DETAILS OF ANTISEPTIC SURGERY 237 



in the middle line, and my object was to get the margins of these folds to unite 

 by paring them and stitching them together, so as to complete the urethra 

 with epidermis-covered skin on the internal as well as the external surface. 

 But, as I knew that perfect absence of tension in the uniting parts would be 

 essential to success, I freed the skin by three preliminary incisions, one in the 

 middle line of the dorsum of the penis throughout its length except the preputial 

 margin, and two in the anterior part of the scrotum, obliquely placed so as to 

 be more or less parallel to the urethra at that situation. These incisions gaping 

 widely permitted the cutaneous folds to meet with the utmost freedom in the 

 situation of the proposed raphe, and their rounded margins being pared off, 

 they were closely sewn together with deep sutures of silver wire and intermediate 

 superficial ones of horsehair for accurate approximation of the external cutaneous 

 edges, the wounds at the sites of the preliminary incisions being left to heal 

 as they might. 



As regards the antiseptic measures, the penis and scrotum were thoroughly 

 washed with i to 20 carbolic lotion before the operation, which was performed 

 throughout under the spra\s as it was of essential importance to avoid the 

 presence of any septic material in the blood-clots which might collect between 

 the approximated raw surfaces or in the interior of the new urethra. Then 

 with respect to the subsequent avoidance of the access of putrefaction, I knew 

 that no contamination would come from within — that is to say, from the sound 

 part of the urethra — because it had been abundantly established by experiments 

 which I had made with reference to the germ theory of fermentative changes ^ 

 that a perfectly healthy urethral mucous membrane is free to its extreme orifice 

 from septic organisms. All that was needed, therefore, was an efficient external 

 antiseptic dressing, mild enough in its action to permit healing to take place 

 beneath it, for which purpose wet boracic lint was the most eligible. But 

 there was this peculiarity in the present case, as compared with that of cancer 

 of the penis above recorded, that the patient, being only six years old. could 

 not be entrusted with the management of an}- part of the dressing on the occa- 

 sions of micturition ; and even if a special nurse w^re provided for this charge, 

 there would be great risk of negligence on her part letting in the septic mischief. 

 This difficulty was got over bv never allowing the parts to be exposed at all, 

 either by nurse or patient, but keeping them permanently covered with a mass 

 of moist boracic lint, securely fixed in ]wsition b\- stitching it to a T bandage, 

 the ends of the s})lit longitudinal part of which were not onl\- attached to the 

 jmrt that encircled the pelvis, but were also carried round tlie uj-tper parts of 

 the thighs and crossed over the perineum. Over this permanent dressing was 



' Sec ' A further Conlnbulion to tl)c Natural History of Bacteria ', tic. (See vol. i, p. 309.) 



