DETAILS OF ANTISEPTIC SURGERY 235 



ment being, as usual, less implicated than the spongy and cavernous structures, 

 I proceeded as in a modified circular amputation in a limb, dividing the skin 

 sufficiently in advance of the deeper parts to form a covering for them, and 

 cutting its margin in the shape of short antero-posterior semilunar flaps which 

 might be accurately adjusted without puckering, the removal being completed 

 by a transverse stroke of the knife after retraction of the loose investment. 

 I next sought to carry out the valuable principle first suggested by the late 

 Mr. Teale, of Leeds,^ of endeavouring to obtain union by first intention of the 

 mucous membrane and the skin, so as to prevent subsequent contraction of the 

 orifice. I first slit up the urethra longitudinally at its inferior part for about 

 a third of an inch from its transversely divided extremity in the stump, as 

 advised by Teale, and then perforated the tegumentary pouch at its ventral 

 aspect by a cut equal in length to that in the urethra, taking care that the two 

 openings should exactly correspond in position, and stitched the edges of the 

 hole in the skin accurately, with silver wire at the angles and horsehair along 

 the sides, to the margins of the mucous membrane, paring off the angles of the 

 latter so as to form an oblique oval orifice to the urethra. The edges of the 

 little skin-flaps were now also brought closely together with horsehair stitches, 

 except in the centre, w^here a drainage-tube of crow-quill size was inserted to 

 prevent tension from accumulating blood and serum. The operation was 

 performed under the spray, after the skin had been cleansed with a i to 20 

 carbolic lotion. The vessels having been tied with fine catgut, moist boracic 

 lint was carefulty adjusted so as to cover the end of the stump, but leave the 

 urethral orifice exposed ; and outside this permanent dressing a loose piece of 

 the wet boracic lint was wrapped and covered with gutta-percha tissue, tied 

 with the split end of a bandage which encircled the pelvis. This outer dressing 

 was of course removed by the patient for micturition, and readjusted after 

 washing with boracic solution ; but the deep dressing was left untouched for 

 two days, when it was taken off, entirely free from urinous odour, and, the 

 drainage-tube having been taken out, fresh boracic lint was applied in the same 

 way. The wound was again inspected two days later, and, as there was not 

 the slightest inflammatory blush, and the stitches were evidently occasioning 

 no tension, they were left undisturbed for three days longer, when they were 

 found still lying in their places as they were after the operation a week before, 

 and on their removal the cutaneous and mucous surfaces wore found connected 

 all round the urethral orifice in a line of perfect primary union, and the wound 



* Quoted in Holmes's Surgery, second edition, vol. v, p. i8i, by Professor Huniphiy. who, however 

 proposes another mode of procedure, wliicli suggested to me the idea of providing a co\oring of skin 

 for the end of the stump in combination with Teale's plan. 



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