1974 HUMAN ANATOMY. 



When the swelling consequent upon paraphimosis is well developed there is en- 

 countered first a furrow, the coronary sulcus, which is normally found behind the 

 corona ; in these cases it appears deeper because it is intensified by the oedematous 

 swelling. Covering this furrow, and even overlapping the glans somewhat, is the 

 portion of the prepuce which is normally in contact with the posterior face and border 

 of the corona. Behind this swollen fold is found a second deep, often ulcerated fur- 

 row indicating the position of the preputial muco-cutaneous margin ; this is the actual 

 seat of constriction, and behind it is placed yet another ridge of swollen integument. 



T\\Q fascia poiis (page 1968) gives the organ some of its most important physical 

 characteristics. The tensile strength of the penis, because of its tough fibrous invest- 

 ments, is sufficient to bear the entire weight of the body. That, portion of this fibrous 

 investment which covers the blunt extremities of the two cavernous bodies where they 

 are capped by the glans, delays, and sometimes prevents, the backward extension of 

 inflammatory or infiltrating processes, particularly cancerous infiltration, which pri- 

 marily involve the glans. This fibrous sheath, being a continuation of the deep layer of 

 the superficial fascia, also hmits the forward extension of urinary and purulent infiltra- 

 tions beneath this fascia, such infiltrations leaving the glans uniuA'olved. The free 

 blood-supply to the penis and its rich innervation insure rapid healing in case of 

 wounds, and justify conservative treatment even although the organ has been nearly 

 severed or extensively crushed. 



Contusioyi of the penis is often followed — owing to the laxity of the skin — by 

 such rapid and pronounced ecchymosis and oedema as to simulate gangrene. 



When the vessels of the cavernous bodies are involved there is free subcutaneous 

 bleeding, giving rise to a circumscribed fluctuating tumor, most prominent during 

 erection. This tumor is somewhat slow in forming, and occasionally suppurates. 

 Under conservative treatment it usually disappears. When injury has not only occa- 

 sioned extensive extravasation of blood, but has lacerated the urethral canal, the 

 inflammatory phenomena observed after rupture of the urethra quickly de\'elop. 

 Moreo\'er, there is immediately bleeding from the meatus, which should lead to 

 prompt diagnosis and appropriate treatment. 



Wounds, if involving the erectile tissue, bleed freely, and, if transverse and ex- 

 tensive, may be followed by loss of erectile power in the region anterior to the wound. 

 Ff'acture, in a literal sense, is possible only when the organ has undergone calcifica- 

 tion or ossification {vide infra^, but the term is applied to injuries that result when, 

 during vigorous erection, the penis is subjected to a sudden twist or bend. The 

 resulting condition is not unlike that caused by contusion, but the subcutaneous 

 eftusion is apt to be lacking. The chief lesion is usually in the corpora cavernosa, or 

 in one of them, and is apt, as a result of obliteration of erectile spaces, to leave a 

 flail-like organ, erection anterior to the break being impossible. 



Chronic indnration (ossification, calcification, chronic inflammation) of the sheath 

 and erectile tissue, especially of the corpora cavernosa, is marked by the formation 

 of fibrous, calcareous, or bony thickenings or plates, which form usually in middle- 

 aged or elderly men of gouty diathesis. They cause but little pain, are easily recog- 

 nized by palpation, and are accompanied by bending of the penis to the affected side 

 during erection, which is incomplete in the region anterior to the induration. The 

 condition is unknown before forty or forty-five, and is probably analogous to the 

 thickening and toughening of the palmar fascia, which goes by the name of Dupuy- 

 tren's contraction, and which we recognize as partly due to gout and partly to some 

 constant irritation. Thus they may be met with in both the penis and the hands of 

 the same gouty person (Jacobson). It has been suggested (Metchnikoff) that in 

 their osseous form they represent reversions to the condition existing in many mam- 

 mals and even in the anthropoid apes, in whom an os penis is present. 



Lymphangitis may follov\' peripheral inflammation of any type, but is usually of 

 venereal origin. 



The diagnosis between lymphangitis and phlebitis of the dorsal vein is based 

 upon the much smaller size of the lymphatic vessels as compared with the vein ; upon 

 the fact that the former vessels do not pass upward in the middle line, but are directed 

 into the groins ; and finally upon the ability to lift the indurated vessel up from 

 the deeper parts, this not being possible in the case of the vein, since it is placed in a 



