A good light is essential for the performance of circumcision.
The instruments required are as follows:—
1) Knife of steel, to be made of one piece of metal without joints, crevices or any ornamentation whatsoever. The handle should be stout enough to permit a firm grasp upon it. The blade should be about 5 inches in length and fully half inch in width.
2) Shield. This is a metal plate with a centre slit, the edges of which are made to grasp the prepuce at the level of the amputation. The Shield protects both the glans penis and the scrotum from injury by the knife.
3) Scissors. These are required occasionally to cut through the mucous membrane. They should be of the pattern known as the “blunt pointed.” When it is evident that the mucous membrane is very adherent to the glans, the separation of these two structures may be effected by the use of a Probe. This is a thin metal rod which is easily inserted under the mucous membrane and swept round the glans so as to break through the adhesions.
The person who is to hold the infant, is seated on a chair with his feet on the side rail of a second chair so as to keep the knees raised. The latter must be kept close together. A firm pillow is placed on the knees and the infant is laid thereon facing the Mohel. When the necessary clothing has been loosened, the thighs and knees are bent up completely (flexed) and then the thighs are in addition rotated outwards, and kept in this position by the hands of the individual holding the infant.
The clothes should be displaced behind the buttocks of the infant so as to raise the part.
The antiseptic preparations described in [Chapter iii.] having been carried out, the operation is performed according to the following stages.
Stage I. The root of the penis is taken between the index and middle fingers of the right hand palm downwards, and pressure is made firmly backwards, the index finger being against the scrotum, the middle finger against the lower portion of the abdomen. This steadies the penis, keeps away the skin of the scrotum, and helps towards producing an erection.
Stage II. Keeping these fingers in this position, the glans is grasped between the thumb and index finger of the left hand. It is important not merely to take hold of the foreskin, the glans must be included between the fingers, and it must be examined by them so as to discover where it ends. This is determined by feeling the projecting rim of the Corona, and the neck beneath it. The skin overlying this marks the precise position where the shield is to be placed. When this position is accurately made out the whole of the skin in front of it is withdrawn beyond the glans by the fingers, and very firmly held upwards away from the scrotum.