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                               The Surgery
                                   of
                                 Ritual
                              Circumcision,

                                   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.




PREFACE.


_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 in accordance with that syllabus.
Its main object is to bring the principles of ASEPSIS within the
information of everyone acting as a Mohel, and to insist upon the urgent
need of carrying these principles into practice._

                                                              J. SNOWMAN.

    11, SHOOT-UP-HILL, BRONDESBURY, N.W.
    _July 1904._




CONTENTS.


                                                          PAGE.

      CHAPTER I.--_Causes of Infection of Wounds._           7

     CHAPTER II.--_Results of Infection of Wounds._         13

    CHAPTER III.--_Elements of the Antiseptic method._      17

     CHAPTER IV.--_Surgical Anatomy._                       23

      CHAPTER V.--_Technique of Operation._                 28
                      _The Dressing._
                      _Abnormalities._

     CHAPTER VI.--_Repair of the Wound._                    38

    CHAPTER VII.--_Hæmorrhage._                             44




CHAPTER I.

_Infection of Wounds._


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
elementary teachings of the _Antiseptic System of Surgery_ which is now
universally adopted even in the most trifling surgical proceedings.

Heavy responsibility lies upon the Mohel to carry out every case
strictly in accord with the lessons of surgical cleanliness. _Surgical
Cleanliness_ begins where ordinary cleanliness leaves off. Its object
is to destroy certain minute particles of matter which are invisible to
the naked eye, but which are _living organisms of a vegetable nature_,
able to grow very luxuriantly in blood, and wound discharges. Here they
produce a poison which gets absorbed into the body, causing serious
symptoms of disease; or they themselves enter the blood stream and
circulate in it with even more disastrous results. These organisms can
be observed under the microscope, but can only be seen by the naked eye
when growing together in colonies after being planted in such substances
as gelatine or broth, or on the surface of a slice of potato. They
correspond exactly to the growth of _mould or fungus_ on stale cheese
or meat, or to the growth of yeast in fermenting grape juice. When seen
separately under the microscope, or when growing in the mass they possess
very distinct characters so that the expert is able to distinguish
the one from the other, with the same confidence as a pear may be
distinguished from a fig.

A large number of diseases is due to the growth in the body of certain of
these organisms, and in many diseases we can be sure of always finding
the particular one responsible for the condition, either in the blood or
in the discharges from the body. This is notably the case in Consumption,
Typhoid Fever, and Malarial Fever. We often know how the organism has
obtained entrance into the body; it may be either by the lungs or the
stomach, or in other words through air or through food.

We are however only concerned just now with the _organisms which enter
the body by means of an open wound_.

These nearly all belong to one class--_micro-c