anomalies and curiosities of medicine-第74部分

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　a　well…formed　infant　apparently　without　a　penis；　the　child　passed　urine　through　an　opening　in　the　lower　part　of　the　abdomen　just　above　the　ordinary　location　of　the　penis；　the　scrotum　was　present。　Incisions　were　made　into　a　small　swelling　just　below　the　urinary　opening　in　the　abdomen　which　brought　into　view　the　penis；　the　glans　being　normal　but　the　body　very　small。　The　treatment　consisted　of　pressing　out　the　glans　daily　until　the　wound　healed；　the　penis　receded　spontaneously。　It　is　stated　that　the　organ　would　doubtless　be　equal　to　any　requirements　demanded　of　it。　Demarquay　quotes　a　somewhat　similar　case　in　an　infant；　but　it　had　no　urinary　opening　until　after　operation。

Among　the　older　writers　speaking　of　deficient　or　absent　penis　are　Bartholinus；　Bauhinus；　Cattierus；　the　Ephemerides；　Frank；　Panaroli；　van　der　Wiel；　and　others。　Renauldin　describes　a　man　with　a　small　penis　and　enormous　mammae。　Goschler；　quoted　by　Jacobson；　speaks　of　a　well…developed　man　of　twenty…two；　with　abundant　hair　on　his　chin　and　suprapubic　region　and　the　scrotum　apparently　perfect；　with　median　rapine；　a　careful　search　failed　to　show　any　trace　of　a　penis；　on　the　anterior　wall　of　the　rectum　four　lines　above　the　anus　was　an　orifice　which　gave　vent　to　urine；　the　right　testicle　and　cord　were　normal；　but　there　was　an　acute　orchitis　in　the　left。　Starting　from　just　in　front　of　the　anal　orifice　was　a　fold　of　skin　1　1/2　inches　long　and　3/4　inch　high　continuous　with　the　rapine；　which　seemed　to　be　formed　of　erectile　tissue　and　which　swelled　under　excitement；　the　enlargement　lasting　several　minutes　with　usually　an　emission　from　the　rectum。　It　was　possible　to　pass　a　sound　through　the　opening　in　the　rectum　to　the　bladder　through　a　urethra　1　1/2　inches　wide；　the　patient　had　control　of　the　bladder　and　urinated　from　every　three　to　five　hours。

Many　instances　of　rudimentary　development　of　the　penis　have　been　recorded；　most　of　them　complicated　with　cryptorchism　or　other　abnormality　of　the　sexual　organs。　In　other　instances　the　organ　is　present；　but　the　infantile　type　is　present　all　through　life；　sometimes　the　subjects　are　weak　in　intellect　and　in　a　condition　similar　to　cretinism。　Kaufmann　quotes　a　case　in　a　weakly　boy　of　twelve　whose　penis　was　but　3/4　inch　long；　about　as　thick　as　a　goose…quill；　and　feeling　as　limp　as　a　mere　tube　of　skin；　the　corpora　cavernosa　were　not　entirely　absent；　but　ran　only　from　the　ischium　to　the　junction　of　the　fixed　portion　of　the　penis；　suddenly　terminating　at　this　point。　Nothing　indicative　of　a　prostate　could　be　found。　The　testicles　were　at　the　entrance　of　the　inguinal　canal　and　the　glans　was　only　slightly　developed。

Binet　speaks　of　a　man　of　fifty…three　whose　external　genitalia　were　of　the　size　of　those　of　a　boy　of　nine。　The　penis　was　of　about　the　size　of　the　little　finger；　and　contained　on　each　side　testicles　not　larger　than　a　pea。　There　was　no　hair　on　the　pubes　or　the　face；　giving　the　man　the　aspect　of　an　old　woman。　The　prostate　was　almost　exterminated　and　the　seminal　vesicles　were　very　primitive　in　conformation。　Wilson　was　consulted　by　a　gentleman　of　twenty…six　as　to　his　ability　to　perform　the　marital　function。　In　size　his　penis　and　testicles　hardly　exceeded　those　of　a　boy　of　eight。　He　had　never　felt　desire　for　sexual　intercourse　until　he　became　acquainted　with　his　intended　wife；　since　when　he　had　erections　and　nocturnal　emissions。　The　patient　married　and　became　the　father　of　a　family；　those　parts　which　at　twenty…six　were　so　much　smaller　than　usual　had　increased　at　twenty…eight　to　normal　adult　size。　There　are　three　cases　on　record　in　the　older　literature　of　penises　extremely　primitive　in　development。　They　are　quoted　by　the　Ephemerides；　Plater；　Schenck；　and　Zacchias。　The　result　in　these　cases　was　impotency。

