.S., M.R.C.P., LOND. Medical Officer of the Initiation Society, &c., &c. LONDON: PUBLISHED UNDER THE AUSPICES OF THE MEDICAL BOARD OF THE INITIATION SOCIETY. 1904. E. W. RABBINOWICZ, PRINTER, 48, COMMERCIAL STREET, E....

The object of the following few pages is to provide a basis of instruction in the surgical aspect of the Jewish rite of circumcision. The performance of this simple operation is not limited to medical men. It is therefore essential that the lay Mohel should possess a scientific knowledge of the important task he undertakes. The Initiation Society which controls the instruction of Mohelim has arranged a Syllabus which guarantees such an acquaintance with the subject. This little book is planned i

The greatest advance in modern surgery has been to show how wounds become infected and cause general blood poisoning. This applies both to wounds made by the knife of the Surgeon as well as to accidental injuries. The principles concerned in this matter involve not only the arrangements necessary for a severe and prolonged operation but also those required for the simple circumcision of an infant. It is therefore essential that those who perform ritual circumcision should be familiar with the el

The name usually given to the conditions which result from wound infection is Septic Disease . This includes both the mild and the grave troubles which may ensue. The mild forms of infection usually appear as interference with the rapid healing of the circumcision wound. The principal of these are:— 1) Ulceration at the cut edge of the prepuce. 2) Ulceration in the raw tissue left on the under surface of the penis between the reflected mucous membrane and the cut skin. 3) Sloughing or mortificat

The purpose of Antiseptic Surgery is to avoid the occurrence of the dangers of infection referred to in the preceding chapter. There are many methods of carrying out the system, but the present description being limited to the requirements of circumcision does not aim at being exhaustive. The two objects aimed at are: 1) The prevention of any micro-organisms gaining entrance to the wound. This end is attained by the disinfection of the hands and especially the thumbnails of the operator, of the

It is essential for the Mohel to possess a knowledge of the structure of the organ on which he operates. The skin of the penis is continuous on the upper surface with the skin of the abdomen, and on the under surface with that of the scrotum. On drawing forward the prepuce or foreskin it is very easy to include the skin of the scrotum in the grasp of the fingers unless due care is taken. If the traction on the foreskin is too forcible and the skin of the scrotum is therefore pulled up tightly, t

The penis is subject to many departures from its usual anatomy, but here it will only be necessary to notice some of the more usual abnormalities. 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 impor

In amputating the foreskin a number of minute hair-like blood vessels which permeate the skin are cut through. There is little or no bleeding, because the blood immediately clots, and almost at once a rim of coagulum is formed at the margin of the circumcision. Besides this the injury destroys a minute amount of living tissue known as connective tissue cells . The wound causes a special degree of activity in the adjacent blood vessels, so that certain important constituents of the blood flow out

Besides the bleeding which may occur immediately on the infliction of a wound, there is another variety which may take place subsequently, known as Secondary Hæmorrhage. This occurs when there is some failure in the process previously described, by which the wound heals. The coagulum is disturbed and the vessels are practically re-opened, or the coagulum becomes softened through the action of an infective agent . As a rule secondary hæmorrhage indicates some form of infection. Often in changing

Some infants are born with a tendency to bleed, without any evident cause, either from the nose, bowels, or in the skin. The separation of the navel may be followed by bleeding. Many of these cases are due to hereditary disease of one character or another. Of these, there is one which requires special mention, because when fatal hæmorrhage has occurred after circumcision it has been due to it. This is Hæmophilia . Subjects of this disease are called Bleeders , and it usually only affects males.