Part 24 (1/2)
In some instances the p.e.n.i.s is so large as to forbid coitus and even inconvenience its possessor, measuring as much as ten or even more inches in length. Extraordinary cases of large p.e.n.i.s are reported by Albinus (who mentions it as a cause for sterility), Bartholinus, Fabricius Hilda.n.u.s, Paullini, Peyer, Plater, Schurig, Sinibaldus, and Zacchias. Several cases of enormous p.e.n.i.ses in the new-born have been observed by Wolff and others.
The p.e.n.i.s palme, or suture de la verge of the French, is the name given to those examples of single cutaneous envelope for both the t.e.s.t.i.c.l.es and p.e.n.i.s; the p.e.n.i.s is adherent to the s.c.r.o.t.u.m by its inferior face; the glans only is free and erection is impossible. Chretien cites an instance in a man of twenty-five, and Schrumpf of Wesserling describes an example of this rare anomaly. The p.e.n.i.s and testes were inclosed in a common sac, a slight projection not over 1/4 inch long being seen from the upper part of this curious s.c.r.o.t.u.m. When the child was a year old a plastic operation was performed on this anomalous member with a very satisfactory result. Pet.i.t describes an instance in which the p.e.n.i.s was slightly fused with the s.c.r.o.t.u.m.
There are many varieties of torsion of the p.e.n.i.s. The glans itself may be inclined laterally, the curvature may be total, or there may be a veritable rotation, bringing the inferior face above and the superior face below. Gay describes a child with epispadias whose p.e.n.i.s had undergone such torsion on its axis that its inferior surface looked upward to the left, and the child pa.s.sed urine toward the left shoulder. Follin mentions a similar instance in a boy of twelve with complete epispadias, and Verneuil and Guerlin also record cases, both complicated with a.s.sociate maldevelopment. Caddy mentions a youth of eighteen who had congenital torsion of the p.e.n.i.s with out hypospadias or epispadias. There was a complete half-turn to the left, so that the slit-like urinary meatus was reversed and the frenum was above. Among the older writers who describe incurvation or torsion of the p.e.n.i.s are Arantius, the Ephemerides, Haenel, Pet.i.t, Schurig, Tulpius, and Zacchias.
Zacutus Lusitans speaks of torsion of the p.e.n.i.s from freezing.
Paullini mentions a case the result of masturbation, and Hunter speaks of torsion of the p.e.n.i.s a.s.sociated with arthritis.
Ossification of the p.e.n.i.s.--MacClellann speaks of a man of fifty-two whose p.e.n.i.s was curved and distorted in such a manner that urine could not be pa.s.sed without pain and coitus was impossible. A bony ma.s.s was discovered in the septum between the corpora cavernosa; this was dissected out with much hemorrhage and the upward curvature was removed, but there resulted a slight inclination in the opposite direction. The formation of bone and cartilage in the p.e.n.i.s is quite rare. Velpeau, Kauffmann, Lenhoseck, and Duploy are quoted by Jacobson as having seen this anomaly. There is an excellent preparation in Vienna figured by Demarquay, but no description is given. The Ephemerides and Paullini describe osseous p.e.n.i.ses.
The complete absence of the frenum and prepuce has been observed in animals but is very rare in man. The incomplete or irregular development is more frequent, but most common is excessive development of the prepuce, const.i.tuting phimosis, when there is abnormal adherence with the glans. Instances of phimosis, being quite common, will be pa.s.sed without special mention. Deficient or absent prepuce has been observed by Blasius, Marcellus Donatus, and Gilibert. Partial deficiency is described by Pet.i.t Severinus, and others.
There may be imperforation or congenital occlusion of some portion of the urethra, causing enormous acc.u.mulation of urine in the bladder, but fortunately there is generally in such cases some anomalous opening of the urethra giving vent to the excretions. Tulpius mentions a case of deficient urethra. In the Ephemerides there is an account of a man who had a constant flow of s.e.m.e.n from an abnormal opening in the abdomen.
La Peyroma describes a case of impotence due to e.j.a.c.u.l.a.t.i.o.n of the spermatic ducts into the bladder instead of into the urethra, but remarks that there was a cicatrix of a wound of the neighboring parts.
There are a number of instances in which the urethra has terminated in the r.e.c.t.u.m. Congenital dilatation of the urethral ca.n.a.l is very rare, and generally accompanied by other malformation.
Duplication of the urethra or the existence of two permeable ca.n.a.ls is not accepted by all the authors, some of whom contend that one of the ca.n.a.ls either terminates in a culdesac or is not separate in itself.
