The modes of gastroraphé described by Galen and Celsus are explained and commented upon by Van Swieten (Comment. cccxi), and by Fabricius ab Aquapendente. (Œuv. Chir. ii, 53.) A complete history of the operation is given by Sprengel. (Hist. de la Méd. xviii, 21.) Ambrose Paré performed the operation exactly like Galen.
SECT. LIII.—ON DEFICIENCY OF THE PREPUCE.
When there is a small deficiency in the skin of the penis, some, in order to repair the deformity, have attempted a double surgical operation; sometimes cutting the skin all round above at the commencement of the penis, in order that by this solution of continuity the skin may be drawn downwards until the glans (as it is called) be covered; and sometimes with a scalpel dissecting its inner surface from the root of the glans, and then drawing it downwards, and surrounding the glans with a soft ligature; but a piece of cloth must be interposed at the incision, in order to prevent an adhesion of the prepuce to the glans. Antyllus approves most of this method, of which he gives a full description, but we have been content with a brief outline, because it is rare that this surgical operation is required, as the complaint neither occasions any defect of the functional office, nor such deformity that one would choose to submit to the hazard of an operation on account of it.
Commentary. Celsus describes the operation as follows: “Cutis circa glandem prehenditur et extenditur, donec illam ipsam condat; ibique deligatur: deinde, juxta pubem, in orbem tergus inciditur, donec coles nudatur; magnâque curâ cavetur, ne vel urinæ iter, vel venæ quæ ibi sunt, incidantur. Eo facto, cutis ad vinculum inclinatur, nudaturque circa pubem velut circulus; eoque linamenta dantur, ut caro increscat, et id impleat: satisque velamenti supra latitudo plagæ præstat. Sed, donec cicatrix sit, cinctum esse id debet: in medio tantum relicto exiguo urinæ itinere.” (vii, 25.)
Rhases directs us to put a proper piece of lead upon the glans, then to draw the prepuce over it, and secure it with a ligature, having previously dissected it from the parts below, if necessary. (Cont. xiv.) This is much the same as our author’s operation for phimosis. See [section lv].
The reader will find the ancient operation described by Fabricius ab Aquapendente. (Œuv. Chirurg. ii, 61.)
SECT. LIV.—ON HYPOSPADIÆUM, OR IMPERFORATE GLANS PENIS.
In many children the glans is not perforated at birth, but the meatus is situated under the part called canis, at the termination of the glans. Hence they can neither make water forwards unless they draw up the member to the pubes, nor procreate, as the semen cannot be injected direct into the uterus. In addition to these defects, the complaint occasions no ordinary deformity. Wherefore, the simplest and least dangerous mode of operation is that by amputation. Having then placed the patient in a supine posture, we have to stretch the glans forcibly with the fingers of the left hand, and then with the point of a scalpel we are to amputate the glans at the corona, not making the amputation obliquely, but carving it, as it were, all round, so that an eminence may appear in the middle resembling the glans. And since a hemorrhage frequently takes place, we may stop it by styptics if possible, but if not, we must have recourse to burning with slender cauteries.