SECT. LVII.—ON CIRCUMCISION.
We do not treat at present of those who are circumcised in conformity to a heathen rite, but of those in whom the prepuce has become black from some affection of the privy part. In such cases, it becomes necessary to cut off the blackened portion all around; and afterwards we must have recourse to the squama æris, with honey, or to pomegranate-rind and tare, in the form of those applications which are made upon a pledget. And if there be a hemorrhage, we must use lunated cauteries, which contribute to two good purposes: I mean the stoppage of the bleeding and of the spreading sore. But if the whole glans be consumed, having introduced a leaden tube into the urethra, we direct the patients to make water through it.
Commentary. See a similar description in Albucasis. (Chirurg. ii, 57.) Albucasis describes the mode of performing the operation on boys, as a rite of the Jewish religion. He directs the prepuce to be cut with a pair of scissors, and the part allowed to bleed freely. From the manner in which he expresses himself respecting the operation, there can be no doubt that he was a Jew, and it is equally clear that our author was a Pagan.
Fabricius ab Aquapendente describes a similar operation. (Œuv. Chirurg. ii, 64.) Guido de Cauliaco directs us to draw the prepuce forwards, and cut it off; after which the bleeding is to be stopped with powders, or the cautery. (vi, 2.)
SECT. LVIII.—OF THYMI ON THE PENIS.
Thymi are fleshy excrescences, forming sometimes upon the glans, and sometimes upon the prepuce; and some of them are malignant, and some are not. Those which are of a mild nature it will be proper to pare away with the edge of a scalpel, and sprinkle the part with chalcitis; but when malignant, the part must be burned after they are removed. If there be thymi on both sides of the prepuce, some internal and others external, we must not attempt all at the same time, lest by mistake we should cut off the prepuce, which is thin; but we must first cut off the internal, and, when they are healed, we may next attempt the external. Some of the moderns effect a cure by cutting them off with a pair of scissors, and by binding them with a horse-hair; as, in like manner, some burn them with the cold cautery.
Commentary. Albucasis copies our author’s description. (Chirurg. ii, 56.) When the tumour is of a malignant nature, he particularly approves of using the actual cautery. These intractable tumours on the genital member are now frequently met with.
SECT. LIX.—ON CATHETERISM, AND INJECTION OF THE BLADDER.
When the urine is suppressed in the bladder, owing to some obstruction, such as a coagulum, or stones, or from any other cause, we have recourse to catheterism for the removal of it. Wherefore, taking a catheter proportionate to the age and sex we prepare the instrument for use. The mode of preparation is this: having bound a little wool round with a thread, and introduced the thread with a sharp rush into the pipe of the catheter, we adapt the wool to the opening at the head of the catheter, and having cut off the projecting parts of the wool with a pair of scissors, we put the catheter into oil. Having then placed the patient on a convenient seat, and used fomentations, if nothing prohibit, we take the catheter and introduce it at first direct down to the base of the penis, then we must draw the privy parts upwards to the umbilicus, (for at this place there is a curvature of the passage,) and thus push the instrument forwards. When in the perineum it approaches the anus, we must bend the member with the instrument in it down to its natural position, for from the perineum to the bladder the passage is upwards; and we must push the instrument forwards until it reach the cavity of the bladder. We afterwards take out the thread fastened into the opening of the catheter, in order that the urine being attracted by the wool may follow, as happens in syphons. Such is the method of introducing the catheter. But since we have often occasion to wash an ulcerated bladder, if an ear-syringe be sufficient to throw in the injection it may be used, and is to be introduced in the manner described above. But if we cannot succeed with it we may fix a skin or the bladder of an ox to the catheter, and throw in the injection through its opening.
Commentary. Although we have treated succinctly of strangury and retention of urine in the [Third Book], it may be proper, before explaining the ancient methods of introducing the catheter, to give some further account of the causes of these complaints, and the opinions entertained by the physiologists with regard to the functional offices of the urinary organs. Galen states that the bladder is possessed of two faculties, a retentive and an expulsive, both of which arise from muscular power; that the retentive resides in the neck of the bladder, and is of the voluntary kind of powers; but that the expulsive belongs to the class of natural or involuntary powers, being of the same kind as the peristaltic faculty of the intestines. When a person, then, makes water voluntarily, it is by suspending the voluntary action of the sphincter vesicæ, that is to say, of the retentive faculty of the bladder, whereby the expulsive or peristaltic powers are brought into action, and the contents of the bladder are thereby evacuated. He properly adds, however, that this involuntary or expulsive faculty may be assisted by the action of the voluntary muscles which surround the bladder, especially the recti muscles of the abdomen. Retention of urine, therefore, may arise from the loss of either of these faculties. The expulsive faculty is most commonly lost, either from over-distension of the bladder, as when its contents have been allowed to accumulate too far, or from injury of the spinal marrow which supplies it with nerves. Rhases remarks that when retention of urine proceeds from debility of the expulsive faculty, the bladder may be evacuated by merely making pressure above the pubes.