Til
vol. V. of Holmes'
System of Surgery" Humphry operation of amclose the f.o up pubes as follows:?"I putating have; after making a straight cut. through the penis in the ordinary manner, carried an incision through the raphe of the scrotum into the perin reum, exposing the corpus spongiosum. I then dissected this body from the corpus cavernosum as far as the crura penis, turned it down into the perinauim, and left it hanging out there half an inch beyond the level of the skin. The cut edges of the scrotum were united by a few points Prof.
AMPUTATION OF THE PENIS. By
Surgeon-Major Civil
T.
J. McGanx,
f.r.c.s.e;,
Surgeon, Mysore.
I think it may be accepted as a that but few cases of cancer of the
general rule penis come
in this country, or, at all events, to operative measures, before the submit will whole, or nearly the whole, of the organ is involvto
hospitals
ed in the disease, and with but little of what might be safely called healthy structures left behind. When the disease is limited and confined to
glans and prepuce, with the tissues behind in an apparently healthy condition, amputation may, perhaps in many cases, be safely performed by cutting free of the disease and leaving a the
stump.
operation is a simple one by any of the methods usually adopted, and I am inclined to think well of the old one of removing the organ with one clean sweep of the knife and slitting up and stitching back the urethra. The other, (Hilton's) and by some considered the neater method, which leaves the corpus spongiosum longer than the corpora cavernosa, has the disadvantage, as regards the patient, that the The
retained parts must be cut closer to the disease with the possible retention of a minute portion of the diseased
tissues,
which would
soon
reassert
itself. Of what
the st'unp can be, beyond a mere organ, I am at a loss to know, and
use
micturating assumption or postulate^ be correct, or and if there is the smallest doubt as so, nearly to the integrity of the parts behind the cancerous mass, decidedly the safest course is to remove the whole organ close up to or under the pubes. and that this can be safely and easily rion* if this
the followinc: remarks and
cases
will show.
"
describes the
of suture in front of the urethral
orifice.
The
patient recovered quickly, and experienced no difficulty in passing water through the perineal aperture." In a case demanding entire removal of the penis I amputated as advised in the above. The result was satisfactory as regards the operation itself, and the patient left hospital with the parts perfectly cicatrized, and with no difficulty in passing water through the opening in the perineum. It appeared to me, however, that complete division of the scrotum was an unnecessarily severe procedure, and that the length of time ft took for the divided parts to unite was, in a great measure, avoidable, as, from the mobility
tendency to protrusion of the testicles and contractility of the scrotal structures, sutures rapidly cut through, and strapping was less effective than elsewhere in keeping the parts in opposition and permitting of union by granulation. A modification of Professor Humphry's operation which I performed in my next case, and described in the British Medical Journal of 29th January 1881, under the heading, An Improved Method of Amputatiug the Penis," was done as follows :?The patient was placed on the table in the lithotomy position, and chloroform having been given, an assistant, holding the scrotum in both hands, drew it forwards, keeping the raphe of the scrotum and perinreum in the and
"
same
line.
i-k:v
inches in
scrotum
An
of tw:-and-a-half
incision
length
was
made behind the
in the median line, with its
the bulb ; the corpus
completely exposed;
or
centre
over
spongiosum having
been
and
a
little fine dissection
NEVE ON MALARIOUS URTICARIA.
December, 1SS3.] made
so as
to
separate it laterally from the
cor-
pus cavernosum, the scrotum was allowed to drop and was drawn slightly backwards, and the
penis having
been
seized,
was
pulled
for-
single sweep of the by knife close under the pubis. A few bleeding wards and removed
vessels is
having
again
a
been twisted
drawn forwards
or
tied, the
before,
as
scrotum
when the cut
surface of the corpus spongiosum presents itself through the posterior incision, and this being from the corpus cavernosum, is turned down into the perinreum, and left hanging out
separated
there half
an
inch
beyond
the level of the skin.
The front and back incisions are then united by a few points of suture, and the protruding spongy
body slit on the lower or posterior aspect and the edges united to the perinatal skin on either side by two points of suture ; the operation is completed. On the completion of the operation there is but a small wound visible in front, and the scrotum, which is practically intact, has to be raised to This render the posterior incision visible. method of operation will, I think, be considered by most as a great improvement upon that described by Professor Humphry. The amount of cutting is very much less, a consideration of great weight with every surgeon, the after treatment is much easier, the time occupied in recovery much shorter, and the operation itself perhaps less difficult. The following cases
1.
are
the outlines
operated on :? Devah, Hindu, aged
50,
01
of the
some
admitted
19th
March 1881, with cancer of the penis of six months' duration, involving the zi'hole organOperated on in .the-manner above, described on the 6th
Apr;l 1881,
-'8th ofajie.
