,! ,surg]y ( ,ritual ,circumcision1 ,,by ,,jacob ,,sn[man1 ,m4,d41 ,m4,r4,c4,s41 ,m4,r4,c4,p41 ,,lond4 ,m$ical ,(fic] ( ! ,initiation ,society1 c41 c4 ,,london3 ,,publi%$ ,,"u ,,! ,,auspices ,,( ,,! ,,m$ical ,,bo>d ,,( ,,! ,,initiation ,,society4 #aijd4 ,e4 ,w4 ,,rabb9[icz1 ,,pr9t]1 #dh1 ,,comm]cial ,,/reet1 ,e4 ,,preface4 ,! object ( ! foll[+ few pages is to provide a basis ( in/ruction 9 ! surgical aspect ( ! ,jewi% rite ( circumcision4 ,! p]=mance ( ?is simple op]ation is n limit$ to m$ical m54 ,x is !re=e ess5tial t ! lay ,mohel %\ld possess a sci5tific k ( ! important task he und]takes4 ,! ,initiation ,society :i* controls ! in/ruction ( ,mohelim has arrang$ a ,syllabus :i* gu>antees su* an acqua9tance ) ! subject4 ,?is little book is plann$ 9 accordance ) t syllabus4 ,its ma9 object is to br+ ! pr9ciples ( ,,asepsis )9 ! in=mation ( ev]yone act+ z a ,mohel1 & to insi/ ^u ! urg5t ne$ ( c>ry+ ^! pr9ciples into practice4 ,j4 ,,sn[man4 #aa1 ,,%oot-,,up-,,hill1 ,,brondesbury1 ,n4,w4 ,july #aijd4 ,,cont5ts4 ,,page4 ,,*apt] ,i4--,causes ( ,infection ( ,w\nds4 #g ,,*apt] ,,ii4--,results ( ,infection ( ,w\nds4 #ac ,,*apt] ,,iii4--,elem5ts ( ! ,antiseptic me?od4 #ag ,,*apt] ,,iv4--,surgical ,anatomy4 #bc ,,*apt] ,v4--,te*nique ( ,op]ation4 #bh ,! ,dress+4 ,abnormalities4 ,,*apt] ,,vi4--,repair ( ! ,w\nd4 #ch ,,*apt] ,,vii4--,hmorrhage4 #dd ,,*apt] ,i4 ,infection ( ,w\nds4 ,! greate/ advance 9 mod]n surg]y has be5 to %[ h[ w\nds become infect$ & cause g5]al blood poison+4 ,?is applies bo? to w\nds made by ! knife ( ! ,surgeon z well z to accid5tal injuries4 ,! pr9ciples conc]n$ 9 ?is matt] involve n only ! arrangem5ts necess>y = a sev]e & prolong$ op]ation b also ^? requir$ = ! simple circumcision ( an infant4 ,x is !re=e ess5tial t ^? :o p]=m ritual circumcision %\ld be famili> ) ! elem5t>y tea*+s ( ! ,antiseptic ,sy/em ( ,surg]y :i* is n[ univ]sally adopt$ ev5 9 ! mo/ trifl+ surgical proce$+s4 ,heavy responsibility lies ^u ! ,mohel to c>ry out e case /rictly 9 accord ) ! lessons ( surgical cleanl9ess4 ,surgical ,cleanl9ess beg9s :]e ord9>y cleanl9ess leaves (f4 ,its object is to de/roy c]ta9 m9ute p>ticles ( matt] :i* are invisible to ! nak$ eye1 b :i* are liv+ organisms ( a vegetable nature1 able to gr[ v luxuriantly 9 blood1 & w\nd dis*>ges4 ,"h !y produce a poison :i* gets absorb$ into ! body1 caus+ s]i\s symptoms ( disease2 or !y !mselves ent] ! blood /ream & circulate 9 x ) ev5 m disa/r\s results4 ,^! organisms c be obs]v$ "u ! microscope1 b c only be se5 by ! nak$ eye :5 gr[+ toge!r 9 colonies aft] be+ plant$ 9 su* sub/ances z gelat9e or bro?1 or on ! surface ( a slice ( potato4 ,!y correspond exactly to ! gr[? ( m\ld or fungus on /ale *eese or meat1 or to ! gr[? ( yea/ 9 f]m5t+ grape juice4 ,:5 se5 sep>ately "u ! microscope1 or :5 gr[+ 9 ! mass !y possess v di/9ct *>act]s s t ! exp]t is able to di/+ui% ! "o f ! o!r1 ) ! same confid5ce z a pe> may be di/+ui%$ f a fig4 ,a l>ge numb] ( diseases is due to ! gr[? 9 ! body ( c]ta9 ( ^! organisms1 & 9 _m diseases we c be sure ( always f9d+ ! p>ticul> "o responsible = ! condition1 ei!r 9 ! blood or 9 ! dis*>ges f ! body4 ,?is is notably ! case 9 ,consumption1 ,typhoid ,fev]1 & ,mal>ial ,fev]4 ,we (t5 "k h[ ! organism has obta9$ entrance into ! body2 x may be ei!r by ! lungs or ! /oma*1 or 9 o!r words ?r\gh air or ?r\gh food4 ,we are h[ev] only conc]n$ j n[ ) ! organisms :i* ent] ! body by means ( an op5 w\nd4 ,^! ne>ly all belong to "o class--micro-cocci4 ,!y are m9ute r\nd bodies ab\t #a_/bejjj in* 9 diamet]4 ,!y possess ! peculi>ity ( gr[+ toge!r 9 clu/]s l grapes1 or 9 *a9s4 ,!y are responsible = ! diseas$ conditions ( w\nds :i* delay heal+1 = inflammation ar\nd w\nds & = ! g5]al blood-poison+ :i* may result4 ,^! organisms are v abundant 9 ! du/ ( rooms1 on dirty clo!s & unclean g5]al surr\nd+s1 & !re c be no d\bt t ev]ybody is (t5 infect$ by !m4 ,b =tunately disease results only r>ely1 because !re are special p[]s resid5t 9 ! vital tissues :i* enable !m successfully to resi/ ! poison\s effects ( ^! organisms4 ,!re are h[ev] c]ta9 circum/ances 9 :i* !y are liable to be m h>mful ?an 9 o!rs4 #a7 ,:5 !y are absorb$ 9 especially l>ge numb]s4 #b7 ,:5 absorb$ 9 an especially active /ate4 #c7 ,:5 ! body is 9 a condition ( ill-heal? f :atev] cause4 #d7 ,9 ! pres5ce ( cold4 ,ea* "o ( ^! circum/ances is ( special importance 9 relation to circumcision & may be comm5t$ on z foll[s4 #a7 ,! slighte/ dep>ture f scrupul\s cleanl9ess ei!r on ! g5itals ( ! infant1 on ! in/rum5ts or dress+s us$1 or on ! h&s ( ! ,mohel enorm\sly increases ! numb] ( microbes :i* may possibly infect ! w\nd4 ,h5ce ! necessity = absolute ord9>y cleanl9ess be=e resort+ to antiseptic measures4 #b7 ,x is well kn[n t ^! organisms exi/ 9 a v virul5t =m 9 unheal?y w\nds1 9 boils & 9 abscesses1 & ! wor/ cases ( blood poison+ h result$ f ! direct infection ( a heal?y w\nd f an unheal?y "o4 ,= ?is reason all ! precautions 9 reg>d to ! dis9fection ( ! h&s1 :i* w be ref]r$ to subsequ5tly1 mu/ be c>ri$ out ) rigor\s c>e1 :5 !re has be5 any possibility ( _! hav+ come 9 contact ) su* s\rces ( infection4 #c7 ,! natural protective p[] ( ! body aga9/ infection is dim9i%$ :5 ! g5]al heal? is bel[ ! normal /&>d4 ,?is occurs 9 infants ma9ly1 :5 !y are premature1 or suff]+ f jaundice1 sickness or di>rha1 cong5ital disease ( ! he>t or o!r organs4 ,9 ^! circum/ances ! circumcision mu/ be delay$4 ,:5 ! p>ts are unduly bruis$1 ! local resi/ance is consid]ably l[]$2 h5ce ! p>am\nt necessity ( ! op]ation be+ p]=m$ neatly & dext]\sly4 ,if ^! micro-cocci h already f\nd access to ! body 9 o!r p>ts1 z evid5c$ by purul5t oph?almia 7i4e4 matt] dis*>g+ f ! eye lids7 or suppuration ab\t ! navel1 x is important t ^! conditions be cur$ be=e ! circumcision is und]tak51 because exp]i5ce %[s t 9 _! pres5ce ! risks ( a g5]al blood infection are increas$4 #d7 ,!re is a special liability = ! sk9 ( an infant1 p>ticul>ly 9 ! region ( ! scrotum1 to become irritat$ by its excretions & to pres5t ! eruption kn[n z eczema4 ,! folds ( ! gro9 occasionally suff] 9 ! same way1 ! sk9 becom+ r$d5$ & peel+4 ,^! cases dem& m$ical att5tion be=e op]ation1 ow+ to special risks ( infection4 ,no infant pres5t+ a ra% ( any k9d %\ld be circumcis$ )\t previ\s exam9ation by a doctor1 because x may indicate con/itutional disease4 #e7 ,cold always indicates t ! bodily processes are defici5t 9 activity4 ,infants are especially liable to cold1 & h5ce ! necessity to supply !m ) abundant artificial w>m?4 ,?is is especially requir$ dur+ ! exposure :i* a circumcision involves1 & !re=e due att5tion mu/ be paid to ! temp]ature ( ! room :]e ! op]ation takes place1 draughts mu/ be avoid$1 & adequate protection ( ! infant :5 c>ri$ f & to ! b$room1 mu/ be ensur$4 ,illu/ration ,,*apt] ,,ii4 ,results ( ! ,infection ( ,w\nds4 ,! "n usually giv5 to ! conditions :i* result f w\nd infection is ,septic ,disease4 ,?is includes bo? ! mild & ! grave tr\bles :i* may ensue4 ,! mild =ms ( infection usually appe> z int]f]5ce ) ! rapid heal+ ( ! circumcision w\nd4 ,! pr9cipal ( ^! are3-- #a7 ,ulc]ation at ! cut edge ( ! prepuce4 #b7 ,ulc]ation 9 ! raw tissue left on ! "u surface ( ! p5is betwe5 ! reflect$ muc\s membrane & ! cut sk94 #c7 ,sl\gh+ or mortification ( ! reflect$ muc\s membrane4 ,^! conditions are usually att5d$ ) "s am\nt ( swell+2 & ! unheal?y /ate ( ! w\nd ) ! accompany+ dis*>ge af=d a f]tile soil = ! rapid gr[? & multiplication ( micro-organisms & _! absorption into ! sy/em4 ,( ! m s]i\s results ( infection ! pr9cipal is ,erysipelas 9 its v>i\s =ms4 ,"h we f9d t z ! signs ( unheal?y inflammation ar\nd ! w\nd occur1 symptoms ( con/itutional illness beg94 ,! infant becomes fev]i%1 !re is loss ( appetite1 rapid brea?+ & wa/+ sup]v5e1 ) a pr(\nd alt]ation 9 ! g5]al appe>ance4 ,! signs evid5t1 locally1 are r$ness ( ! sk9 increas+ to a vivid blu% :i* spreads on to ! ?ighs1 scrotum or abdom54 ,! surface is t5d]1 & ! edge ( ! r$ pat* is %>ply def9$ f ! surr\nd+ heal?y sk94 ,! disease is mo/ active at ?is %>p m>g9 = x is !re t ! micro-cocci may be f\nd 9 abundance4 ,! gl&s 9 ! gro9 become swoll5 & t5d]1 & ! circumcision w\nd1 fail+ to heal w probably inflame & suppurate4 ,:ile ?is is go+ on1 a poison is be+ manufactur$ by ! microbes 9 _! gr[?1 & ?is poison be+ absorb$ into ! circulation1 g5]ally proves fatal to ! infant4 ,! process is usually limit$ to ! sk91 & its upp]mo/ lay] is (t5 rais$ into blebs conta9+ cle> or discol\r$ blood s]um4 ,b ! morbid *ange may take place fir/ 9 ! tissues "u ! sk91 :5 !re w be great swell+ & dropsy ( ! "p s t ! pressure ( ! f+] w leave a pit 9 ! sk9 be=e ! latt] becomes itself inflam$4 ,9 ^! cases ! organisms readily ent] ! blood /ream & be+ c>ri$ away to di/ant organs set up infection 9 ^!4 ,^! are necess>ily ! mo/ hopeless cases ( blood-poison+4 ,s f> we h briefly consid]$ infection by ! gr\p ( organisms kn[n z micro-cocci4 ,x is necess>y to po9t out "h t at lea/ two ( ! organisms ( ! gr\p ( ,bacilli h be5 kn[n to infect ! circumcision w\nd4 ,! "o is ! ,tetanus 7lockjaw7 ,bacillus1 ! o!r is ! ,tub]cle ,bacillus4 ,9 ,tetanus ! fir/ symptom notic$ is t ! infant is unable to suck1 & on exam9ation x w be f\nd t ?is is due to cramp ( ! muscles ( ! jaw1 :i* become fix$ & h>d4 ,! face assumes a peculi> aspect :i* is q *>act]i/ic ( ?is disease1 spasms ( ! limbs & !n convulsions ( ! :ole body take place1 ! jo9ts become /iff & ! case is almo/ inv>iably fatal4 ,9 reg>d to ! infection by ! ,tub]cle ,bacillus x may be said t ?is occurr5ce is "o ( ! r>e/ ( ! r>e sequels ( circumcision1 b x appe>s t tub]cul> ulc]s h aris5 ov] ! area ( ! w\nd :5 ! ,,metzizah has be5 p]=m$ by m\? suction on ! "p ( a ,mohel :o 0 suff]+ f ,tub]culosis4 ,a numb] ( ^! cases h be5 report$ f "t to "t1 & 9 "s ( !m x app>5tly l$ to g5]al ,tub]culosis 7consumption74 ,! =ego+ brief /atem5ts exhau/ mo/ ( ! possibilities ( w\nd infection by means ( micro-organisms4 ,!re is h[ev] ano!r s\rce ( infection1 n yet def9itely prov$ to be ( microbic orig91 :i* has important relations to circumcision4 ,?is is ! poison ( ,syphilis4 ,if ! ,mohel %\ld be suff]+ f ?is disease ! secretions ( ! m\? are infective & ! disease may easily be transmitt$ to ! infant by means ( ,metzizah4 ,on ! o!r h&1 %\ld ! infant be born ) ! disease--a circum/ance ( n infrequ5t occurr5ce--x mu/ be rememb]$ t its blood is *>g$ ) ! poison1 & is capable ( infect+ a heal?y individual :5 x is br\ght into contact ) any w\nd1 abrasion or o!r brea* ( surface4 ,illu/ration ,,*apt] ,,iii4 ,elem5ts ( ! ,antiseptic ,me?od4 ,! purpose ( ,antiseptic ,surg]y is to avoid ! occurr5ce ( ! dang]s ( infection ref]r$ to 9 ! prec$+ *apt]4 ,!re are _m me?ods ( c>ry+ out ! sy/em1 b ! pres5t description be+ limit$ to ! requirem5ts ( circumcision does n aim at be+ exhau/ive4 ,! two objects aim$ at are3 #a7 ,! prev5tion ( any micro-organisms ga9+ entrance to ! w\nd4 ,?is end is atta9$ by ! dis9fection ( ! h&s & especially ! ?umbnails ( ! op]ator1 ( ! in/rum5ts & dress+s us$2 & by p]fect cleanl9ess ( ! g5itals ( ! infant4 ,x may be said t ! brief exposure ( ! p>ts dur+ ! p]=mance ( ! circumcision c>ries ) x no risk ( infection1 because ! organisms we h be5 consid]+ are n usually airborne4 #b7 ,! application ( su* dress+s z w keep ! w\nd 9 an aseptic condition4 ,ev5 ! small am\nt ( dis*>ge f a circumcision w\nd =ms a spl5did soil = ! gr[? ( micro-organisms4 ,x is necess>y !re=e to apply a dress+ :i* has be5 saturat$ ) su* antiseptics z w de/roy t con/itu5t ( ! dis*>ge :i* makes x a good culture mat]ial4 ,! mo/ conv5i5t antiseptic = g5]al use is ,c>bolic ,acid4 ,?is is a cle>1 col\rless liquid ( r oily consi/5ce1 :i* rapidly becomes conv]t$ into solid cry/als 9 cold wea!r4 ,:5 requir$ = purposes ( dis9fection x %\ld be mix$ ) #ci times its quantity ( wat]1 or r\ghly "o p9t ( wat] requires "o tablespoonful ( pure ,c>bolic ,acid to make a solution ( #a 9 #dj4 ,?is solution is requir$ = soak+ ! h&s aft] !y h be5 wa%$ ) soap & w>m wat]1 & ! nails scrubb$ ) a nail bru%4 ,?is latt] proce$+ is "o ( ord9>y cleanl9ess1 ! soak+ 9 ! ,c>bolic ,acid solution1 :i* %\ld be w>m1 is 9 ord] to obta9 ,surgical ,cleanl9ess4 ,x w be readily und]/ood1 t if ! h&s come 9 contact ) any possible s\rce ( infection aft] ?is soak+1 !n x mu/ be repeat$ be=e beg9n+ ! op]ation4 ,! dis9fection ( ! h&s mu/ be ! la/ /age 9 all ! prep>ations = ! circumcision4 ,a simil> solution ( #a 9 #dj ,c>bolic ,acid may be us$ = plac+ ! in/rum5ts 9 be=e ! op]ation4 ,!y are to be tak5 directly out ( ! solution z requir$4 ,a %all[ di% ( a mat]ial easily clean$1 z metal1 glass or porcela9 %\ld be fill$ ) #b ounces 7#e tablespoons7 ( wat] :i* has be5 boil$1 & to ?is "o half a teaspoonful ( ,c>bolic ,acid is add$1 tak+ c>e t ! acid is ?or\ghly well mix$ up ) ! wat] & n all[$ to float ab\t 9 droplets4 ,if ! in/rum5ts are scrupul\sly clean1 i4e41 if !y h be5 wa%$ ?or\ghly ) soap & hot wat]1 !y require to rema9 = "o h\r 9 ! ,c>bolic ,acid solution to r5d] !m suffici5tly dis9fect$ = op]at+ purposes4 ,x is !re=e quick]1 z x is also m sci5tific1 to /]ilize ! in/rum5ts be=e us+ !m4 ,by /]iliz+ !m we kill any micro-organisms t may be pres5t on !m1 & we are !n confid5t t no liv+ g]ms are c>ri$ to ! w\nd by means ( ! in/rum5ts4 ,9 o!r words !y are aseptic4 ,in/rum5ts are /]iliz$ by boil+ = ab\t t5 m9utes 9 clean wat]4 ,x is useful to add wa%+ soda 9 ! proportion ( #e gra9s to e two tablespoons ( wat]4 ,x is obvi\s t ! in/rum5ts mu/ be ( metal1 z no o!r mat]ial w /& boil+4 ,!y mu/ be made 9 su* a way z to prev5t ! accumulation ( du/ or dirt 9 jo9ts or crevices4 ,compact app>atus = /]ilization is suppli$ by e surgical in/rum5t mak]4 ,! in/rum5ts are usually plac$ on a wire gauze tray ) h&les & !n into ! /]iliz+ di%1 s t :5 ! boil+ is complet$1 !y are lift$ out on ?is tray by means ( hooks suppli$ = ! purpose4 ,!y are at once transf]r$ to ! %all[ di% conta9+ ! #a 9 #dj ,c>bolic ,acid solution detail$ above4 ,by ^! means ! in/rum5ts are cool$ ready = use1 = obvi\sly !y _c be tak5 directly out ( ! boil+ wat] ) ! f+]s2 & ! fact t !y are 9 an antiseptic solution1 prev5ts ! access ( any g]ms dur+ ! %ort int]val be=e !y are actually h&l$4 ,! dress+s us$ 9 ,circumcision %\ld consi/ only ( l9t & gauze4 ,x is necess>y t ! dress+ %\ld be /]iliz$ & also impregnat$ ) "s antiseptic s z to r5d] h>mless any infective mat]ial :i* may accid5tally contam9ate ! w\nd aft] circumcision4 ,^! dress+s are suppli$ by manufactur]s1 already /]iliz$ by exposure to sup]-heat$ /eam1 & r5d]$ antiseptic by v>i\s *emical ag5ts4 ,c>bolic ,acid us$ = ! h&s & ! in/rum5ts1 is (t5 employ$ = ! dress+s1 ! antiseptic be+ fix$ 9 ! l9t & ! gauze by a special process4 ,mo/ surgeons1 h[ev]1 pref] 8d\ble cyanide0 dress+s1 9 :i* ! antiseptic us$ is a salt kn[n z cyanide ( z9c & m]cury4 ,f ! fir/ dress+ until ! circumcision is absolutely heal$ no?