Amputation of the penis 385 



then with a strong antiseptic solution. The skin of this field 

 ■is very filthy, and as the wound is one that on account of 

 its position, can not be submitted to much after-care, it must 

 at all hazards be kept from being unnecessarily infected dur- 

 ing the amputation. 



INSTRUMENTS REQUIRED.- 1. Scalpels, two or 

 three, exceptionally sharp ones. The dissection of the ure- 

 thra from the penis itself, which is hereafter recommended, 

 necessitates the use of very keen edged knives. 



2. Dissecting forceps. 



3. Artery forceps. 



4. Needles and strong braided silk. 



5. Muslin bandage one and a half yards long. 



6. Catheter. 



TECHNIQUE.— First Step.— Adjustment of the Tourni- 

 quet. — The penis is drawn out as far as possible and held 

 firmly by an assistant and the muslin bandage, rolled into a 

 loose cord, is applied around it at the level of the sheath ori- 

 fice. The bandage is applied in the form of a double-half 

 hitch, drawn very tight and then secured by a firm double 

 knot. The protruding ends of the bandage now serve as a 

 hold to keep the penis out in a perfectly exposed and control- 

 lable position. 



Second Step.-^Dissection of the Urethra.— Beginning at 

 the meatus, leaving the normal urethral termination unmo- 

 lested, the, urethra is carefully dissected out as far back as 

 the proposed point of section. The first incision to this 

 end is a line through the skin from the point of section to the 

 meatus, exposing the urethra along the entire part to be 

 amputated. The, incision is then carried around the red 

 meatus, releasing it from the surrounding skin. The cathe- 

 ter is inserted into the urethra as far as the tourniquet, to 

 facilitate the dissection, which is now continued from before 

 backward until the point of section is reached. In dissecting 

 the urethra care is taken not to cut into it here and there, 

 as might easily be accidentally done if some pains are not 

 taken to prevent, and equal care is taken not to leave any of 

 the surrounding penal tissues attached to it. No part of the 

 cavernous body which surmounts the urethra superiorly 

 should be left attached to the dissected urethra. When the 

 dissection has been completed, if properly done, only the mu- 

 cous membrane and its surrounding muscular coat should be 

 included, for if a part of the cavernous body is attached to it 

 and can not as a consequence be ligated, troublesome bleed- 

 ing is sure to follow the completion of the amputation. 



Third Step. — Amputation. — The amputation, which is ef- 



