AMPUTATION OF THE PENIS.. 573 



in two instances. On one occasion it was found necessary to re- 

 place the chain twice, and to complete the amputation with the 

 knife. 



Keynal has modified the crushing operation by making the 

 action of the ecraseur slower. He has invented a smaU instru- 

 ment (ecraseiir) which is left in place for two or three days, being 

 tightened every day, or several times a day, until the mortification 

 is complete, and the diseased penis sloughs off. In this method, 

 a metallic catheter is placed in the urethra ; ia the other the 

 catheter is not required. 



In reflecting upon the various modes of operation we have 

 thus described, and noting especially the two very important, and 

 indeed, essential requirements referred to by Zundel, in respect to 

 the matters of micturition and hemorrhage, we are struck with 

 the fact that in none of those methods are these obvious require- 

 ments complied with, or if they are, it is in a manner so faintly 

 impUed, and so indefinite and unsatisfactory as to be scarcely 

 intelligible, and certainly to leave no distinct impression on the 

 miad, of the importance of the points referred to. 



In every case the danger of possible subsequent interference with 

 micturition is threatened, whether the catheter is used during or 

 after the operation, or even, we fear, if left in the passage " at least 

 two months," as recommended by Peuch and Toussaiat. We can 

 remember cases of our own which, with even a longer retention 

 of the catheter, were followed by failure. We have attempted the 

 formation of an artificial urethral opening below the ischial arch, 

 and with no better result. 



We are tempted to believe that the hemorrhage is less danger- 

 ous than many think, and we believe it could be controlled by 

 ordinary pressure, or by plugging the sheath afterward, or by 

 still other means of hemostasia. 



Taking all this into consideration, we cannot but think strange 

 of it, that the process used in human surgery, which we find 

 merely mentioned in some European works, but which we believe 

 has been performed by Gerlach, and which we ourselves adopted 

 more than fifteen years ago, should be practicaUy ignored or 

 rejected by writers as weU as practitioners. We have practiced it 

 during the period mentioned without having encountered the 

 slightest complication or troublesome sequelse. 



We refer to it as the only safe, and as, therefore, the best mode 



