572 OPERATIONS ON THE GENITO-UEINAKY APPARATUS. 



or a catlieter, or again enlarged by an incision with the bistoury. 

 Instead of the ordinary string, an elastic ligatm-e may be sub- 

 stituted with the advantage of maintaining an uninterrupted pres- 

 sure upon the tissues up to the moment when mortification is 

 established in the part to be amputated. 



Cauterization. — No catheter is required with this plan. Two 

 ligatures are applied, one anterior, by which the penis is kept out 

 of its sheath, and one posterior, acting as a hemostatic, placed 

 above the point where the division is to be made. The operator 

 then with a flat and sharp cautery, heated to white heat, makes a 

 complete section of the penis. 



But, says Zundel, " as the urethra is especially dehcate and 

 sensitive, it is better, in order to avoid its retraction, to separate 

 it from the cavernous body about half an inch in front of the place 

 where the section is made." A hollow bougie of india rubber 

 inserted into the urethra will also prevent its contraction. 



Professor Nocard has recommended the use of the galvano- 

 cautery, to obtain an easier division of the tissues, a more perfect 

 hemostatis and to shorten the duration of the operation. 



Excision. — After introducing a metallic catheter, a rapid sec- 

 tion of the organ is made by a single stroke of the knife. Again, 

 says Zundel, " when the lu-ethra is reached, it must be dissected 

 a little forward, toward the glans penis, and caused to protrude 

 about half an inch beyond the point cauterized." 



Scraping of the perns. — This method, which was put in prac- 

 tice in 1829 by Moiroud and Delafond, consists in scraping the 

 penis with a bistoury, in such a way that the remaining portion of 

 the organ forms a cone, with its apex formed by the urethra. A 

 catheter may be introduced into the canal previous to the opera- 

 tion and left in place for awhUe ; or again, it may, if thought 

 proper, be entirely dispensed mth. This mode precludes the 

 danger of hemorrhage. 



Crushing. — By operating with the ecraseur, the amputation is 

 perfected without danger of hemorrhage. The chain of the 

 instrument is applied at the point of amputation, and by slow and 

 gradual action, cuts through the tissues until the diseased part 

 drops off. The danger attending this method is that the chain 

 may break during the process, in consequence of the resistance of 

 the cavernous tissue. This accident has certainly been encoun- 

 tered by many practitioners, and we have oui'selves witnessed it 