+ b gauze ne$ be us$4 ,9 a normal case no o!r application ( any k9d :atsoev] is requir$4 ,x is usual h[ev] 9 apply+ ! fir/ dress+ at ! circumcision to use l9t to surr\nd ! root ( ! p5is z x is firm] ?an gauze4 ,:5 ?is is done a piece ( tape is twi/$ r\nd ! l9t to reta9 x 9 position4 ,! tape & ! l9t mu/ bo? be /]iliz$ l ! gauze4 ,! be/ c\rse to adopt 9 reg>d to ! dress+s is to obta9 !m f a reliable firm ( manufactur]s1 :o w supply !m ready cut to ! patt]n requir$1 pack$ 9 small seal$ aseptic t9 cases ready = use4 ,hav+ adopt$ all ^! precautions ! ,mohel may be confid5t t 9 reg>d to 8 own h&s1 ! in/rum5ts1 & ! dress+s he has ex]cis$ e c>e :i* surgical sci5ce dem&s4 ,! only o!r important detail :i* dem&s att5tion is ! "p conc]n$ 9 circumcision4 ,x is obvi\s t all ! safegu>ds hi!rto consid]$ are valueless unless ! infant himself is 9 a p]fectly clean condition4 ,! dis9fection ( ! sk9 ( an adult be=e an op]ation is always a s]i\s & difficult matt]1 because ! sk9 h>b\rs s _m micro-organisms1 includ+ ! v micro-cocci ref]r$ to previ\sly4 ,elaborate measures are !re=e employ$ = ! sk9 dis9fection4 ,b 9 ! case ( an infant ! sk9 _c be suppos$ to be su* a probable s\rce ( w\nd infection4 ,x is suffici5t t ! g5itals be wa%$ ab\t half an h\r be=e circumcision1 ) soap & w>m wat]1 & subsequ5tly a fom5tation ( ,boracic l9t appli$4 ,x is z well to avoid ! use ( ! v>i\s baby p[d]s :i* nurses are s fond ( spr9kl+ freely on ! folds ( ! sk94 ,if x is ?\ght desirable to employ su* a du/+ p[d]1 x %\ld be a mixture ( equal p>ts ( ,boracic ,acid & ,/>*4 ,! infant hav+ be5 prep>$ z "h /at$1 ! circumcision may proce$ z soon z he is put 9 position4 ,%\ld any soil+ h tak5 place1 ! infant mu/ aga9 be cleans$1 & 9 ?is case ! g5itals mu/ be wa%$ ) ! ,c>bolic ,acid solution 7#a 9 #dj7 by means ( a swab ( cotton wool4 ,illu/ration ,,*apt] ,,iv4 ,surgical ,anatomy4 ,x is ess5tial = ! ,mohel to possess a k ( ! /ructure ( ! organ on :i* he op]ates4 ,! sk9 ( ! p5is is cont9u\s on ! upp] surface ) ! sk9 ( ! abdom51 & on ! "u surface ) t ( ! scrotum4 ,on draw+ =w>d ! prepuce or =esk9 x is v easy to include ! sk9 ( ! scrotum 9 ! grasp ( ! f+]s unless due c>e is tak54 ,if ! traction on ! =esk9 is too =cible & ! sk9 ( ! scrotum is !re=e pull$ up tightly1 !re is a dang] ( ! scrotal sk9 be+ slit up to "s ext5t4 ,! intimate connection ( ! sk9 ( ! p5is & scrotum mu/ always be kept well 9 m9d4 ,"u ! =esk9 & cont9u\s ) x at its free m>g9 !re is a membrane :i* ris+ f ! neck or con/riction bel[ ! glans envelops ! latt] entirely up to ! op5+ ( ! ure?ra4 ,"h x leaves ! glans & jo9s ! out] sk94 ,! "n giv5 to ?is /ructure is muc\s membrane1 & ! me?od ( deal+ ) x con/itutes ! pr9cipal portion ( ! art ( circumcision4 ,?is muc\s membrane is ! :iti% gli/5+ /ructure :i* appe>s aft] ! removal ( ! sk94 ,x is important to note ! disposition ( ?is muc\s membrane1 z reveal$ aft] ! amputation ( ! prepuce4 #a7 ,x usually cov]s ov] ! glans "r up to ! orifice ( ! ure?ra4 #b7 ,x may be reflect$ (f ! glans be=e rea*+ ?is po9t1 & become cont9u\s ) or adh]5t to ! sk9 l9+4 ,9 ?is case ! glans w n be completely cov]$ by ! muc\s membrane1 because a small portion w h be5 cut (f 9 ! fir/ /age ( ! op]ation4 ,9 ^? cases ! membrane miss+ f ! upp] "p ( ! glans w be f\nd on ! inside ( ! amputat$ =esk94 #c7 ,9 o!r cases ?is inn] muc\s membrane is v defici5t cov]+ only ?ree qu>t]s or less ( ! surface ( ! glans1 ! rema9+ portion be+ adh]5t to ! inn] surface ( ! =esk94 ,! consi/5ce ( ?is membrane is su* t x c be easily torn ?r\gh b1 #a7 ,x may be ela/ic s t x /ret*es )\t te>+4 #b7 ,x may be s ?9 t x is liable to be pu%$ d[n by ! nails in/ead ( be+ torn4 #c7 ,x may be s ?ick z to necessitate ! use ( ! scissors to cut x4 ,x may be loosely appli$ to ! glans s t ! ?umb nails are easily ins]t$ b5ea? x1 or x may be s adh]5t t great difficulty is exp]i5c$ 9 te>+ x ?r\gh & peel+ x (f ! glans4 ,an important fold ( ?is membrane1 triangul> 9 %ape is atta*$ to ! "u surface ( ! glans bel[ its base rea*+ almo/ up to ! op5+ ( ! ure?ra4 ,?is is call$ ! ,frnum1 & x is fully expos$ dur+ ! second /age ( ! op]ation4 ,! body ( ! p5is itself is compos$ ( ?ree p>ts4 ,on ! upp] surface beh9d ! glans are ! two ,corpora ,cav]nosa1 unit$ firmly toge!r1 b leav+ a holl[ on _! "u surface = ! ,corpus ,spongiosum :i* is prolong$ beyond !m 9 an enl>g$ extremity kn[n z ! glans4 ,! con/riction b5ea? ! glans is call$ ! ,c]vix or ,neck1 :ile ! project+ rim ( ! glans above ?is is call$ ! ,corona4 ,occasionally !re are f\nd "h small masses ( s(t creamy mat]ial1 :i* is ! natural secretion ( ! "p4 ,! canal ( ! ure?ra runs 9 ! corpus spongiosum4 ,ea* ( ^! ?ree corpora is firmly unit$ to ! pubic bone beh9d4 ,!y are con/ruct$ ( an out] %ea? f ! inn] surface ( :i* num]\s f9e membran\s p>titions /ret*1 divid+ ! :ole up into num]\s small comp>tm5ts4 ,^! comp>tm5ts are l9$ ) a f9e network ( ve9s1 :i* are able to exp& ) blood & to di/5d & fill up ^! spaces4 ,:5 ?is occurs ! :ole organ swells & becomes firm & ! t5sion ( ! fibr\s mat]ial =m+ ! ma9 /ructure is call$ into play s t ! process assumes ! =m ( an erection4 ,! ve9s :i* %\ld dra9 ! p5is ( blood are compress$ by ! action ( c]ta9 muscles & ?is adds to ! engorgem5t ( ! organ4 ,:5 ! p5is ( an infant is 9 a /ate ( erection ! op]ation ( circumcision c be m easily p]=m$ & ! dress+ m effici5tly appli$4 ,! manipulation ( ! organ necess>y to grasp ! prepuce is g5]ally suffici5t to /imulate ! increas$ blood supply requisite = an erection4 ,! sk9 ( ! p5is does n %>e ) ! re/ ( ! organ1 a great] am\nt ( blood dur+ ?is /ate4 ,x /ret*es by its own ela/icity4 ,all ! art]ies & ve9s ( ! p5is run 9 ! deep /ructures previ\sly allud$ to1 s t circumcision1 9 an infant at any rate1 c nev] w\nd a blood vessel4 ,! ,frnum is freely suppli$ ) blood1 & if cut w produce tr\blesome hmorrhage1 b a circumcision 9 no way int]f]es ) ?is "p4 ,illu/ration ,,*apt] ,v4 ,te*nique ( ,op]ation4 ,a good light is ess5tial = ! p]=mance ( circumcision4 ,! in/rum5ts requir$ are z foll[s3-- #a7 ,knife ( /eel1 to be made ( "o piece ( metal )\t jo9ts1 crevices or any ornam5tation :atsoev]4 ,! h&le %\ld be /\t en\gh to p]mit a firm grasp ^u x4 ,! blade %\ld be ab\t #e in*es 9 l5g? & fully half in* 9 wid?4 #b7 ,%ield4 ,?is is a metal plate ) a c5tre slit1 ! edges ( :i* are made to grasp ! prepuce at ! level ( ! amputation4 ,! ,%ield protects bo? ! glans p5is & ! scrotum f injury by ! knife4 #c7 ,scissors4 ,^! are requir$ occasionally to cut ?r\gh ! muc\s membrane4 ,!y %\ld be ( ! patt]n kn[n z ! 