The surgical diseases of the genito-urinary organs including syphilis / by E.L. Keyes ; a revision of Van Buren and Keyes's text-book upon the same subjects.

  • Keyes, E. L. (Edward Lawrence), 1843-1924.
Date:
1889, ©1888
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Licence: Public Domain Mark

Credit: The surgical diseases of the genito-urinary organs including syphilis / by E.L. Keyes ; a revision of Van Buren and Keyes's text-book upon the same subjects. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    or, unless it becomes troublesome, by getting constantly inllamccl, or occasions and keeps uj) balanitis. Great length of the prepuce is some- times the result of constant traction, as in children with stone. CIRCUMCISION. In this operation the orilice of the prejiuce, with more or less of its mucous and cutaneous layers, is cut away. According to Hebrew chronologists, circumcision was instituted as a religious rite by Abra- ham in the year of the world 2059—nineteen hundred and forty-one years before Christ. Several Eastern nations still practice it as a hygienic measure. The chosen people preserve the custom as a re- ligious ceremony, performing it on the eighth day. Few operations in surgery have received more modifications than this simple one of ablation of the prepuce. The indication is to re- move the orilice of the prepuce and all redundant tissue, and to insure looseness of what is left. This may be accomplished as follows : If phimosis exists, first insert a well-oiled probe into the preputial cul-de-sac, and with it sweep the entire surface of the glans to detect adhesions and break them up, if they are not too firm. Then mark oflf with an aniline pencil the limits of the integument which it is proposed to remove. This line should follow the curve of the corona glaudis at a short distance in front of it, while the member is lying at rest. !Evow seize the redundant ^Dre- puce laterally on both sides, and draw it forward until the circumcision forcej^s can be locked in such a manner upon the redundant integument that the aniline line shall lie just in front of the closed blades, taking care not to include the tip of the glans in the grasp of the forceps. To do this the forceps must not be applied transversely to the long axis of the ]ienis, but obliquely, and sometimes it is necessary to roll the integument a little forward and not to catch the preputial orifice as a point of traction in order to get the aniline line outside of the forceps. With scissors curved on the flat, the outlying portion of prepuce may now be cut away. This method of operating removes two dangers. The aniline line insures a removal of exactly that portion of integument which it is desired to take away, and the possibility of cutting away a band of integument of in- definite dimensions is averted. Moreover, a loose oval orifice is insured for the new prepuce, and the narrow, circular, con- stricting band of cicatrix, sometimes left by the old operation to re- new the deformity after healing, becomes impossible.* Furthermore, * I have more than once been called upon to relieve by operation a phimosis resulting from a former operation (Keyes). circumcision.