anomalies and curiosities of medicine-第173部分

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he　penis　made　an　angle　of　about　45　degrees　with　the　pubes；　and　this　condition；　he　affirmed；　lasted　three　months。　On　his　return　to　England　his　penis　was　flaccid；　and　his　symptoms　had　disappeared。

Salzer　presents　an　interesting　paper　on　priapism　which　was　quoted　in　The　Practitioner　of　London。　Salzer　describes　one　patient　of　forty…six　who　awoke　one　morning　with　a　strong　erection　that　could　not　be　reduced　by　any　means。　Urine　was　voided　by　jerks　and　with　difficulty；　and　only　when　the　subject　was　placed　in　the　knee　and　elbow　position。　Despite　all　treatment　this　condition　continued　for　seven　weeks。　At　this　time　the　patient's　spleen　was　noticed　to　be　enormously　enlarged。　The　man　died　about　a　year　after　the　attack；　but　a　necropsy　was　unfortunately　refused。　Salzer；　in　discussing　the　theories　of　priapism；　mentions　eight　cases　previously　reported；　and　concludes；　that　such　cases　are　attributable　to　leukemia。　Kremine　believes　that　continued　priapism　is　produced　by　effusion　of　blood　into　the　corpora　cavernosa；　which　is　impeded　on　its　return。　He　thinks　it　corresponds　to　bleeding　at　the　nose　and　rectum；　which　often　occurs　in　perfectly　healthy　persons。　Longuet　regards　the　condition　of　the　blood　in　leukemia　as　the　cause　of　such　priapism；　and　considers　that　the　circulation　of　the　blood　is　retarded　in　the　smaller　vessels；　while；　owing　to　the　great　increase　in　the　number　of　white　corpuscles；　thrombi　are　formed。　Neidhart　and　Matthias　conclude　that　the　origin　of　this　condition　might　be　sought　for　in　the　disturbance　of　the　nerve…centers。　After　reviewing　all　these　theories；　Salzer　states　that　in　his　case　the　patient　was　previously　healthy　and　never　had　suffered　the　slightest　hemorrhage　in　any　part；　and　he　therefore　rejects　the　theory　of　extravasation。　He　is　inclined　to　suppose　that　the　priapism　was　due　to　the　stimulation　of　the　nervi　erigentes；　brought　about　either　by　anatomic　change　in　the　nerves　themselves；　or　by　pressure　upon　them　by　enlarged　lumbar　glands；　an　associate　condition　of　leukemia。

Burchard　reports　a　most　interesting　case　of　prolonged　priapism　in　an　English　gentleman　of　fifty…three。　When　he　was　called　to　see　the　man　on　July　15th　he　found　him　suffering　with　intense　pain　in　the　penis；　and　in　a　state　of　extreme　exhaustion　after　an　erection　which　had　lasted　five　hours　uninterruptedly；　during　the　whole　of　which　time　the　organ　was　in　a　state　of　violent　and　continuous　spasm。　The　paroxysm　was　controlled　by　3/4　grain　morphin　and　1/50　grain　atropin。　Five　hours　later；　after　a　troubled　sleep；　there　was　another　erection；　which　was　again　relieved　by　hypodermic　medication。　During　the　day　he　had　two　other　paroxysms；　one　lasting　forty…five　minutes；　and　another；　three　hours　later；　lasting　eighteen　minutes。　Both　these　were　controlled　by　morphin。　There　was　no　loss　of　semen；　but　after　the　paroxysms　a　small　quantity　of　glairy　mucus　escaped　from　the　meatus。　The　rigidity　was　remarkable；　simulating　the　spasms　of　tetanus。　No　language　could　adequately　describe　the　suffering　of　the　patient。　Burchard　elicited　the　history　that　the　man　had　suffered　from　nocturnal　emissions　and　erotic　dreams　of　the　most　lascivious　nature；　sometimes　having　three　in　one　night。　During　the　day　he　would　have　eight　or　ten　erections；　unaccompanied　by　any　voluptuous　emotions。　In　these　there　would　rarely　be　any　emission；　but　occasionally　a　small　mucous　discharge。　This　state　of　affairs　had　continued　three　years　up　to　the　time　Burchard　saw　him；　and；　chagrined　by　pain　and　his　malady；　the　patient　had　become　despondent。　After　a　course　of　careful　treatment；　in　which　diet；　sponging；　application　of　ice…bags；　and　ergot　were　features；　this　unfortunate　man　recovered。

