1920 Journal of the American Medical Association (JAMA)  
A need for improvement in the technic of draping the penis for urologic work has long been felt. The towel employed after the penis has been cleaned is usually one with a hole in the center. Often the hole is either too small, leading to constriction of the penis, or too large, resulting in the carrying of pubic hairs into the operative field. The use of several towels round the base of the penis is just as unsatisfactory. The towel presented herewith for routine use in instrumentation and
more » ... scopy is recomended for better and cleaner technic. The towel (Fig. 1) is so designed that it has a hole, to the edges of which is attached a conical pocket with a draw Fig. 1.-Towel for urologie work. string at the apex. The measurements of the towel as found convenient at the Hebrew Hospital are given in the illustration. It is easily made by sewing together two corresponding pieces of material, and then making a band for the drawstring. The penis is cleansed, and a sterile towel then placed over it. The first three fingers of one hand are introduced into the pocket ; the glans penis is grasped and brought out. The Fig. 2.-Towel in use; nothing but glans penis exposed. draw-string is then tightened behind the glans in the coronary sulcus (Fig. 2) . By this method nothing but the glans penis is exposed. The strings at the corners of the towel may be tied on each side beneath the thighs. The towel has been employed successfully for circumcisions and for plastic work on the penis, as well as for instrumentation. For those who are still using the snare for the removal of tonsils, I offer a tenaculum which gives the operator a firmer hold, so that he can more easily dissect the adherent gland from the pillars. The snare can be more easily slipped over this instrument than other forceps used for this purpose, and when traction is made, less likelihood of its tearing out Fig. 1.-Tenaculum open, ready to lock. occurs. This firm hold enables the surgeon to reach the base with his snare with greater facility. This instrument can also be used wherever volsella are indicated, i. e., for work around the uterus. It takes up less room and holds the uterus with a firm grip. It will be found useful also for the removal of neoplasms with a firm consistency, which require considerable dissection from the substructures, such as fibromas, sarcomas and sebaceous cyst capsules\p=m-\infact, any tumor or Fig. 2. -Segments, with set screw. structure requiring removal in which a firm hold of the tissue to be extirpated is desired by the surgeon. In removal of the tonsils the distal prongs are embedded in the gland just anterior to the posterior pillar. The gland is now pulled outward and the instrument deflected to the opposite side of the mouth and the proximal prongs are then locked into the gland. Care must be exercised before locking that the anterior pillar is not included in the bite. After removal the tissue is released by lifting the proximal prong by means of two alae on the lateral aspect of the elevation (which is used to facilitate the locking*)f the instrument), lifting it from the serrations on the inferior surface of the prong. A little experience enables the operator to release it within a few seconds. The accompanying illustrations of the segments will clear up the principle on which it was devised. I am indebted to V. Mueller, instrument maker of Chicago, for valuable suggestions concerning the mechanics of the instrument. My colleagues at the hospitals have suggested changes which I rtope to incorporate in subsequent modifications should I deem them expedient. 3014 Fullerton Avnue.
doi:10.1001/jama.1920.26220460001016 fatcat:5yejhzwyrjahtjgceqgbjox6sa