anomalies and curiosities of medicine-第172部分

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Amputation　of　the　penis　is　not　always　followed　by　loss　of　the　sexual　power　and　instinct；　but　sometimes　has　the　mental　effect　of　temporarily　increasing　the　desire。　Haslam　reports　the　case　of　a　man　who　slipped　on　the　greasy　deck　of　a　whaler；　and　falling　forward　with　great　violence　upon　a　large　knife　used　to　cut　blubber；　completely　severed　his　penis；　beside　inflicting　a　wound　in　the　abdomen　through　which　the　intestines　protruded。　After　recovery　there　was　a　distinct　increase　of　sexual　desire　and　frequent　nocturnal　emissions。　In　the　same　report　there　is　recorded　the　history　of　a　man　who　had　entirely　lost　his　penis；　but　had　supplied　himself　with　an　ivory　succedaneum。　This　fellow　finally　became　so　libidinous　that　it　was　necessary　to　exclude　him　from　the　workhouse；　of　which　he　was　an　inmate。

Norris　gives　an　account　of　a　private　who　received　a　gunshot　wound　of　the　penis　while　it　was　partly　erect。　The　wound　was　acquired　at　the　second　battle　of　Fredericksburg。　The　ball　entered　near　the　center　of　the　glans　penis；　and　taking　a　slightly　oblique　direction；　it　passed　out　of　the　right　side　of　the　penis　1　1/2　inches　beyond　the　glans；　it　then　entered　the　scrotum；　and　after　striking　the　pelvis　near　the　symphysis；　glanced　off　around　the　innominate　bone；　and　finally　made　its　exit　two　inches　above　the　anus。　The　after…effects　of　this　injury　were　incontinence　of　urine；　and　inability　to　assume　the　erect　position。

Bookey　cites　the　case　of　six　wounds　from　one　bullet　with　recovery。　The　bullet　entered　the　sole　and　emerged　from　the　dorsum　of　the　foot。　It　then　went　through　the　right　buttock　and　came　out　of　the　groin；　only　to　penetrate　the　dorsum　of　the　penis　and　emerge　at　the　upper　part　of　the　glans。　Rose　speaks　of　a　case　in　which　a　man　had　his　clothes　caught　in　machinery；　drawing　in　the　external　genital　organs。　The　testicles　were　found　to　be　uninjured；　but　the　penis　was　doubled　out　of　sight　and　embedded　in　the　scrotum；　from　whence　it　was　restored　to　its　natural　position　and　the　man　recovered。

Nelaton　describes　a　case　of　luxation　of　the　penis　in　a　lad　of　six　who　fell　from　a　cart。　Nelaton　found　the　missing　member　in　the　scrotum；　where　it　had　been　for　nine　days。　He　introduced　Sir　Astley　Cooper's　instrument　for　tying　deeply…seated　arteries　through　a　cutaneous　tube；　and　conducting　the　hook　under　the　corporus　cavernosum；　seized　this　crosswise；　and　by　a　to…and…fro　movement　succeeded　in　replacing　the　organ。

Moldenhauer　describes　the　case　of　a　farmer　of　fifty…seven　who　was　injured　in　a　runaway　accident；　a　wheel　passing　over　his　body　close　to　the　abdomen。　The　glans　penis　could　not　be　recognized；　since　the　penis　in　toto　had　been　torn　from　its　sheath　at　the　corona；　and　had　slipped　or　been　driven　into　the　inguinal　region。　This　author　quotes　Stromeyer's　case；　which　was　that　of　a　boy　of　four　and　a　half　years　who　was　kicked　by　a　horse　in　the　external　genital　region。　The　sheath　was　found　empty　of　the　penis；　which　had　been　driven　into　the　perineum。

