Jacob Snowman

“ The disinfection of the skin of an adult before an operation is always a serious and difficult matter, because the skin harbours so many micro-organisms, including the very micro-cocci referred to previously. Elaborate measures are [22] therefore employed for the skin disinfection. But in the case of an infant the skin cannot be supposed to be such a probable source of wound infection. It is sufficient that the genitals be washed about half an hour before circumcision, with soap and warm water, and subsequently a fomentation of Boracic lint applied. ”

“ On the other hand, should the infant be born with the disease—a circumstance of not infrequent occurrence—it must be remembered that its blood is charged with the poison, and is capable of infecting a healthy individual when it is brought into contact with any wound, abrasion or other breach of surface. ”

“ If the instruments are scrupulously clean, i.e., if they have been washed thoroughly with soap and hot water, they require to remain for one hour in the Carbolic Acid solution to render them sufficiently disinfected for operating purposes. It is therefore quicker, as it is also more scientific, to sterilize the instruments before using them. By sterilizing them we kill any micro-organisms that may be present on them, and we are then confident that no living germs are carried to the wound by means of the instruments. ”

“ The application of such dressings as will keep the wound in an aseptic condition. Even the small amount of discharge from a circumcision [18] wound forms a splendid soil for the growth of micro-organisms. It is necessary therefore to apply a dressing which has been saturated with such antiseptics as will destroy that constituent of the discharge which makes it a good culture material.
The most convenient antiseptic for general use is Carbolic Acid. This is a clear, colourless liquid of rather oily consistence, which rapidly becomes converted into solid crystals in cold weather. ”

“ The disease is most active at this sharp margin for it is there that the micro-cocci may be found in abundance. The glands in the groin become swollen and tender, and the circumcision wound, failing to heal will probably inflame and suppurate. While this is going on, a poison is being manufactured by the microbes in their growth, and this poison being absorbed into the circulation, generally proves fatal to the infant. ”

“ All the arteries and veins of the penis run in the deep structures previously alluded to, so that circumcision, in an infant at any rate, can never wound a blood vessel. The Frænum is freely supplied with blood, and if cut will produce troublesome hæmorrhage, but a circumcision in no way interferes with this part. ”

“ But fortunately disease results only rarely, because there are special powers resident in the vital tissues which enable them successfully to resist the poisonous effects of these organisms. There are however certain circumstances in which they are liable to be more harmful than in others. ”

“ 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. ”

“ It is necessary that the dressing should be sterilized and also impregnated with some antiseptic so as to render harmless any infective material which may accidentally contaminate the wound after circumcision. These dressings are supplied by manufacturers, already sterilized by exposure to super-heated steam, and rendered antiseptic by various chemical agents. Carbolic Acid used for the hands and the instruments, is often employed for the dressings, the antiseptic being fixed in the lint and the gauze by a special process. ”

“ In order that these new cells should be properly nourished they require a sufficient blood supply, and it is found that while their formation is proceeding minute new blood vessels shoot forth from the existing ones, and they grow into the soft newly developing scar tissue. Owing to this fact, free oozing of blood takes place when a healing wound is disturbed. ”

“ Subjects of this disease are called Bleeders, and it usually only affects males. It runs in families, one or two members may be affected while the rest are free. The females in a family of “bleeders”, though they may not suffer themselves, transmit the disease to their children. In this condition the slightest injury will start profuse hæmorrhage. The use of a toothbrush may be sufficient to cause severe bleeding from the gums. If the family history of any child reveals the presence of this disease circumcision must not be performed. ”

“ These nearly all belong to one class—micro-cocci. They are minute round bodies about 1/25000 inch in diameter. They possess the peculiarity of growing together in clusters like grapes, or in chains. They are responsible for the diseased conditions of wounds which delay healing, for inflammation around wounds and for the general blood-poisoning which may result.
These organisms are very abundant in the dust of rooms, on dirty clothes and unclean general surroundings, and there can be no doubt that everybody is often infected by them. ”

“ This gap will necessarily be very small when the reflection of the mucous membrane has been complete. Where approximation of the two edges occurs union is rapid and healing by “first intention” results. Where some loss of substance occurs the gap becomes gradually filled by what is called granulation tissue, and the term “second intention” is given to the healing process.
Healing by first intention.
In amputating the foreskin a number of minute hair-like blood vessels which permeate the skin are [40] cut through. ”

“ 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. ”

“ 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. ”

“ In other words they are aseptic. Instruments are sterilized by boiling for about ten minutes in clean water. It is useful to add washing soda in the proportion of 5 grains to every two tablespoons of water. ”