Bruce　mentions　the　case　of　an　Irishman　of　fifty…five　who；　without　apparent　cause；　was　affected　with　a　painful　priapism　which　lasted　six　weeks；　and　did　not　subside　even　under　chloroform。　Booth　mentions　a　case　of　priapism　in　a　married　seaman　of　fifty…five；　due　to　local　inflammation　about　the　muscles；　constricting　the　bulb　of　the　penis。　The　affection　lasted　five　weeks；　and　was　extremely　painful。　There　was　a　similar　case　of　priapism　which　lasted　for　three　weeks；　and　was　associated　with　hydrocele　in　a　man　of　forty…eight。

Injuries　of　the　testicle　and　scrotum　may　be　productive　of　most　serious　issue。　It　is　a　well…known　surgical　fact　that　a　major　degree　of　shock　accompanies　a　contusion　of　this　portion　of　the　body。　In　fact；　Chevers　states　that　the　sensitiveness　of　the　testicles　is　so　well　known　in　India；　that　there　are　cases　on　record　in　which　premeditated　murder　has　been　effected　by　Cossiah　women；　by　violently　squeezing　the　testicles　of　their　husbands。　He　also　mentions　another　case　in　which；　in　frustrating　an　attempt　at　rape；　death　was　caused　in　a　similar　manner。　Stalkartt　describes　the　case　of　a　young　man　who；　after　drinking　to　excess　with　his　paramour；　was　either　unable；　or　indifferent　in　gratifying　her　sexual　desire。　The　woman　became　so　enraged　that　she　seized　the　scrotum　and　wrenched　it　from　its　attachments；　exposing　the　testicles。　The　left　testicle　was　completely　denuded；　and　was　hanging　by　the　vas　deferens　and　the　spermatic　vessels。　There　was　little　hemorrhage；　and　the　wound　was　healed　by　granulation。

Avulsion　of　the　male　external　genitalia　is　not　always　accompanied　by　serious　consequences；　and　even　in　some　cases　the　sexual　power　is　preserved。　Knoll　described　a　case　in　1781；　occurring　in　a　peasant　of　thirty…six　who　fell　from　a　horse　under　the　wheels　of　a　carriage。　He　was　first　caught　in　the　revolving　wheels　by　his　apron；　which　drew　him　up　until　his　breeches　were　entangled；　and　finally　his　genitals　were　torn　off。　Not　feeling　much　pain　at　the　time；　he　mounted　his　horse　and　went　to　his　house。　On　examination　it　was　found　that　the　injury　was　accompanied　with　considerable　hemorrhage。　The　wound　extended　from　the　superior　part　of　the　pubes　almost　to　the　anus；　the　canal　of　the　urethra　was　torn　away；　and　the　penis　up　to　the　neck　of　the　bladder。　There　was　no　vestige　of　either　the　right　scrotum　or　testicle。　The　left　testicle　was　hanging　by　its　cord；　enveloped　in　its　tunica　vaginalis。　The　cord　was　swollen　and　resembled　a　penis　stripped　of　its　integument。　The　prostate　was　considerably　contused。　After　two　months　of　suffering　the　patient　recovered；　being　able　to　evacuate　his　urine　through　a　fistulous　opening　that　had　formed。　In　ten　weeks　cicatrization　was　perfect。　In　his　〃Memoirs　of　the　Campaign　of　1811；〃　Larrey　describes　a　soldier　who；　while　standing　with　his　legs　apart；　was　struck　from　behind　by　a　bullet。　The　margin　of　the　sphincter　and；　the　skin　of　the　perineum；　the　bulbous　portion　of　the　urethra；　some　of　the　skin　of　the　scrotum；　and　the　right　testicle　were　destroyed。　The　spermatic　cord　was　divided　close　to　the　skin；　and　the　skin　of　the　penis　and　prepuce　was　torn。　The　soldier　was　left　as　dead　on　the　field；　but　after　four　months'　treatment　he　recovered。