8blunt po9t$40 ,:5 x is evid5t t ! muc\s membrane is v adh]5t to ! glans1 ! sep>ation ( ^! two /ructures may be effect$ by ! use ( a ,probe4 ,?is is a ?9 metal rod :i* is easily ins]t$ "u ! muc\s membrane & swept r\nd ! glans s z to break ?r\gh ! adhesions4 ,! p]son :o is to hold ! infant1 is seat$ on a *air ) 8 feet on ! side rail ( a second *air s z to keep ! knees rais$4 ,! latt] mu/ be kept close toge!r4 ,a firm pill[ is plac$ on ! knees & ! infant is laid !reon fac+ ! ,mohel4 ,:5 ! necess>y clo?+ has be5 loos5$1 ! ?ighs & knees are b5t up completely 7flex$7 & !n ! ?ighs are 9 addition rotat$ outw>ds1 & kept 9 ?is position by ! h&s ( ! individual hold+ ! infant4 ,! clo!s %\ld be displac$ beh9d ! buttocks ( ! infant s z to raise ! "p4 ,! antiseptic prep>ations describ$ 9 ,*apt] iii4 hav+ be5 c>ri$ out1 ! op]ation is p]=m$ accord+ to ! foll[+ /ages4 ,/age ,i4 ,! root ( ! p5is is tak5 betwe5 ! index & middle f+]s ( ! "r h& palm d[nw>ds1 & pressure is made firmly backw>ds1 ! index f+] be+ aga9/ ! scrotum1 ! middle f+] aga9/ ! l[] portion ( ! abdom54 ,?is /eadies ! p5is1 keeps away ! sk9 ( ! scrotum1 & helps t[>ds produc+ an erection4 ,/age ,,ii4 ,keep+ ^! f+]s 9 ?is position1 ! glans is grasp$ betwe5 ! ?umb & index f+] ( ! left h&4 ,x is important n m]ely to take hold ( ! =esk91 ! glans mu/ be includ$ betwe5 ! f+]s1 & x mu/ be exam9$ by !m s z to discov] :]e x ends4 ,?is is det]m9$ by feel+ ! project+ rim ( ! ,corona1 & ! neck b5ea? x4 ,! sk9 ov]ly+ ?is m>ks ! precise position :]e ! %ield is to be plac$4 ,:5 ?is position is accurately made out ! :ole ( ! sk9 9 front ( x is )drawn beyond ! glans by ! f+]s1 & v firmly held upw>ds away f ! scrotum4 ,/age ,,iii4 ,! f+]s are n[ to be remov$ f ! root ( ! p5is1 & ! %ield is tak5 into ! "r h& & adju/$ on ! prepuce exactly at ! level ( ! f+] tips :i* are grasp+ x4 ,! direction ( ! %ield is important4 ,x mu/ n be put on at "r angles to ! p5is1 b obliquely upw>ds1 i4e41 ! "p ( ! %ield held 9 ! h& mu/ incl9e t[>ds ! abdom5 ( ! infant1 & ! o!r "p away f x4 ,9 ?is way ! circumcision w take (f ! =esk9 9 a quill %ape1 & x w leave a suffici5t am\nt ( sk9 on ! "u surface ( ! p5is4 ,if ?is precaution is n obs]v$ !re is a great risk ( d5ud+ ! "u surface ( ! sk9 almo/ z f> z ! scrotum4 ,/age ,,iv4 ,! knife is !n tak5 9 ! "r h& & ) "o sweep along ! %ield ! =esk9 is amputat$4 ,! knife mu/ be h&l$ firmly1 & ! cut made f ! heel4 ,! cut circul> edge ( ! sk9 imm$iately retracts beh9d ! corona1 ?\gh on ! "u surface ! am\nt ( sk9 rema9+ may fall %ort ( ?is level4 ,/age ,v4 ,! amputat$ =esk9 & ! knife are n[ put aside1 ! %ield hav+ already fall5 (f4 ,! ,mohel w n[1 at a glance1 obs]ve ! disposition ( ! muc\s membrane cov]+ ! glans4 ,he ins9uates ! nail ( "o ?umb "u its edge1 & seizes x betwe5 ! nail & ! index f+]4 ,:5 ?is is grasp$ ! manuvre is repeat$ ) ! ?umbnail & index f+] ( ! o!r h&1 keep+ ! two h&s close toge!r4 ,be=e proce$+ fur!r1 ! ,mohel mu/ be sure t he has a firm hold ( ! membrane4 ,! next /ep is to te> ! membrane d[n 9 ! c5tre1 until ! prom95t edge ( ! corona is expos$4 ,?is te>+ may be complet$ ) "o movem5t ( ! h&s1 b if ! membrane is long m ?an "o movem5t may be requir$ to te> x ?r\gh completely4 ,:5 ! neck bel[ ! corona is se51 ! flaps are reflect$ lat]ally backw>ds1 s t ! torn edges ( ! muc\s membrane may jo9 ! cut edge ( ! sk94 ,c>e mu/ be tak5 t ! membrane is peel$ (f z f> z possible 7i4e4 till its junction ) ! frnum7 f ! "u surface ( ! glans & reflect$ directly backw>ds s z to unite ) ! cut edge ( ! sk94 ,! ess5ce ( ! op]ation consi/s 9 ! prop] p]=mance ( ?is /age4 ,if n p]=m$ effici5tly ! result+ circumcision is v imp]fect4 ,! mi/akes usually made by beg9n]s are z foll[s3 #a7 ,! muc\s membrane is /ret*$ )\t be+ torn ?r\gh2 ! glans !n projects completely giv+ ! impression t x has be5 expos$ by ! prop] me?od4 #b7 ,! membrane is roll$ back ov] ! glans in/ead ( be+ torn back4 #c7 ,! membrane is cle>$ (f f ! upp] surface ( ! glans1 b is n suffici5tly peel$ (f f ! "u surface4 ,/age ,,vi4 ,! op]ation is really complet$ ) ! prec$+ /age4#a ,! practice ( ,metzizah may n[ be c>ri$ out by means ( a swab ( /]iliz$1 cotton wool ) :i* ! p5is is to be firmly compress$4 ,?is w effectually absorb ! small am\nt ( blood free 9 ! tissues & at ! same "t helps to clean up ! "p4 ,/age ,,vii4 ,! dress+ consi/s ( a /rip ( /]iliz$ & antiseptic l9t or gauze long en\gh to encircle ! p5is bel[ ! glans two or ?ree times1 & wide en\gh to