236 ON RECENT IMPROVEMENTS IN THE 



over the end of the stump was hkewise entirely healed except the part where 

 the drainage-tube had lain. The same dressing was continued till this spot 

 also had cicatrized, the blood-clot within the pouch of skin becoming organized 

 without suppuration ; and the patient left the hospital three weeks after the 

 operation, having suffered literally no pain or inconvenience from first to last, 

 and with a remarkably natural appearance of the part. 



This case illustrates well, though on a small scale, the whole subject of this 

 paper. Without antiseptic measures the careful fitting and close stitching of 

 the parts would in all likelihood have been so much trouble thrown away. The 

 wound at the end of the stump would probably in a few days have been freely 

 opened up through suppuration due to putrefaction of the blood-clot in the 

 investing pouch, and the stitches around the urethral orifice would soon have 

 cut their way out under the influence of acrid ammoniacal urine. Again, even 

 though putrefaction had been prevented, had the little drainage-tube been 

 omitted and an additional stitch inserted in its place, tension from accumulated 

 blood and serum would have arisen, producing inflammatory disturbance which 

 might have marred the whole result. And, lastly, if an antiseptic more irritating 

 to the skin or mucous membrane had been kept in contact with the wounds, 

 it would, in proportion to the degree of its irritating property, have interfered 

 with the primary union both at the new meatus urinarius and at the end of 

 the organ. 



It is with regard to this last point that the special value of boracic acid 

 is exemplified. In such a situation it would have been practically impossible 

 to maintain in position a protective layer such as is used under a dressing of 

 carbolic acid ; but, thanks to the mildness of the watery solution of boracic 

 acid, the absence of such protective and the frequent copious ablutions with the 

 antiseptic were productive of no disadvantage. 



In further illustration of the value of the wet boracic lint for operations 

 in this situation I may mention a case of aggravated hypospadias under my 

 care last \vinter. The floor of the urethra was deficient from the end of the 

 penis to about the middle of the scrotum, which in its cleft condition resembled 

 at first sight the labia of a female ; and for about three-quarters of an inch 

 from the end of the glans the mucous membrane was entirely absent, a shallow 

 sulcus lined with the integument being the onty indication of the canal. The 

 mode of procedure adopted was as follows : A straight rod, as large as a full-sized 

 catheter, being held vertical by an assistant, with its extremity inserted in the 

 orifice of the complete part of the urethra in the scrotum, the skin of the penis 

 and front of the scrotum, by virtue of its extreme laxity, could be readily made 

 to slip upon itself so as to cover in the straight bougie, meeting in two folds 