Raven　mentions　a　case　of　spontaneous　retraction　of　the　penis　in　a　man　of　twenty…seven。　While　in　bed　he　felt　a　sensation　of　coldness　in　the　penis；　and　on　examination　he　found　the　organ　（a　normal…sized　one）　rapidly　retracting　or　shrinking。　He　hastily　summoned　a　physician；　who　found　that　the　penis　had；　in　fact；　almost　disappeared；　the　glans　being　just　perceptible　under　the　pubic　arch；　and　the　skin　alone　visible。　The　next　day　the　normal　condition　was　restored；　but　the　patient　was　weak　and　nervous　for　several　days　after　his　fright。　In　a　similar　case；　mentioned　by　Ivanhoff；　the　penis　of　a　peasant　of　twenty…three；　a　married　man；　bodily　disappeared；　and　was　only　captured　by　repeated　effort。　The　patient　was　six　days　under　treatment；　and　he　finally　became　so　distrustful　of　his　virile　member　that；　to　be　assured　of　its　constancy；　he　tied　a　string　about　it　above　the　glans。

Injuries　of　the　penis　and　testicles　self…inflicted　are　grouped　together　and　discussed　in　Chapter　XIV。

As　a　rule；　spontaneous　gangrene　of　the　penis　has　its　origin　in　some　intense　fever。　Partridge　describes　a　man　of　forty　who　had　been　the　victim　of　typhus　fever；　and　whose　penis　mortified　and　dried　up；　becoming　black　and　like　the　empty　finger　of　a　cast…off　glove；　in　a　few　days　it　dropped　off。　Boyer　cites　a　case　of　edema　of　the　prepuce；　noticed　on　the　fifteenth　day　of　the　fever；　and　which　was　followed　by　gangrene　of　the　penis。　Rostan　mentions　gangrene　of　the　penis　from　small…pox。　Intermittent　fever　has　been　cited　as　a　cause。　Koehler　reports　a　fatal　instance　of　gangrene　of　the　penis；　caused　by　a　prostatic　abscess　following　gonorrhea。　In　this　case　there　was　thrombosis　of　the　pelvic　veins。　Hutchinson　mentions　a　man　who；　thirty　years　before；　after　six　days'　exposure　on　a　raft；　had　lost　both　legs　by　gangrene。　At　the　age　of　sixty…six　he　was　confined　to　bed　by　subacute　bronchitis；　and　during　this　period　his　whole　penis　became　gangrenous　and　sloughed　off。　This　is　quite　unusual；　as　gangrene　is　usually　associated　with　fever；　it　is　more　than　likely　that　the　gangrene　of　the　leg　was　not　connected　with　that　of　the　penis；　but　that　the　latter　was　a　distinct　after…result。　Possibly　the　prolonged　exposure　at　the　time　he　lost　his　legs　produced　permanent　injury　to　the　blood…vessels　and　nerves　of　the　penis。　There　is　a　case　on　record　in　which；　in　a　man　of　thirty…seven；　gangrene　of　the　penis　followed　delirium　tremens；　and　was　attributed　to　alcoholism。　Quoted　by　Jacobson；　Troisfontaines　records　a　case　of　gangrene　of　the　skin　and　body　of　the　penis　in　a　young　man；　and　without　any　apparent　cause。　Schutz　speaks　of　regeneration　of　the　penis　after　gangrenous　destruction。

Gangrene　of　the　penis　does　not　necessarily　hinder　the　performance　of　marital　functions。　Chance　mentions　a　man　whose　penis　sloughed　off；　leaving　only　a　nipple…like　remnant。　However；　he　married　four　years　later；　and　always　lived　in　harmony　with　his　wife。　At　the　time　of　his　death　he　was　the　father　of　a　child；　subsequent　to　whose　birth　his　wife　had　miscarried；　and　at　the　time　of　report　she　was　daily　expecting　to　be　again　confined。

Willett　relates　the　instance　of　a　horseman　of　thirty…three　who；　after　using　a　combination　of　refuse　oils　to　protect　his　horse　from　gnats；　was　prompted　to　urinate；　and；　in　so　doing；　accidentally　touched　his　penis　with　the　mixture。　Sloughing　phagedena　rapidly　ensued；　but　under　medical　treatment　he　eventually　recovered。