.--iinc
and
discharged
well
011
the
month.
Rungiiih; '.Ijiouu, aged C-. admitted to hospital M :'r. Decern be", \ ' r. w :iu incer of the -ver one penis, involving. :h u h -ie organ. year's duration. Operation as above described, performed on the 12th December 18S1, and patient discharged well on the 6th of February following. Recovery in this case was delay'
>
consequence of
a
little too much of the corpus
335
spongiosum having been left, which necessitated its being touched with caustic potash, and subsequently dressed with sulphate of zinc lotion. 3. Naujundiah, Brahmin, aged 45, admitted on the 27th April 1883, with cancer of the penis, involving the whole of the organ right up to the pubis, of one and half years' duration. This man came to hospital in April 1882, but refused operation. He was operated upon on the 1st May 1883 ; the wounds were perfectly healed on the 20th, and he was discharged on the 26th. To get a firm hold of the penis so as to be able to exert to tic
a
traction
some
piece
of
it, it
on
at
whipcord Y' '. '
11
m
was
necessary the base for the f|J
':
purpose. 4. Hootcha
Naik, Hindu, aged 58, admitted to hospital 6th June 1883, with a state of things similar to that in case 3. He was operated on iii a manner precisely the same as the others, and is now (24th June,) within a few days of his discharge. In some of the cases (all are not recorded here) it
necessary to draw off the urine after
was
but in
the
there any with the
diffculty corpus introducing a catheter as described. slit and sutured spongiosum I claim no particular credit for the improvement introduced by me if it is original, and as
operation,
none
was
in
far I
as
I know it is
so
;
nevertheless, I writer
pleased at seeing recently describe, in the British an operation similar to mine, a
was
cannot say
comparatively Journal
Medical and
at
the
same
time omit any mention of urine. One more remark. I have not as yet met with a case of of the
cancer
mine
penis
have been
in
among
Hindus,
Mahomedans, all and if absence of
cleanliiies.-. and retention of be
siilticient
1
>i"
irritating secretion exciting causes, it is easily under-
stood,^.- Mahouiedans respects. J/rs r, '
are
2.1th J line, 1883.
much cleaner in these
vol. V. of Holmes'
System of Surgery" Humphry operation of amclose the f.o up pubes as follows:?"I putating have; after making a straight cut. through the penis in the ordinary manner, carried an incision through the raphe of the scrotum into the perin reum, exposing the corpus spongiosum. I then dissected this body from the corpus cavernosum as far as the crura penis, turned it down into the perinauim, and left it hanging out there half an inch beyond the level of the skin. The cut edges of the scrotum were united by a few points Prof.
AMPUTATION OF THE PENIS. By
Surgeon-Major Civil
T.
J. McGanx,
f.r.c.s.e;,
Surgeon, Mysore.
I think it may be accepted as a that but few cases of cancer of the
general rule penis come
in this country, or, at all events, to operative measures, before the submit will whole, or nearly the whole, of the organ is involvto
hospitals
ed in the disease, and with but little of what might be safely called healthy structures left behind. When the disease is limited and confined to
glans and prepuce, with the tissues behind in an apparently healthy condition, amputation may, perhaps in many cases, be safely performed by cutting free of the disease and leaving a the
stump.
operation is a simple one by any of the methods usually adopted, and I am inclined to think well of the old one of removing the organ with one clean sweep of the knife and slitting up and stitching back the urethra. The other, (Hilton's) and by some considered the neater method, which leaves the corpus spongiosum longer than the corpora cavernosa, has the disadvantage, as regards the patient, that the The
retained parts must be cut closer to the disease with the possible retention of a minute portion of the diseased
tissues,
which would
soon
reassert
itself. Of what
the st'unp can be, beyond a mere organ, I am at a loss to know, and
use
micturating assumption or postulate^ be correct, or and if there is the smallest doubt as so, nearly to the integrity of the parts behind the cancerous mass, decidedly the safest course is to remove the whole organ close up to or under the pubes. and that this can be safely and easily rion* if this
the followinc: remarks and
cases
will show.
"
describes the
of suture in front of the urethral
orifice.
