CHAPTER III.. The Male Generative Organs.

THE MALE GENERATIVE ORGANS.

Section I. OF THE PENIS.

=Congenital Anomalies.= The penis may be very imperfectly developed, even with a normal development of the other organs of generation, although it more frequently occurs when the latter are themselves imperfect.

It occasionally happens that, from an arrest of union in the median line of the penis, a slit or fissure is left communicating with the urethra. This commonly occurs in the under surface, constituting Hypospadias; less frequently on the upper surface, (Epispadias,) and only in cases of extroversion of the bladder.

The prepuce may be wanting.

Congenital phymosis occasionally occurs, usually associated with atrophy of the penis. It is supposed by some, to be a predisposing cause of cancer of the penis.

=Hypertrophy and Atrophy.= In consequence of long-continued onanism, the penis may become hypertrophied, or as the result of chronic irritation and disease, we may have an hypertrophy of the prepuce and of the body of the penis, sometimes attaining an enormous size. Vidal has related and figured a case where the organ reached to below the knees, and was as large as a thigh. Atrophy of the penis, accompanied with obliteration of the cavernous textures, occurs with atrophy of the testicles.

=Fracture of the Penis= has occurred from the giving way of the erectile tissue during coition, in consequence of the state of hyperæmia of the penis. The organ appears broken, and cannot assume the erect condition beyond the part injured.

=Paraphymosis=, by the strangulation of the glans in front of a tight prepuce, may, if not relieved, lead to inflammation, and even gangrene.

=Balanitis= commonly occurs as the result of local irritation, not unfrequently set up by a gonorrhœa. The prepuce is much swollen, infiltrated and reddened. The inflammation is generally complicated with inflammation of the internal lamina of the foreskin, and the mucous membrane of the glans (posthitis), giving rise to excoriation, exudation of coagulable lymph, adhesion of the prepuce to the glans, suppuration and ulceration. “When chronic, it induces exuberant formation of epidermis; and if the deeper parts of the parenchyma of the glans are involved, obliteration, cartilaginous induration and atrophy follow.”

=Herpes of the Glans and Prepuce=, is characterized by the formation of small vesicles or excoriated points upon the mucous membrane of this region, chiefly occurring in persons of a gouty habit of body, with an irritable mucous membrane.

Psoriasis of the prepuce, produces a red, thickened, and fissured condition of the part. Phymosis is apt to occur as a consequence.

=Chancres.= These specific ulcerations form usually upon the glans, although they may be found in the internal surface of the prepuce, the frænum, and near the meatus within the urethra.

The Hunterian or hard chancre, is nearly circular, deep and excavated; base and edges are as hard as cartilage, but the hardness is circumscribed; its color is livid or tawny. It may occur upon the integument, the glans, or the body of the penis.

The non-indurated or soft chancre is more frequently found on the inner surface of the prepuce. It appears as a foul, yellowish, or tawny sore. Indolent fungous granulations are subsequently thrown out, unless it be situated upon the glans.

Phagedenic chancres are of irregular shape, their edges ragged or undermined, their surface yellow and dotted with red streaks. The surrounding margin of skin usually looks pulpy and œdematous; but is sometimes firm and of a vivid red.

The cicatrices left by chancres which have healed, are whitish, more or less hard, striated and depressed.

Morbid Growths.

Warts, belonging to the class of epithelial tumors, sometimes form on the glans, or on the inside of the prepuce. They are commonly the result of repeated inflammations.

Cancer of the penis is of two distinct kinds, occurring as scirrhus or as epithelioma. According to Dr. Walshe, the disease may originate as a warty excrescence, or as a pimple, which discharges an excoriating fluid, scabs, and breaks out afresh, while induration, followed by ulceration, advances at its base. Or it may infiltrate the glans, so as to convert that part into an indurated mass; or venereal ulcers may take on cancerous action.

When of the scirrhus form, it usually springs from the ulcers behind the glans, and may thence invade the neighboring parts of the organ.

Epithelioma, commencing as a tubercle in the prepuce, may after a time give rise to a large, irregular, and sprouting mass, having a granular fungous appearance. In other cases, it commences as a hard scirrhus mass, of a pale, reddish-white color, situated on the glans, or between the prepuce and the glans. This increases in size, cracks, and allows the exudation of a serous fetid discharge. Ulceration then rapidly takes place.

Secondary cancers, except in the adjacent glands, are not a common occurrence. Phymosis and the irritation caused by the retained secretion, seem to act as an exciting, and advancing age as a predisposing cause of cancer.

Encysted tumors, nævus and fibro-plastic tumors, situated about the prepuce, may also occur.