cov] ! :ole space betwe5 ! corona & ! root ( ! p5is1 i4e4 #d 94 94 ,! fir/ lay] ( dress+ is appli$ entirely bel[ ! glans & cov]s ov] ! :ole ( ! reflect$ muc\s membrane4 ,c>e mu/ be tak5 to apply ?is /rip ( l9t at ! v root ( ! p5is & to beg9 on ! "u surface2 o!rwise !re is a t5d5cy = ! dress+ 9 ?is latt] position only to j to rea* ! edge ( ! incision & to pu% x back t[>ds ! scrotum & ?us increase ! size ( ! raw area4 ,! glans mu/ be q free ( ! dress+ encircl+ ! p5is & mu/ project completely beyond ! /rip ( l9t appli$ bel[ x4 ,?is piece ( l9t or gauze adh]es q well by itself1 b to ensure its rema9+ 9 position1 x is bett] to secure x by surr\nd+ x once or twice ) a piece ( /]iliz$ tape & twi/+ up ! ends4 ,if ?is is done too tightly x may ob/ruct ! free fl[ ( ur9e1 or conge/ ! glans4 ,! dress+ is complet$ by cov]+ ov] ! nak$ & project+ glans ) a squ>e piece ( antiseptic gauze4 ,a diap] fold$ 9 ! ord9>y triangul> %ape is !n put on1 & ?is is secur$ firmly by means ( broad tape4 ,two or ?ree turns mu/ be giv5 r\nd ! ?ighs s z to keep !m fix$1 & ! ends are to be ti$ ov] ! hip4 ,dur+ ! aft] treatm5t ! re-dress+ may be regulat$ z foll[s4 ,aft] ab\t #aj or #ab h\rs1 b at any rate )9 ! fir/ #bd h\rs1 ! piece ( gauze cov]+ ! glans mu/ be remov$ & ! tape surr\nd+ ! dress+ untwi/$ & also remov$4 ,if ! circumcision has be5 prop]ly & c>efully p]=m$1 s t ! :ole ( ! muc\s membrane & sk9 are kept back by ! dress+1 & ! :ole ( ! glans rema9s expos$1 no?+ fur!r ne$ be done b to replace "s fre% gauze ov] ! glans4 ,on ! foll[+ day ! :ole ( ! dress+ %\ld be remov$1 & gauze be re-appli$ ar\nd ! p5is leav+ ! end ( ! glans free4 ,?is dress+ w fall (f :5 ! infant is 9 ! ba?1 & may be r5ovat$ z (t5 z necess>y4 ,z an alt]native proc$ure ! :ole dress+ may be remov$ aft] ! fir/ #bd h\rs1 & ! "p re-dress$ ) gauze4 #a ,! p]=mance ( ,metzizah accord+ to /atutory ,jewi% ,law consi/s ( suction by ! m\?4 ,! orig9al s\rces ( ?is practice indicate t x 0 consid]$ an ess5tial "p ( ! op]ation 9 ! same way z ! dress+ ( ! w\nd 04 ,failure to c>ry out ?is measure 0 reg>d$ z con/itut+ a s]i\s risk to ! infant4 ,! possible dang]s ( ?is practice h become obvi\s dur+ rec5t ye>s & direct suction ( ! w\nd is1 f e po9t ( view1 inadmissible4 ,9 ord] to c>ry out ! anci5t practice a device is us$ by "s ,mohelim by :i* ! suction is p]=m$ ?r\gh a small glass tube ) a p]=ation at its end & conta9+ a piece ( absorb5t wool 9 its int]ior4 ,circumcision 9 ,abnormal ,cases4 ,! p5is is subject to _m dep>tures f its usual anatomy1 b "h x w only be necess>y to notice "s ( ! m usual abnormalities4 #a/4 ,9 "s cases ! p5is is sunk5 into ! pubic sk91 s t on grasp+ ! prepuce ! :ole integum5t ( ! p5is is pull$ up leav+ ! organ itself buri$ 9 ! sk9 beh9d4 ,x w be f\nd t 9 _m ( ^! cases ! te/icles h n desc5d$ into ! scrotum4 ,! fir/ /age ( ! op]ation1 9 ^! in/ances1 is all important4 ,! root ( ! p5is is embrac$ betwe5 ! second & ?ird f+]s ( ! "r h& z previ\sly expla9$ & firm pressure backw>ds is made until a def9ite erection is made4 ,! am\nt ( sk9 to be amputat$ mu/ be v accurately e/imat$1 ! %ield c>efully adju/$ 9 an oblique direction1 z 9 ^! cases ! inclusion ( "s ( ! sk9 ( ! scrotum is v easy4 ,! muc\s membrane (t5 proves to be v ?ick1 b :atev] its consi/5ce may be x %\ld be cut away ) scissors aft] reflection z ?is proce$+ helps to prev5t ! glans s9k+ back into ! sk94 ,a c>eful exam9ation ( ! infant mu/ be made 9 ^! cases because !y frequ5tly d5ote immature developm5t1 & call = po/ponem5t ( ! p]=mance ( ! circumcision4 #bnd4 ,! prepuce is sometimes defici5t4 ,! upp] portion ( ! glans may be expos$ & project beyond ! %ort prepuce4 ,! am\nt ( ! latt] :i* %\ld be remov$ is s small1 t on pull+ x =w>d !re is n suffici5t 9 ! small circle ( sk9 = ! f+]s to obta9 a firm grasp4 ,9 ?is case =ceps %\ld be employ$ to hold ! =esk94 #crd4 ,"s infants are born app>5tly circumcis$4 ,on exam9ation x w be f\nd t a consid]able am\nt ( prepuce /ill rema9s on ! upp] surface ( ! p5is1 :ile ! "u surface may be q free4 ,9 ^! cases ! :ole ( ! rema9+ prepuce is grasp$ betwe5 ! f+]s & ! op]ation is p]=m$ 9 ! usual mann]4 ,"h also ! und]ly+ muc\s membrane %\ld be entirely cut away aft] x has be5 torn ?r\gh4 ,illu/ration ,,*apt] ,,vi4 ,repair ( ! ,w\nd4 ,z ! :ole diff]5ce betwe5 a sci5tific op]ator & a m]ely me*anical ,mohel lies 9 an appreciation ( ! process ( repair 9 ! w\nd inflict$1 x becomes necess>y to consid] ?is 9 detail4 ,! area ( ! circumcision w\nd ext5ds betwe5 ! corona ( ! glans & ! circul> cut edge ( ! sk94 ,! sk9 ( ! p5is always retracts1 s t if ! %ield has be5 plac$ 9 ! position previ\sly indicat$1 ! sk9 w n aft] ! circumcision rea* q up to ! corona2 ! neck ( ! glans w be well expos$4 ,?is is ! condition to be atta9$ 9 ritual circumcision4 ,! muc\s membrane1 aft] be+ torn ?r\gh & reflect$ cov]s ov] ! area ( ! result+ w\nd4 ,! plann+ ( ! op]ation %\ld be s c>ri$ out t ! torn edges ( ! muc\s membrane may unite ) ! cut edge ( ! sk94 ,?is approximation is n usually complete all r\nd ! w\nd4 ,! te>+ ?r\gh ( ! muc\s membrane produces a n>r[ ,v %ap$ r5t2 ?is is wid5$ out :5 ! membrane is reflect$1 & if c>efully appos$ to ! cut sk91 w