238 ON RECENT IMPROVEMENTS IN THE 



applied an apron of wet boracic lint and gutta-percha tissue, fixed by an ordinary 

 T bandage, which could be loosened at pleasure ; and directions were given 

 to the nurse that when the boy, whose hands were tied out of harm's way, wished 

 to relieve the bladder she should loosen the outer bandage, and, raising the 

 apron, allow him to pass his water through the mass of the permanent dressing 

 into a bed-pan placed beneath him to receive the urine and also a copious 

 effusion of saturated boracic solution which was to be poured on at the con- 

 clusion of the act ; after which the apron was to be readjusted. This plan 

 answered completely : there was nothing to indicate inflammatory disturbance ; 

 and when, after the lapse of about a fortnight, the stitches were removed, 

 perfect union was found to have taken place along the middle line, except a small 

 oval aperture about the base of the prepuce and a minute orifice, like a pin's 

 point, at the scrotum, which now no longer suggested by its form the characters 

 of the other sex. The retractile preputial covering of the glans was quite natural 

 in appearance, except the oval aperture before mentioned, which will no doubt 

 be readily closed at a future period ; and the new canal, being formed of non- 

 contractile material, is sure to remain of adequate calibre. The sores resulting 

 from the incisions were at the same period far advanced in healing, and their 

 cicatrization was soon completed under a continuance of the same mode of 

 dressing. 



There can be no doubt that the irritation caused by fermenting urine has 

 hitherto been a great cause of failure in plastic operations in this situation ; 

 for which, therefore, we may fairly anticipate a far greater measure of success 

 in the future. 



While this paper has been going through the press, another case has occurred 

 so illustrative of this department of the subject that it seems deserving of intro- 

 duction. A boy nine years old being brought to me on account of difficulty of 

 micturition, I found that though, on superficial inspection, the meatus urinarius 

 appeared natural, it was merely represented by a shallow sulcus in the integu- 

 ment, except at the posterior extremity, where an orifice existed so minute as 

 only to admit the eyed end of a fine sewing needle. It would have been an 

 easy matter to have extended this aperture by cutting backwards ; for the 

 soft parts between the urethra and the surface were very thin at the ventral 

 aspect of the organ, so that the edges of the divided skin and mucous membrane 

 could have been readily brought together by sutures for primary union. But such 

 a procedure would have resulted in an inferiorly situated meatus urinarius, or, 

 in other words, a degree of hypospadias. On the other hand, to cut forwards 

 through the substantial spongy texture of the glans seemed at first sight most 

 unpromising, because it would be impossible to cover in the wound with skin 



