664 AMPUTATION OF THE PENIS. 



are then excised, layer by layer, over the space covered by this wound 

 until the urethra is exposed. This is opened at the lower margin 

 of the wound by a transverse section. The catheter is then re- 

 moved, and a grooved director passed into the exposed end of the 

 divided urethra, the groove being directed towards the lower surface 

 of the tube, and the urethra is divided with the bistoury along its 

 middle line throughout the entire length of the part exposed. It 

 is next divided transversely, and each flap of the mucous membrane 

 of the urethra united to the corresponding flap of the integument 

 of the penis by silk sutures. The operation is completed by applying 

 just at the base of the wound, four or five turns of a tightly- 



PiG. 440. — Amputation of the penis showing stump and urethral orifice. 



stretched rubber cord. The ends of the cord are fastened together, 

 and the penis divided an inch or so below by a single cut (Fig. 439). 

 With the method referred to a mass of dead tissue remains for 

 several days adherent to the end of the penis. Any risk of infection 

 is prevented by antiseptic irrigation. The dead mass and ligature 

 fall away between the sixth and tenth days. The stump is then 

 usually much tumefied, but the swelling and cedema rapidly diminish. 

 The wound suppurates little. A layer of granulations soon covers 

 it, becomes hard, and contracts, gradually drawing the skin over 

 the stump until towards the end of the third month, the cicatrix is 

 comparatively small. As for the muco-cutaneous wound, when 

 the sutures hold, and the mucous membrane does not cut through, 

 the apposed edges rapidly unite. Most frequently, however, the 

 mucous membrane cuts through at one or more points and becomes 

 separated from the integument ; vegetations occur on the exposed 