In　the　Army　and　Medical　Museum　at　Washington　are　two　injected　specimens　of　the　male　organ　divested　of　skin。　From　the　meatus　to　the　pubis　they　measure　6　1/2　and　5　1/2　inches；　from　the　extremity　to　the　termination　of　either　crus　9　3/4　and　8　3/4　inches；　and　the　circumferences　are　4　3/4　and　4　1/4　inches。　Between　these　two　we　can　strike　an　average　of　the　size　of　the　normal　penis。

In　some　instances　the　penis　is　so　large　as　to　forbid　coitus　and　even　inconvenience　its　possessor；　measuring　as　much　as　ten　or　even　more　inches　in　length。　Extraordinary　cases　of　large　penis　are　reported　by　Albinus　（who　mentions　it　as　a　cause　for　sterility）；　Bartholinus；　Fabricius　Hildanus；　Paullini；　Peyer；　Plater；　Schurig；　Sinibaldus；　and　Zacchias。　Several　cases　of　enormous　penises　in　the　new…born　have　been　observed　by　Wolff　and　others。　

The　penis　palme；　or　suture　de　la　verge　of　the　French；　is　the　name　given　to　those　examples　of　single　cutaneous　envelope　for　both　the　testicles　and　penis；　the　penis　is　adherent　to　the　scrotum　by　its　inferior　face；　the　glans　only　is　free　and　erection　is　impossible。　Chretien　cites　an　instance　in　a　man　of　twenty…five；　and　Schrumpf　of　Wesserling　describes　an　example　of　this　rare　anomaly。　The　penis　and　testes　were　inclosed　in　a　common　sac；　a　slight　projection　not　over　1/4　inch　long　being　seen　from　the　upper　part　of　this　curious　scrotum。　When　the　child　was　a　year　old　a　plastic　operation　was　performed　on　this　anomalous　member　with　a　very　satisfactory　result。　Petit　describes　an　instance　in　which　the　penis　was　slightly　fused　with　the　scrotum。

There　are　many　varieties　of　torsion　of　the　penis。　The　glans　itself　may　be　inclined　laterally；　the　curvature　may　be　total；　or　there　may　be　a　veritable　rotation；　bringing　the　inferior　face　above　and　the　superior　face　below。　Gay　describes　a　child　with　epispadias　whose　penis　had　undergone　such　torsion　on　its　axis　that　its　inferior　surface　looked　upward　to　the　left；　and　the　child　passed　urine　toward　the　left　shoulder。　Follin　mentions　a　similar　instance　in　a　boy　of　twelve　with　complete　epispadias；　and　Verneuil　and　Guerlin　also　record　cases；　both　complicated　with　associate　maldevelopment。　Caddy　mentions　a　youth　of　eighteen　who　had　congenital　torsion　of　the　penis　with　out　hypospadias　or　epispadias。　There　was　a　complete　half…turn　to　the　left；　so　that　the　slit…like　urinary　meatus　was　reversed　and　the　frenum　was　above。　Among　the　older　writers　who　describe　incurvation　or　torsion　of　the　penis　are　Arantius；　the　Ephemerides；　Haenel；　Petit；　Schurig；　Tulpius；　and　Zacchias。

Zacutus　Lusitans　speaks　of　torsion　of　the　penis　from　freezing。　Paullini　mentions　a　case　the　result　of　masturbation；　and　Hunter　speaks　of　torsion　of　the　penis　associated　with　arthritis。

