422 



The Penis 



In anasarca the prepuce is specially enlarged, so that to find the en- 

 trance to the urethra it may be necessary to slit up the swollen fore- 

 skin along the dorsal aspect. (Edema may be due to the root of the 

 penis having been constricted by an elastic band or a string. 



The prepuce of the new-born child is usually extremely long, but 

 in the course of subsequent development a proper proportion between 

 the parts is generally established. 



Phimosis (</H/MO<, to close with a muzzle) implies that the prepuce 

 is so tight, or redundant, as to be incapable of 

 easy retraction. When the glans becomes 

 inflamed (balanitis, aAai/o$-, acorn\ or a sore 

 occurs beneath the tight prepuce, circumcision 

 is indispensable. Hardened crusts of smegma 

 and calculi, which have escaped from the 

 bladder, may be lodged beneath a tight fore- 

 skin. Phimosis is very apt to cause inconti- 

 nence of urine (p. 379), especially in childhood. 



I have seen the glans penis of an adult small and wrinkled from com- 

 pression of a foreskin which had been tight from birth. In later life 

 the effects of a chronic irritation of the glans from phimosis, and want 

 of cleanliness, are likely to be hypertrophy of the papillae in the form 

 of large and branching warts, which are not necessarily of venereal 

 origin, and a long continuance of the irritation may cause intractable 

 eczema and eventually epithelioma. I have recently cured a young 

 athlete of intractable and depressing seminal incontinence by removing 

 his long prepuce. 



Phimosis may so obstruct the outflow of urine as to cause the 

 disease known as Surgical Kidney (p. 410). 



For slight phimosis dilatation of the preputial orifice by a pair of 

 dressing forceps may suffice, but, if the measure prove inefficient, cir- 

 cumcision should be performed forthwith. At the time of operation 

 the furrow behind the corona should be completely exposed by break- 

 ing down adhesions, and all smegma should be cleared away. 



When a prepuce with a small orifice has been retracted behind the 

 glans, it may remain caught in the corona, 

 the condition being called para-phimosis 

 (napa, beyond). The glans becomes greatly 

 swollen from the constriction, as does also 

 the lining of the prepuce, which has been 

 thus everted. The constricting band, which 

 is the preputial margin, is on the hindermost 

 depression. By gently but firmly compress- 

 ing the swollen tissues with the finger and 

 thumb of the left hand, they may be emptied 

 of blood, so that with the finger and thumb of the other hand the 

 glans may be pushed back again through the constriction. At some 