Madden　mentions　a　man　of　fifty　who　fell　under　the　feet　of　a　pair　of　horses；　and　suffered　avulsion　of　the　testicles　through　the　scrotum。　The　organs　were　mangled；　the　spermatic　cord　was　torn　and　hung　over　the　anus；　and　the　penis　was　lacerated　from　the　frenum　down。　The　man　lost　his　testicles；　but　otherwise　completely　recovered。　Brugh　reports　an　instance　of　injury　to　the　genitalia　in　a　boy　of　eighteen　who　was　caught　in　a　threshing…machine。　The　skin　of　the　penis　and　scrotum；　and　the　tissue　from　the　pubes　and　inguinal　region　were　torn　from　the　body。　Cicatrization　and　recovery　were　complete。　Brigham　cites　an　analogous　case　in　a　youth　of　seventeen　who　was　similarly　caught　in　threshing　machinery。　The　skin　of　the　penis　and　the　scrotum　was　entirely　torn　away；　both　sphincters　of　the　anus　were　lacerated；　and　the　perineum　was　divested　of　its　skin　for　a　space　2　1/2　inches　wide。　Recovery　ensued；　leaving　a　penis　which　measured；　when　flaccid；　three　inches　long　and　1　1/2　inches　in　diameter。

There　is　a　case　reported　of　a　man　who　had　his　testicles　caught　in　machinery　while　ginning　cotton。　The　skin　of　the　penis　was　stripped　off　to　its　root；　the　scrotum　torn　off　from　its　base；　and　the　testicles　were　contused　and　lacerated；　and　yet　good　recovery　ensued。　A　peculiarity　of　this　case　was　the　persistent　erection　of　the　penis　when　cold　was　not　applied。

Gibbs　mentions　a　case　in　which　the　entire　scrotum　and　the　perineum；　together　with　an　entire　testicle　and　its　cord　attached；　and　nearly　all　the　integument　of　the　penis　were　torn　off；　yet　the　patient　recovered　with　preservation　of　sexual　powers。　The　patient　was　a　negro　of　twenty…two　who；　while　adjusting　a　belt；　had　his　coat　（closely　buttoned）　caught　in　the　shafting；　and　his　clothes　and　external　genitals　torn　off。　On　examination　it　was　found　that　the　whole　scrotum　was　wrenched　off；　and　also　the　skin　and　cellular　tissue；　from　2　1/2　inches　above　the　spine　of　the　pubes　down　to　the　edge　of　the　sphincter　ani；　including　all　the　breadth　of　the　perineum；　together　with　the　left　testicle　with　five　inches　of　its　cord　attached；　and　all　the　integument　and　cellular　covering　of　the　penis　except　a　rim　nearly　half　an　inch　wide　at　the　extremity　and　continuous　with　the　mucous　membrane　of　the　prepuce。　The　right　testicle　was　hanging　by　its　denuded　cord；　and　was　apparently　covered　only　by　the　tunica　vaginalis　as　high　up　as　the　abdominal　ring；　where　the　elastic　feeling　of　the　intestines　was　distinctly　perceptible。　There　was　not　more　than　half　an　ounce　of　blood　lost。　The　raw　surface　was　dressed；　the　gap　in　the　perineum　brought　together；　and　the　patient　made　complete　recovery；　with　preservation　of　his　sexual　powers。　Other　cases　of　injuries　to　the　external　genital　organs　（self…inflicted）　will　be　found　in　the　next　chapter。

The　preservation　of　the　sexual　power　after　injuries　of　this　kind　is　not　uncommon。　There　is　a　case　reported　of　a　man　whose　testicles　were　completely　torn　away；　and　the　perineal　urethra　so　much　injured　that　micturition　took　place　through　the　wound。　After　a　tedious　process　the　wound　healed　and　the　man　was　discharged；　but　he　returned　in　ten　days　with　gonorrhea；　stating　that　he　had　neither　lost　sexual　desire　nor　power　of　satisfaction。　Robbins　mentions　a　man　of　thirty…eight　who；　in　1874；　had　his　left　testicle　removed。　In　the　following　year　his　right　testicle　became　affected　and　was　also　removed。　The　patient　stated　that　since　the　removal　of　the　second　gland　he　had　regular　sexual　desire　and　coitus；　a