DETAILS OF ANTISEPTIC SURGERY 239 



or mucous membrane, and the lateral granulating surfaces which must result 

 would have a powerful tendency to coalescence at their angle of union in front. 

 But on reflection I determined to try this latter method, in the hope that a more 

 favourable issue might be obtained through avoiding as much as possible all 

 irritation of the divided textures, by providing a smooth metallic surface for 

 contact witli them, and at the same time preventing the urine from becoming 

 acrid through putrefaction. The operation was performed, on the 9th of March, 

 by making successive notches forwards with a tenotomy knife guided by succes- 

 sively larger metallic rods till the incision extended through the whole length 

 of the superficial sulcus which indicated the natural position of the meatus, 

 and a No. 12 bougie could be passed freely into the canal. I then introduced 

 and secured with a t bandage a gum-elastic catheter, of about No. 9 size, having 

 its anterior end sheathed for an inch and a half or so with a tube of Berlin silver 

 to serve the double purpose of presenting a smooth surface to the divided 

 textures and conferring rigidity upon the portion of the flexible tube which 

 occupied the terminal part of the canal and that which projected beyond it, 

 so that it might be tied in with perfect security. The metallic portion was 

 also expanded at a short distance from its free end into a collar presenting 

 a concave surface towards the glans, to protect the new meatus from irritation 

 by the threads used for tying in the instrument. The catheter was made long 

 enough to reach back to the membranous part of the urethra, but not into the 

 bladder, in order to allow the patient control over his urine ; and the eye was 

 terminal instead of lateral, to admit of free exit for the fluid. The antiseptic 

 arrangements were exactly as in the last case ; that is to say, I trusted to the 

 ascertained physiological fact that the healthy urethra contains no fermentative 

 organisms ; and, after scrupulously cleansing the external integument with 

 I to 20 carbolic lotion, conducted the entire operation under the spray, and 

 at its conclusion packed moist boracic lint around and over the organ, making 

 it especially substantial in the perineum, where the urine would flow down ; 

 and over this permanent dressing, which w^as hxed by stitches to the retaining 

 bandage, was arranged a movable portion, in the form of an apron, of boracic 

 lint, covered with thin macintosh ; a special nurse being provided to watch 

 the boy, and attend to him during acts of micturition, as in the former case. 

 The deep dressing was left untouched for Ave da\'s, except that the patient 

 passed his water through it, and that boracic lotion was poured freeh' over it 

 after each occasion. When removed, it was found free from any ammoniacal 

 odour, and a similar dressing was apphed without disturbing the catheter. 

 The second deep dressing was left untouched for another week, the boy mean- 

 while having lost entirely the pain in micturition of which he complained during 



