AMPUTATION OF THE PENIS. 661 



Amputation may be rendered necessary, as described, by the 

 presence of tumours, by paralysis, and by inflammation and necrosis 

 of the penis. The following methods have been proposed : — ■ 



(1) Ligation. This gives the greatest security against bleeding; 

 is, however, very painful, and requires particular care to preserve 

 the urethra. To prevent its occlusion from pressure of the ligature, 

 the uretha must previously be dissected out, or a metal tube thrust 

 into it to keep it open. The elastic ligature is particularly valuable, 

 and will be considered later. Hertwig recommends the castrating 

 loop. By daily tightening the cord, the penis is cut through in 

 from six to eight days. When the ligature has to be applied high 

 up the prepuce must previously be laid open. 



Ligation is, of course, useless in dogs over the region of the os 

 penis. 



(2) The actual cautery. To prevent bleeding, a knife-shaped 

 cautery has been recommended. Its application is very painful, 

 but the pain may be avoided by narcosis. The urethra is exposed, 

 and the penis cut through with the cautery. In order to fix it 

 conveniently, two ligatures are passed around it, and the division 

 made between them ; particular care is required in severing the 

 dorsal vessels. Nocard recommends the galvano-cautery for small 

 animals, though it is not always to be found even in large cliniques. 



(3) Simple section. It has often been remarked that even in 

 large animals simple section produces no dangerous bleeding. 

 Some operators first ligature the dorsal vessels, others cut through 

 them at once ; Barthelemy and Chariot operated in this way in 

 the horse, Fellenberg in the dog. Two ligatures are applied, between 

 which the amputation is made ; the upper ligature prevents bleeding. 

 That even this is not always necessary is shown by a case of 

 Hunting's, where a pony's penis was simply cut through, the stump 

 compressed by an assistant for half an hour, and no particular 

 bleeding ensued. If the horse is cast for operation, that portion 

 of the prepuce covering the penis may be drawn together with sutures 

 in front of the stump. Haase operated in this way, using catgut, 

 and states having had healing by primary intention. In such cases 

 it is necessary to expose the urethra, and divide its mucous mem- 

 brane, which is stitched to the tissues on either side to prevent 

 stricture. 



If the animal is cast, the actual cautery may be employed after 

 section to check bleeding. It is better to ligature each bleeding 

 vessel separately, and in the horse to draw the integument over 

 the stump and suture it in that position. 



