Non- Venereal Infections which Invade the Genitalia 331 



than tuberculosis of the glans or of the sheath. The prepu- 

 tial membrane, which is far more delicate than that of the 

 sheath, is exposed during copulation to special injury at 

 the base of the glans. At this point the epithelium of the 

 glans becomes reflected, to constitute the lining epithelium 

 of the preputial sac. At the moment of the copulatory 

 thrust, the parietal, or outer preputial membrane is sud- 

 denly and violently reversed, to constitute the covering of 

 the penis from the base of the glans backwards for a dis- 

 tance approximately equal to the length of the glans itself. 

 Further back, the sheath mucous membrane succeeds, the 

 prepuce as the mucous covering of the protruded penial 

 body. The prepuce and the sheath mucosa become completely 

 reversed. That end of the sheath mucosa which, while the 

 penis was at rest, was situated most anteriorly now be- 

 comes most posterior. The mucosa of the sheath and of the 

 prepuce become reversed in relation to each other. When 

 the penis is at rest, the prepuce is behind the sheath, but 

 when the penis is protruded the prepuce is in front of the 

 reversed sheath mucosa. Accordingly the prepuce, at the 

 point of its attachment to the base of the glans, is one of 

 the most vulnerable areas at which tuberculosis and other 

 infections may effect an entrance. When infection occurs, 

 it usually leaves scant trace in the epithelium of the glans, 

 but involves chiefly the lymph glands of the submucosa. 



As soon as infection occurs and inflammation is estab- 

 lished, the loose areolar tissue between the prepuce and the 

 external dartoid sheath becomes involved, adhesions occur, 

 and the penis is incarcerated. By studying Figures 8-11, 

 pp. 14-18, it will be seen that as soon as such inflammatory 

 adhesions become established copulation is at an end, be- 

 cause the preputial wall can not become reflected upon the 

 body of the penis. The adhesion of the outer with the inner 

 layer at the base of the glans serves to hold the penis firmly 

 in its retracted position. 



Clinically, the lesion is probably not usually observed un- 

 til well established. That is, the infection probably goes 

 unobserved even though several copulations are made dur- 



