Dilatation of Phimosis

1886 Boston Medical and Surgical Journal  
half dollar and the placenta could be felt to one side. I opened the head and removed the child as soon as I could sufficiently open the womb. I did not attempt to use forceps for fear of another gush of blood, which would have been quite likely to have proved fatal. The patient made a good recovery. In two of the above cases the placenta passed before the child, and with them the flooding ceased. About five weeks ago, IL S., a young man of twenty-four, came to consult me in regard to a
more » ... . The prepuce, stretched to its utmost would allow a circle of less than three-eighths of an inch in diameter to be seen of the glans. As he contemplated marriage he was desirous of relief, but dreaded the operation of circumcision. I had seen in the British Medical Journal (Novem-8, 1884, and January 31, 1885) articles upon this subject, the first of which articles has reappeared in Braithwaite's Retrospect for July ; but as I was not able to procure readily the instruments described, I improvised one which, though ludicrously simple, perfectly answered the purpose. It was made from an ordinary clothes-pin. I split the pin through to the end, and, cutting away to a proper angle the inner side of the shorter arms. I had twin levers of the first class, which a rubber band at the point of bearing kept together. The ends and edges of the longer arms were carefully filed smooth. I also provided half a yard of elastic cord which, when wound around the shorter arms, gave the necessary power. I inserted the well-oiled ends of the longer arms between the prepuce and glans, and found that I could obtain by my rubber cord any degree of dilatation ; but the stretching was far from being so painless as one of the correspondents of the Journal asserts. Accordingly, before my next trial I applied the four per cent, solution of cocaine, using four drops, and after ten minutes four more. Then waiting ten minutes longer, I inserted the instrument and dilated the foreskin readily, and without causing the slightest pain. I repeated the operation twice a week, and now the prepuce easily passes over the glans. 'Plie instrument costs altogether less than five cents, and as it will accomplish its work readily and painlessly (thanks to cocaine) I have thought it worth presenting to the notice of the profession.
doi:10.1056/nejm188601281140406 fatcat:xak3wzzgcrfzflacfel7hgca4m