THE PENIS. 1011 



Surgical Anatomy. The relation of the prostate to the rectum should be noted : by means 

 of the finger introduced into the gut the surgeon detects enlargement or other disease of this 

 organ ; he can feel the apex of the gland, which is the guide to Cock's operation for stricture ; 

 he is enabled also by the same means to direct the point of a catheter when its introduction is 

 attended with difficulty either from injury or disease of the membranous or prostatic portions of 

 the urethra. When the finger is introduced into the bowel the surgeon may, in some cases, 

 especially in boys, learn the position, as well as the size and weight, of a calculus in the bladder; 

 and in the operation for its removal, if, as is not unfrequently the case, it should be lodged behind 

 an enlarged prostate, it may be displaced from its position by pressing upward the base of the 

 bladder from the rectum. The prostate gland is occasionally the seat of suppuration, either due to 

 injury, gonorrhoea, or tuberculous disease. The gland, being enveloped in a dense unyielding 

 capsule, determines the course of the abscess, and also explains the great pain which is present 

 in the acute form of the disease. The abscess most frequently bursts into the urethra, the 

 direction in which there is least resistance, but may occasionally burst into the rectum, or more 

 rarely in the perinseum. In advanced life the prostate becomes considerably enlarged, and pro- 

 jects into the bladder so as to impede the passage of the urine. According to Dr. Messer's 

 researches, conducted at Greenwich Hospital, it would seem that such obstruction exists in 20 

 per cent, of all men over sixty years of age. In some cases the enlargement aifects principally 

 the lateral lobes, which may undergo considerable enlargement without causing much incon- 

 venience. In other cases it would seem that the middle lobe enlarges most, and even a small 

 enlargement of this lobe may act injuriously, by forming a sort of valve over the urethral orifice, 

 preventing the passage of the urine, and the more the patient strains, the more completely will 

 it block the opening into the urethra. In consequence of the enlargement of the prostate a 

 pouch is formed at the base of the bladder behind the projection, in which water collects and 

 cannot entirely be expelled. It becomes decomposed and ammoniacal, and leads to cystitis. 

 For this condition "prostatectomy" is sometimes done. The bladder is opened by an incision 

 above the symphysis pubis, the mucous membrane incised, and the enlarged and projecting 

 middle lobe enucleated. 



COWPER'S GLANDS. 



Cowper's Glands are two small, rounded, and somewhat lobulated bodies of 

 a yellow color, about the size of peas, placed behind the fore part of the mem- 

 branous portion of the urethra, between the two layers of the triangular ligament. 

 They lie close above the bulb, and are enclosed by the transverse fibres of the 

 Compressor urethrge muscle. Their existence is said to be constant : they gradually 

 diminish in size as age advances. 



Structure. Each gland consists of several lobules held together by a fibrous 

 investment. Each lobule consists of a number of acini lined by columnar 

 epithelial cells, opening into one duct, which, joining with the ducts of other 

 lobules outside the gland, form a single excretory duct. The excretory duct of 

 each gland, nearly an inch in length, passes obliquely forward beneath the 

 mucous membrane, and opens by a minute orifice on the floor of the bulbous 

 portion of the urethra. 



THE PENIS. 



The Penis consists of a root, body, and extremity or glans penis. 



The root is firmly connected to the rami of the os pubis and ischium by two 

 strong tapering, fibrous processes, the crura, and to the front of the symphysis 

 pubis by the suspensory ligament, a strong band of fibrous tissue which passes 

 downward from the front of the symphysis pubis to the upper surface of the root 

 of the penis, where it splits into two portions and blends with the fascial sheath 

 of the organ. 



The extremity or glans penis, presents the form of an obtuse cone, flattened 

 from above downward. At its summit is a vertical fissure, the orifice of the 

 urethra (meatus urinarius). The base of the glaris forms a rounded projecting 

 border, the corona glandis, and behind the corona is a deep constriction, the 

 cervix. Upon both of these parts numerous small sebaceous glands are found, 

 the glandulce Tysonii odoriferce. They secrete a sebaceous matter of very peculiar 

 odor, which probably contains caseine and becomes easily decomposed. 



1 Stieda (Comptes rendus du XII Congrts International de Medec.we, Moscow, 1897) asserts that 

 Tyson's glands are never found on the corona glandis, and that what have hitherto been mistaken for 

 glands are really large papillae. 