The
patient recovered quickly, and experienced no difficulty in passing water through the perineal aperture." In a case demanding entire removal of the penis I amputated as advised in the above. The result was satisfactory as regards the operation itself, and the patient left hospital with the parts perfectly cicatrized, and with no difficulty in passing water through the opening in the perineum. It appeared to me, however, that complete division of the scrotum was an unnecessarily severe procedure, and that the length of time ft took for the divided parts to unite was, in a great measure, avoidable, as, from the mobility
tendency to protrusion of the testicles and contractility of the scrotal structures, sutures rapidly cut through, and strapping was less effective than elsewhere in keeping the parts in opposition and permitting of union by granulation. A modification of Professor Humphry's operation which I performed in my next case, and described in the British Medical Journal of 29th January 1881, under the heading, An Improved Method of Amputatiug the Penis," was done as follows :?The patient was placed on the table in the lithotomy position, and chloroform having been given, an assistant, holding the scrotum in both hands, drew it forwards, keeping the raphe of the scrotum and perinreum in the and
"
same
line.
i-k:v
inches in
scrotum
An
of tw:-and-a-half
incision
length
was
made behind the
in the median line, with its
the bulb ; the corpus
completely exposed;
or
centre
over
spongiosum having
been
and
a
little fine dissection
NEVE ON MALARIOUS URTICARIA.
December, 1SS3.] made
so as
to
separate it laterally from the
cor-
pus cavernosum, the scrotum was allowed to drop and was drawn slightly backwards, and the
penis having
been
seized,
was
pulled
for-
single sweep of the by knife close under the pubis. A few bleeding wards and removed
vessels is
having
again
a
been twisted
drawn forwards
or
tied, the
before,
as
scrotum
when the cut
surface of the corpus spongiosum presents itself through the posterior incision, and this being from the corpus cavernosum, is turned down into the perinreum, and left hanging out
separated
there half
an
inch
beyond
the level of the skin.
The front and back incisions are then united by a few points of suture, and the protruding spongy
body slit on the lower or posterior aspect and the edges united to the perinatal skin on either side by two points of suture ; the operation is completed. On the completion of the operation there is but a small wound visible in front, and the scrotum, which is practically intact, has to be raised to This render the posterior incision visible. method of operation will, I think, be considered by most as a great improvement upon that described by Professor Humphry. The amount of cutting is very much less, a consideration of great weight with every surgeon, the after treatment is much easier, the time occupied in recovery much shorter, and the operation itself perhaps less difficult. The following cases
1.
are
the outlines
operated on :? Devah, Hindu, aged
50,
01
of the
some
admitted
19th
March 1881, with cancer of the penis of six months' duration, involving the zi'hole organOperated on in .the-manner above, described on the 6th
Apr;l 1881,
-'8th ofajie.
.--iinc
and
discharged
well
011
the
month.
Rungiiih; '.Ijiouu, aged C-. admitted to hospital M :'r. Decern be", \ ' r. w :iu incer of the -ver one penis, involving. :h u h -ie organ. year's duration. Operation as above described, performed on the 12th December 18S1, and patient discharged well on the 6th of February following. Recovery in this case was delay'
>
consequence of
a
little too much of the corpus
335
spongiosum having been left, which necessitated its being touched with caustic potash, and subsequently dressed with sulphate of zinc lotion. 3. Naujundiah, Brahmin, aged 45, admitted on the 27th April 1883, with cancer of the penis, involving the whole of the organ right up to the pubis, of one and half years' duration. This man came to hospital in April 1882, but refused operation. He was operated upon on the 1st May 1883 ; the wounds were perfectly healed on the 20th, and he was discharged on the 26th. To get a firm hold of the penis so as to be able to exert to tic
a
traction
some
piece
of
it, it
on
at
whipcord Y' '. '
11
m
was
necessary the base for the f|J
':
purpose. 4. Hootcha
Naik, Hindu, aged 58, admitted to hospital 6th June 1883, with a state of things similar to that in case 3. He was operated on iii a manner precisely the same as the others, and is now (24th June,) within a few days of his discharge. In some of the cases (all are not recorded here) it
necessary to draw off the urine after
was
but in
the
there any with the
diffculty corpus introducing a catheter as described. slit and sutured spongiosum I claim no particular credit for the improvement introduced by me if it is original, and as
operation,
none
was
in
far I
as
I know it is
so
;
nevertheless, I writer
pleased at seeing recently describe, in the British an operation similar to mine, a
was
cannot say
comparatively Journal
Medical and
at
the
same
time omit any mention of urine. One more remark. I have not as yet met with a case of of the
cancer
mine
penis
have been
in
among
Hindus,
Mahomedans, all and if absence of
cleanliiies.-. and retention of be
siilticient
1
>i"
irritating secretion exciting causes, it is easily under-
stood,^.- Mahouiedans respects. J/rs r, '
are
2.1th J line, 1883.
much cleaner in these