unite ) x4 ,b ! edge ( t portion ( ! membrane peel$ (f f ! "u surface ( ! glans w (t5 fail to unite ) ! exit edge ( ! sk9 on ! "u surface ( ! p5is4 ,x frequ5tly does n rea* z f> back z ! cut sk91 especially :5 ! =esk9 has be5 freely remov$ or :5 ! muc\s membrane has a t5d5cy to curl up4 ,! result 9 ! majority ( circumcisions is t ! upp] portion ( ! w\nd heals rapidly1 :]e ! lac]at$ edge ( ! muc\s membrane has unit$ to ! cut edge ( ! sk91 :ile on ! "u surface1 ! muc\s membrane w adh]e to ! raw surface ( ! p5is left by ! retract+ sk91 b !re w probably be a gap :]e ! membrane has fail$ to rea* ! cut edge ( ! sk94 ,?is gap w necess>ily be v small :5 ! reflection ( ! muc\s membrane has be5 complete4 ,:]e approximation ( ! two edges occurs union is rapid & heal+ by 8fir/ int5tion0 results4 ,:]e "s loss ( sub/ance occurs ! gap becomes gradually fill$ by :at is call$ granulation tissue1 & ! t]m 8second int5tion0 is giv5 to ! heal+ process4 ,heal+ by fir/ int5tion4 ,9 amputat+ ! =esk9 a numb] ( m9ute hair-l blood vessels :i* p]meate ! sk9 are cut ?r\gh4 ,!re is little or no ble$+1 because ! blood imm$iately clots1 & almo/ at once a rim ( coagulum is =m$ at ! m>g9 ( ! circumcision4 ,besides ?is ! injury de/roys a m9ute am\nt ( liv+ tissue kn[n z connective tissue cells4 ,! w\nd causes a special degree ( activity 9 ! adjac5t blood vessels1 s t c]ta9 important con/itu5ts ( ! blood fl[ out ( ! vessels & invade ! cut m>g9 :]e ! blood has coagulat$4 ,?is invasion consi/s ( ! fluid portion ( ! blood--or lymph1 & ! solid elem5ts call$ :ite corpuscles--or leucocytes4 ,^! latt] remove ! cells :i* h be5 kill$ by ! injury1 & get rid ( ! blood clot1 probably by a process ( dige/ion4 ,:5 ?is is effect$1 ! way is pav$ = ! heal+1 i4e4 ! =mation ( ! sc>4 ,! nak$-eye evid5ce ( all ?is is to be f\nd 9 ! moi/ure or exudation on ! surface ( a w\nd4 ,z ?is =ms on bo? surfaces ( a w\nd1 ! exudation is ! fir/ bond ( union4 ,! fluid portion ( ?is exudation becomes absorb$1 & :at rema9s ( x =ms ! scaffold+ on :i* ! sc> is built up4 ,! sc> consi/s ( new connective tissue cells :i* h gr[n into ?is framework1 & multipli$ rapidly1 caus+ firm cohesion ( ! two sep>ate surfaces4 ,9 ord] t ^! new cells %\ld be prop]ly n\ri%$ !y require a suffici5t blood supply1 & x is f\nd t :ile _! =mation is proce$+ m9ute new blood vessels %oot =? f ! exi/+ ones1 & !y gr[ into ! s(t newly develop+ sc> tissue4 ,ow+ to ?is fact1 free ooz+ ( blood takes place :5 a heal+ w\nd is di/urb$4 ,9 ! op]ation ( circumcision x is well se5 h[ ! circulation ( ! blood re-acts to injury4 ,:5 ! muc\s membrane cov]+ ! glans is expos$ x looks pale & transluc5t1 because ( its scanty blood supply & its ?9ness4 ,v soon aft] x has be5 torn ?r\gh1 its :ole "* *anges4 ,x becomes engorg$ ) blood1 x becomes r$ & conge/$ x loses its transluc5cy1 & at its lac]at$ edge ! process ( heal+ takes place z detail$ above4 ,all sc>s are at fir/ p9k 9 col\r1 because m new blood vessels are =m$ ?an are requir$ = ! p]man5t n\ri%m5t ( ! "p :5 completely heal$4 ,9 ! c\rse ( "t ^! blood vessels %r9k & wa/e away & ! sc> becomes :it] ev5 ?an ! adjac5t sk94 ,?is occurs also 9 ! muc\s membrane :i* rema9s p9k = a consid]able "t4 ,! membrane 9 fact und]goes ! fir/ /age ( inflammation z a reaction to ! injury x has su/a9$4 ,! blood vessels become enorm\sly dilat$1 & its blood supply increas$4 ,x pres5ts ! be/ conditions = heal+ along ! edges :]e x has be5 torn1 b ! :ole ( its out] surface also1 :i*1 aft] reflection becomes oppos$ to ! raw surface betwe5 ! corona & ! cut =esk9 inf]iorly1 becomes unit$ by a simil> process to ?is raw area4 ,9 ^? cases :]e ! reflection ( ! muc\s membrane has n be5 p]fect a gap w be left betwe5 its m>g9 & ! cut =esk91 9 :i* heal+ takes place by granulation or second int5tion4 ,! details ( ?is me?od ( heal+ are simil> to ! fir/2 ! dis*>ge or exudation f ! w\nd takes place 9 ! same mann]1 b z !re are n two surfaces to unite to ea* o!r1 ?is exudation simply cov]s ov] ! w\nd 9 ! =m ( a :iti% or pale yell[ lay] ( lymph4 ,! fluid dis*>ge %\ld be tol]ably cle>2 if x t5ds to be ?ick or milk l 9 col\r x indicates t !re has be5 "s accid5tal contam9ation ( ! w\nd1 or t ! vital p[]s necess>y = normal heal?y repair are bel[ ! av]age4 ,x %[s t ! inflammatory re-action ( ! tissues :i* is ! ess5tial requisite = heal+ has be5 excessive4 ,9 ?is case n only has ! w\nd be5 invad$ by ! :ite blood cells1 :i* z previ\sly expla9$1 =m ! gr\ndwork ( ! new tissue cells2 b a fur!r /ep has tak5 place4 ,^! :ite cells h be5 ?r[n (f ! surface ( ! w\nd & toge!r ) ! exud$ fluid g to =m 8pus0 or matt]4 ,all ?is causes delay 9 ! heal+4 ,b ev5tually ! w\nd becomes fill$ up by ! gr[? ( new connective tissue cells2 ^! cont9ue to multiply until ! surface is rea*$1 :5 ! upp]mo/ or epi!lial lay] ( ! cut edge ( ! adjo9+ sk9 gr[s ov] x1 con/itut+ a cont9u\s sk9 cov]+4 ,! defects 9 ! heal+ process may !re=e be briefly summ$ z be+ due to "s int]f]5ce ) ! natural c\rse ( physiological repair4 ,!y may be compris$ "u ! foll[+ heads4 #a7 ,defici5t vitality ( ! infant4 #b7 ,infection ( w\nd4 #c7 ,imp]fect p]=mance ( ! op]ation especially :5 ! te>+ ?r\gh & reflection ( ! muc\s membrane has be5 incomplete4 ,^! defects are to be prev5t$ by a c>eful exam9ation ( ! heal? ( ! infant previ\sly to ! circumcision1 by ! employm5t ( ,antiseptic measures1 & by c>efully c>ry+ out ! te*nique ( ! op]ation4 ,illu/ration ,,*apt] ,,vii4 ,hmorrhage4 ,tr\ble f ble$+ is an exce$+ly r>e occurr5ce at ! circumcision ( an infant1 because no art]ies or ve9s are cut ?r\gh4 ,b ! possibility ( its occurr5ce1 h[ev]1 rema9s1 & !re=e "s po9ts reg>d+ x %\ld come )9 ! in=mation ( e ,mohel4 ,x w be 8 duty to apply fir/ aid1 & consequ5tly a k ( ! pr9ciples ( ! treatm5t ( hmorrhage %\ld be famili> to him4 ,!re are ?ree v>ieties ( ble$+4 #a/4 ,capill>y4 ,?is consi/s ( ! ooz+ ( blood f v>i\s po9ts on a cut surface4 ,! vessels are m9ute hair-l /ructures1 & ble$+ f !m is inv>iably /opp$ by firm pressure4 ,?is loss ( blood occurs 9 m or less degree at e circumcision1 & 9 ! va/ majority ( cases is arre/$ by ! natural process previ\sly expla9$4 #bnd4 ,art]ial4 ,! di/9ctive sign ( ?is k9d ( ble$+ is t x issues =? f ! w\nd 9 spurts1 & n 9 a cont9u\s /ream4 ,ea* spurt corresponds to a he>t beat4 ,?is v>iety ( hmorrhage c only occur if an art]y is cut ?r\gh1 i4e41 a vessel :i* c>ries blood away f ! he>t to supply ! tissues ( ! body4 #crd4 ,v5\s4 ,?is ble$+ is due to ! w\nd ( a vessel :i* returns blood to ! he>t aft] x has circulat$ ?r\gh ! tissues4 ,^! vessels are call$ ve9s4 ,! blood is d>k 9 col\r & issues f "o def9ite spot 9 a cont9u\s /ream4 ,treatm5t4 ,= practical purposes only ! fir/ v>iety ( hmorrhage ne$ be consid]$ "h4 ,circumcision 9 an infant %\ld nev] int]f]e ) an art]y or ve92 b 9 ! ev5t ( ?is accid5t occurr+ a pl$get ( cotton-wool or l9t mu/ be firmly compress$ ) b&age ar\nd ! ble$+ po9t until ! prop] me?od c be adopt$ to deal ) x4 ,?is consi/s ( seiz+ ! ble$+ po9t ) an in/rum5t con/ruct$ = ! purpose 7art]y =ceps7 & !n twi/+ up ! tissue caught 9 ! =ceps1 or apply+ a ligature4 ,?is is a purely surgical proce$+1 & z e case ( hmorrhage %\ld )\t delay receive qualifi$ m$ical att5tion no?+ fur!r ne$ be said on ?is matt] "h4 ,9 mo/ cases ! application ( ! dress+ ) v firm pressure suffices to arre/ ! inevitable ble$+ ( e circumcision4 ,! b&ag+ _c be consid]$ satisfactory until ! blood ceases to ooze ?r\gh ! dress+4 ,9 adju/+ ! diap]s x mu/ be se5 t ! ?ighs are ti$ toge!r s t !y are immovable1 p]fect re/ be+ indisp5sable = ! control ( hmorrhage4 ,?is treatm5t is m]ely a me*anical aid to ! natural processes :i* arre/ ble$+1 & 9 ! va/ majority ( cases is p]fectly successful4 ,!re are h[ev] c]ta9 drugs :i* may be appli$ to a ble$+ surface to ha/5 ! coagulation ( ! blood4 ,^! are call$ a/r+5ts4 ,^! are n to be us$ indiscrim9ately z _m ( !m injure ! tissues & int]f]e ) ! heal+ ( ! w\nd4 ,if pressure alone is insuffici5t to /op ! hmorrhage & ! local application ( an a/r+5t is to be tri$1 ! "p mu/ fir/ be c>efully wa%$ ) an antiseptic solution1 s z to see precisely :]e ! ble$+ is actually com+ f4 ,/rips ( l9t soak$ 9 ! a/r+5t solution are !n c>efully appli$ & reta9$ 9 position by ! firm pressure ( a b&age4 ,! foll[+ are ! pr9cipal drugs :i* may be us$ 9 ?is way4 #a47 ,comp\nd ,t9cture ( ,b5zo94 #b47 ,t9cture ( ,hazel9e4 #c47 ,/rong solution ( ,alum 9 hot wat]4 #d47 ,solution ( ,tannic ,acid 7#d gra9s to ! ounce47 #e47 ,solution ( ,adr5al9 ,*loride4 ,! la/ ( ^! has ! reputation ( be+ ! mo/ p[]ful a/r+5t kn[n4 ,a solution ( ,p]*loride ( ,iron is (t5 us$1 b ?is is op5 to ! objection ( injur+ ! delicate liv+ tissues4 ,second>y ,hmorrhage4 ,besides ! ble$+ :i* may occur imm$iately on ! infliction ( a w\nd1 !re is ano!r v>iety :i* may take place subsequ5tly1 kn[n z ,second>y ,hmorrhage4 ,?is occurs :5 !re is "s failure 9 ! process previ\sly describ$1 by :i* ! w\nd heals4 ,! coagulum is di/urb$ & ! vessels are practically re-op5$1 or ! coagulum becomes s(t5$ ?r\gh ! action ( an infective ag5t4 ,z a rule second>y hmorrhage indicates "s =m ( infection4 ,(t5 9 *ang+ ! dress+ !re is a m9ute am\nt ( hmorrhage4 ,?is is due to injur+ ! develop+ blood vessels 9 ! newly gr[+ sc> tissue4 ,hmorrhage due to con/itutional conditions4 ,"s infants are born ) a t5d5cy to ble$1 )\t any evid5t cause1 ei!r f ! nose1 b[els1 or 9 ! sk94 ,! sep>ation ( ! navel may be foll[$ by ble$+4 ,_m ( ^! cases are due to h]$it>y disease ( "o "* or ano!r4 ,( ^!1 !re is "o :i* requires special m5tion1 because :5 fatal hmorrhage has occurr$ aft] circumcision x has be5 due to x4 ,?is is ,hmophilia4 ,subjects ( ?is disease are call$ ,ble$]s1 & x usually only affects males4 ,x runs 9 families1 "o or two memb]s may be affect$ :ile ! re/ are free4 ,! females 9 a family ( 8ble$]s01 ?\gh !y may n suff] !mselves1 transmit ! disease to _! *ildr54 ,9 ?is condition ! slighte/ injury w />t pr(use hmorrhage4 ,! use ( a too?bru% may be suffici5t to cause sev]e ble$+ f ! gums4 ,if ! family hi/ory ( any *ild reveals ! pres5ce ( ?is disease circumcision mu/ n be p]=m$4 ,%\ld ! op]ation h tak5 place 9 ignorance ( ! condition ! difficulty 9 controll+ ! hmorrhage1 & its recurr5ce if at all reliev$ w at once confirm ! pres5ce ( ,hmophilia4 ,! nature ( ! ble$+ 9 ?is condition is t ref]r$ to be=e z ,capill>y4 ,illu/ration