Journal of the American Medical Association,  1910 

Rapid circumcison of male and female
A new device for "bloodless" circumcision

 In 1910 the Journal of the American Medical Association published an article by S.L. Kistler MD, of Los Angeles, on the need for circumcision in both males and females, along with a vigorous advocacy his own patent “bloodless” method. Like Hiram Yellen and Aaron Goldstein 25 years later, he had invented a special clamp for the purpose. 

Rapid bloodless circumcision of male and female

Circumcision, one of our most common minor operations, is bunglingly done in many instances, notwithstanding its simplicity. This operation, though an old one, is still interesting, and means have long been sought whereby it could be more easily and quickly performed and be attended with less hemorrhage, and consequently meet with less objection on the part of parent and patient.

Many a surgeon has lost his best clients, and likewise many a good prospect has gone glimmering because of the unfortunate outcome of this little operation.

The necessity for circumcision is abundantly evidenced, and although it may be needless to state any reasons for doing this operation, nevertheless I will mention a few:

1. Reduced tendency to convulsions in infancy arising from irritable nervous system.

2. Habit of masturbation not so likely to be formed.

3. Lessened irritability of child or adult.

4. Amorosity reduced.   CanadianCRC editor's note: Sexual desire is lessened because of the damage done. Even in 1910, doctors admitted the damage. 

5. A hygienic condition promoted.

6. Venereal diseases not so readily contracted, and consequently:

7. Fewer pelvic diseases in women.

8. For impotency in old men, as has been advocated.

The ease with which this operation can be done by the use of the instrument here described is so marked that a person could circumcise himself, provided he did not become faint-hearted. Only one-quarter of [the] time required for other methods is needed. The operation is practically bloodless, as all ligatures are uniformly placed and tied before the clamp is removed.

The illustration shows clamp on and ligatures inserted (A); then the removal of the foreskin (B), and next the removal of the upper section of the blades (C), and two ligatures pulled up, one of which has been cut and is ready to be tied (D). The instrument has twelve slots or ports, instead of fourteen as shown in the illustration.

Method of procedure

1. Use local or general anaesthetic as deemed best.

2. Adjust clamps.

3. Insert sutures.

4. Excise foreskin with scissors or blade.

5. Remove upper section of each blade by releasing at distal extremity and lifting off.

6. Insert ligature in anterior portion of foreskin in addition to those already inserted, if desired; also insert one posteriorly.

7. Pull each suture up singly, cut loop in centre, tie each side as indicated, and having tied all the ligatures, remove clamp and apply dressing.

If deemed expedient, spear the mucous membrane and draw out as desired before applying the clamp. If the foreskin adheres to the glans, split on dorsal aspect to corona, break down adhesions, apply clamp and operate one side at a time, and, having loops to pull, only skin and mucosa to unite, you can operate very rapidly. A young child may not always require stitches; however, I think it best to insert several, but each operator will use his own judgement in the matter. A better result will be obtained when the mucous membrane is cut long and the skin comparatively short, as is the case when this instrument is employed. There is practically no blood, no anxiety, no misgivings as to results, and the work is done quickly and easily. Frequently, too much mucous membrane is removed and too little skin. Leave more mucous membrane and less skin, and then an ideal result will be obtained.

Many females need circumcision, and the operation is more easily performed than on the male. The clamp is applied singly to such elongated or hypertrophied parts as it is desired to remove, ligatures inserted, part excised, upper part of blades removed, ligatures tied without necessity of pulling up loops etc, clamp removed and dressing applied.

I have never tried this instrument for protruding pile tumours (of considerable length), but it occurs to me that a beautiful operation could be performed by its use, for the reason that the double ligatures could be inserted through the vein posterior to the sacculated portion, and then the set of ligatures used for the vein could be withdrawn from the skin; thus the veins could be tied separately and the skin then closed with the other set of ligatures loosely tied, which would incidentally hold the vein in close contact with the skin.

Other phimosis clamps have been devised, such as those of Tortat, Levis and Skillern, but the advantages of my clamp and its distinctive feature is the notched, removable portion of the blades. This feature gives a smooth surface along which to remove the redundant tissue, leaving just the margin required to hold the stitches securely. The removal of these portions of the blades leaves the sutures free for rapid tying while the remainder of the clamp is in place.

S.L. Kistler, “Rapid bloodless circumcision of male and female, and its technic”, Journal of the American Medical Association, Vol. 54, 28 May 1910, p. 1782-3

NOTE
It is not clear just what Kistler meant by circumcision as applied to females, though the proposition that they too would derive vast health benefits from the operation was common in the USA until the 1950s. Kistler's reference to “elongated or hypertrophied parts” suggests that any parts of the clitoral hood, labia or clitoris itself which seemed longer than he considered decent or proper were fair game.