Suspensory Ligament of Penis 423 



time subsequently circumcision should be performed or para-phimosis 

 will recur. 



A long prepuce is apt to give rise to < irritation of the bladder ' ; it 

 is the converse of the proposition of stone in the bladder giving rise 

 to an itching at the end of the penis. By day, the boy endeavours to 

 allay the symptoms by pinching the prepuce ; but by night, when the 

 brain is dormant, the voluntary movements suspended, and the super- 

 vision of the genito-urinary tract given over to the cells of the grey 

 matter of the cord, physiological mismanagement is apt to occur. 

 The sensory filaments which are distributed to the muco-cutaneous 

 tissue at the end of the penis are derived from the internal pudic trunk, 

 itself a branch of the sacral plexus (p. 379). The nerves of the 

 plexus lose themselves in the grey matter of a certain part of the spinal 

 cord, from which are passing out, through that same interlacement, 

 the efferent fibres, which are destined for the supply of the muscular 

 walls of the bladder. But more than this, the same colony of cells 

 receives the filaments which carry up sensations from the mucous 

 membrane which lines that viscus. It may be on account of the ex- 

 ceeding instability of the protoplasmic substance of those cells, or 

 that by education and design they are occupied with the care of 

 the bladder rather than of the end of the penis ; but in one way or 

 another they are induced to interpret the irritation of the filaments 

 coming from the latter and less important area as evidence of distress 

 from the bladder itself. For this disquieting condition they have 

 only one means of affording relief, and, putting it in force, the boy is 

 punished in the morning, perhaps, for wetting his bed. 



Circumcision may be rendered a bloodless operation by gently 

 emptying the penis of blood, by compression, and then slipping an 

 india-rubber ring over its root. The prepuce being cut off, the mucous 

 membrane is torn back by two pairs of dressing-forceps and secured 

 by fine catgut sutures. Sutures are not absolutely necessaiy, but 

 they diminish the risk of secondary haemorrhage and promote rapid 

 healing. One suture should be passed deeply through the fraenum, for 

 thence haemorrhage is most likely to occur. The operation should 

 not be performed by passing a director under the dorsal aspect of the 

 foreskin and then incising ; for it has happened that the director has 

 been run along the urethra, and that the dorsal part of the gians itself 

 has been thus divided. 



The frcenum contains an artery of good size, and if the band be 

 torn through during coitus, or if the artery be implicated in a venereal 

 ulceration, serious haemorrhage may result. A short fraenum may 

 cause discomfort, and may require division. 



The suspensory ligament of the penis is attached above to the pubic 

 symphysis, and descends in a fan-shaped manner to surround the penis 

 in a thin aponeurotic layer, \vhich, under the name of fascia penis, 

 invests the vessels and nerves (p. 385). Pus forming beneath this fascia 