Priapism　is　sometimes　seen　as　a　curious　symptom　of　lesion　of　the　spinal　cord。　In　such　cases　it　is　totally　unconnected　with　any　voluptuous　sensation　and　is　only　found　accompanied　by　motor　paralysis。　It　may　occur　spontaneously　immediately　after　accident　involving　the　cord；　and　is　then　probably　due　to　undue　excitement　of　the　portion　of　the　cord　below　the　lesion；　which　is　deprived　of　the　regulating　influence　of　the　brain。　Priapism　may　also　develop　spontaneously　at　a　later　period；　and　is　then　due　to　central　irritation　from　extravasation　into　the　substance　of　the　cord；　or　to　some　reflex　cause。　It　may　also　occur　from　simple　concussion；　as　shown　by　a　case　reported　by　Le　Gros　Clark。　Pressure　on　the　cerebellum　is　supposed　to　account　for　cases　of　priapism　observed　in　executions　and　suicides　by　hanging。　There　is　an　instance　recorded　of　an　Italian　〃castrate〃　who　said　he　provoked　sexual　pleasure　by　partially　hanging　himself。　He　accidentally　ended　his　life　in　pursuance　of　this　peculiar　habit。　The　facts　were　elicited　by　testimony　at　the　inquest。

There　are；　however；　in　literature；　records　of　long　continued　priapism　in　which　either　the　cause　is　due　to　excessive　stimulation　of　the　sexual　center　or　in　which　the　cause　is　obscure　or　unknown。　There　may　or　may　not　be　accompanying　voluptuous　feelings。　The　older　records　contain　instances　of　continued　infantile　priapism　caused　by　the　constant　irritation　of　ascarides　and　also　records　of　prolonged　priapism　associated　with　intense　agony　and　spasmodic　cramps。　Zacutus　Lusitanus　speaks　of　a　Viceroy　of　India　who　had　a　long　attack　of　stubborn　priapism　without　any　voluptuous　feeling。　Gross　refers　to　prolonged　priapism；　and　remarks　that　the　majority　of　cases　seem　to　be　due　to　excessive　coitus。

Moore　reports　a　case　in　a　man　of　forty　who　had　been　married　fifteen　years；　and　who　suffered　spasmodic　contractions　of　the　muscles　of　the　penis　after　an　incomplete　coitus。　This　pseudopriapism　continued　for　twenty…three　days；　during　which　time　he　had　unsuccessfully　resorted　to　the　application　of　cold；　bleeding；　and　other　treatment；　but　on　the　twenty…sixth　day；　after　the　use　of　bladders　filled　with　cold　water；　there　was　a　discharge　from　the　urethra　of　a　glairy　mucus；　similar　in　nature　to　that　in　seminal　debility。　There　was　then　complete　relaxation　of　the　organ。　During　all　this　time　the　man　slept　very　little；　only　occasionally　dozing。　Donne　describes　an　athletic　laborer　of　twenty…five　who　received　a　wound　from　a　rifle…ball　penetrating　the　cranial　parietes　immediately　in　the　posterior　superior　angle　of　the　parietal　bone；　and　a　few　lines　from　the　lambdoid　suture。　The　ball　did　not　make　egress；　but　passed　posteriorly　downward。　Reaction　was　established　on　the　third　day；　but　the　inflammatory　symptoms　influenced　the　genitalia。　Priapism　began　on　the　fifth　day；　at　which　time　the　patient　became　affected　with　a　salacious　appetite；　and　was　rational　upon　every　subject　except　that　pertaining　to　venery。　He　grew　worse　on　the　sixth　day；　and　his　medical　adviser　was　obliged　to　prohibit　a　female　attendant。　Priapism　continued；　but　the　man　went　into　a　soporose　condition；　with　occasional　intervals　of　satyriasis。　In　this　condition　he　survived　nine　days；　there　was　not　the　slightest　abatement　of　the　priapism　until　a　few　moments　before　his　death。　Tripe　relates　the　history　of　a　seaman　of　twenty…five；　in　perfect　health；　who；　arriving　from　Calcutta　on　April　12；　1884；　lodged　with　a　female　until　the　26th。　At　this　time　he　experienced　an　unusually　fierce　desire；　with　intense　erection　of　the　penis　which；　with　pain；　lasted　throughout　the　night。　Though　coitus　was　frequently　resorted　to；　these　symptoms　continued。　He　sought　aid　at　the　London　Hospital；　but　the　priapism　was　persistent；　and　when　he　left；　on　May　10th；　the　penis　formed　an　acute　angle　with　the　pubes；　and　he　again　had　free　intercourse　with　the　same　female。　At　the　time　of　leaving　England　the　penis　made　an　angle　of　about　45　degrees　with　the　pubes；　and　this　condition；