Ossification　of　the　Penis。MacClellann　speaks　of　a　man　of　fifty…two　whose　penis　was　curved　and　distorted　in　such　a　manner　that　urine　could　not　be　passed　without　pain　and　coitus　was　impossible。　A　bony　mass　was　discovered　in　the　septum　between　the　corpora　cavernosa；　this　was　dissected　out　with　much　hemorrhage　and　the　upward　curvature　was　removed；　but　there　resulted　a　slight　inclination　in　the　opposite　direction。　The　formation　of　bone　and　cartilage　in　the　penis　is　quite　rare。　Velpeau；　Kauffmann；　Lenhoseck；　and　Duploy　are　quoted　by　Jacobson　as　having　seen　this　anomaly。　There　is　an　excellent　preparation　in　Vienna　figured　by　Demarquay；　but　no　description　is　given。　The　Ephemerides　and　Paullini　describe　osseous　penises。

The　complete　absence　of　the　frenum　and　prepuce　has　been　observed　in　animals　but　is　very　rare　in　man。　The　incomplete　or　irregular　development　is　more　frequent；　but　most　common　is　excessive　development　of　the　prepuce；　constituting　phimosis；　when　there　is　abnormal　adherence　with　the　glans。　Instances　of　phimosis；　being　quite　common；　will　be　passed　without　special　mention。　Deficient　or　absent　prepuce　has　been　observed　by　Blasius；　Marcellus　Donatus；　and　Gilibert。　Partial　deficiency　is　described　by　Petit　Severinus；　and　others。

There　may　be　imperforation　or　congenital　occlusion　of　some　portion　of　the　urethra；　causing　enormous　accumulation　of　urine　in　the　bladder；　but　fortunately　there　is　generally　in　such　cases　some　anomalous　opening　of　the　urethra　giving　vent　to　the　excretions。　Tulpius　mentions　a　case　of　deficient　urethra。　In　the　Ephemerides　there　is　an　account　of　a　man　who　had　a　constant　flow　of　semen　from　an　abnormal　opening　in　the　abdomen。　La　Peyroma　describes　a　case　of　impotence　due　to　ejaculation　of　the　spermatic　ducts　into　the　bladder　instead　of　into　the　urethra；　but　remarks　that　there　was　a　cicatrix　of　a　wound　of　the　neighboring　parts。　There　are　a　number　of　instances　in　which　the　urethra　has　terminated　in　the　rectum。　Congenital　dilatation　of　the　urethral　canal　is　very　rare；　and　generally　accompanied　by　other　malformation。

Duplication　of　the　urethra　or　the　existence　of　two　permeable　canals　is　not　accepted　by　all　the　authors；　some　of　whom　contend　that　one　of　the　canals　either　terminates　in　a　culdesac　or　is　not　separate　in　itself。　Verneuil　has　published　an　article　clearly　exposing　a　number　of　cases；　showing　that　it　is　possible　for　the　urethra　to　have　two　or　more　canals　which　are　distinct　and　have　separate　functions。　Fabricius　Hildanus　speaks　of　a　double　aperture　to　the　urethra；　Marcellus　Donatus　describes　duplicity　of　the　urethra；　one　of　the　apertures　being　in　the　testicle；　and　there　is　another　case　on　record　in　which　there　was　a　urethral　aperture　in　the　groin。　A　case　of　double　urethra　in　a　man　of　twenty…five　living　in　Styria　who　was　under　treatment　for　gonorrhea　is　described；　the　supernumerary　urethra　opening　above　the　natural　one　and　receiving　a　sound　to　the　depth　of　17　cm。　There　was　purulent　gonorrhea　in　both　urethrae。　Vesalius　has　an　account　of　a　double　urethral　aperture；　one　of　which　was　supposed　to　give　spermatic　fluid　and　the　other　urine。　Borellus；　Testa；　and　Cruveilhier　have　reported　similar　instances。　Instances　of　double　penis　have　been　discussed　under　the　head　of　diphallic　terata；　page　194。

Hypospadias　and　epispadias　are　names　given　to　malformations　of　the　urethra　in　which　the　wall　of　the　canal　is　deficient　either　above　or　below。　These　anomalies　are　particularly　interesting；　as　they　are　nearly　always　found　in　male　hermaphrodites；　the　fissure　giving　the　appearance　of　a　vulva；　as　the　scrotum　is　sometimes　included；　and　even　the　perineum　may　be　fissured　in　continuity　with　the　other　parts；　thus　exaggerating　the　deception。　There　seems　to　be　an　element　of　heredity　in　this　malformation；　and　this　allegation　is　exemplified　by　Sedgwick；　who　quotes　a　case