Verneuil has published an article clearly exposing a number of cases, showing that it is possible for the urethra to have two or more ca.n.a.ls which are distinct and have separate functions. Fabricius Hilda.n.u.s speaks of a double aperture to the urethra; Marcellus Donatus describes duplicity of the urethra, one of the apertures being in the t.e.s.t.i.c.l.e; and there is another case on record in which there was a urethral aperture in the groin. A case of double urethra in a man of twenty-five living in Styria who was under treatment for gonorrhea is described, the supernumerary urethra opening above the natural one and receiving a sound to the depth of 17 cm. There was purulent gonorrhea in both urethrae. Vesalius has an account of a double urethral aperture, one of which was supposed to give spermatic fluid and the other urine.
Borellus, Testa, and Cruveilhier have reported similar instances.
Instances of double p.e.n.i.s have been discussed under the head of diphallic terata, page 194.
Hypospadias and epispadias are names given to malformations of the urethra in which the wall of the ca.n.a.l is deficient either above or below. These anomalies are particularly interesting, as they are nearly always found in male hermaphrodites, the fissure giving the appearance of a v.u.l.v.a, as the s.c.r.o.t.u.m is sometimes included, and even the perineum may be fissured in continuity with the other parts, thus exaggerating the deception. There seems to be an element of heredity in this malformation, and this allegation is exemplified by Sedgwick, who quotes a case from Heuremann in which a family of females had for generations given birth to males with hypospadias. Belloc mentions a man whose urethra terminated at the base of the frenum who had four sons with the same deformity. Picardat mentions a father and son, both of whom had double urethral orifices, one above the other, from one of which issued urine and from the other s.e.m.e.n--a fact that shows the possibility of inheritance of this malformation. Patients in whom the urethra opens at the root of the p.e.n.i.s, the meatus being imperforate, are not necessarily impotent; as, for instance, Fournier knew of a man whose urethra opened posteriorly who was the father of four children.
Fournier supposed that the s.e.m.e.n e.j.a.c.u.l.a.t.ed vigorously and followed the fissure on the back of the p.e.n.i.s to the uterus, the membrane of the v.a.g.i.n.a supplanting the deficient wall of the urethra. The p.e.n.i.s was short, but about as thick as ordinary.
Gray mentions a curious case in a man afflicted with hypospadias who, suffering with delusions, was confined in the insane asylum at Utica.
When he determined to get married, fully appreciating his physical defect, he resolved to imitate nature, and being of a very ingenious turn of mind, he busied himself with the construction of an artificial p.e.n.i.s. While so engaged he had seized every opportunity to study the conformation of this organ, and finally prepared a body formed of cotton, six inches in length, and shaped like a p.e.n.i.s, minus a prepuce.
He sheathed it in pig's gut and gave it a slight vermilion hue. To the touch it felt elastic, and its shape was maintained by a piece of gutta-percha tubing, around which the cotton was firmly wound. It was fastened to the waist-band by means of straps, a central and an upper one being so arranged that the p.e.n.i.s could be thrown into an erect position and so maintained. He had constructed a flesh-colored covering which completely concealed the straps. With this artificial member he was enabled to deceive his wife for fifteen months, and was only discovered when; she undressed him while he was in a state of intoxication. To further the deception he had told his wife immediately after their marriage that it was quite indecent for a husband to undress in the presence of his wife, and therefore she had always retired first and turned out the light. Partly from fear that his virile power would be questioned and partly from ignorance, the duration of actual coitus would approach an hour. When the discovery was made, his wife hid the instrument with which he had perpetrated a most successful fraud upon her, and the patient subsequently attempted coitus by contact with unsuccessful results, although both parties had incomplete o.r.g.a.s.ms. Shortly afterward evidences of mental derangement appeared and the man became the subject of exalted delusions. His wife, at the time of report, had filed application for divorce. Haslam reports a case in which loss of the p.e.n.i.s was compensated for by the use of an ivory succedaneum. Parallel instances of this kind have been recorded by Ammann and Jonston.
Entire absence of the male s.e.xual apparatus is extremely rare, but Blondin and Velpeau have reported cases.
Complete absence of the t.e.s.t.i.c.l.es, or anorchism, is a comparatively rare anomaly, and it is very difficult to distinguish between anorchism and arrest of development, or simple atrophy, which is much more common. Fisher of Boston describes the case of a man of forty-five, who died of pneumonia. From the age of p.u.b.erty to twenty-five, and even to the day of death, his voice had never changed and his manners were decidedly effeminate. He always sang soprano in concert with females.
After the age of twenty-five, however, his voice became more grave and he could not accompany females with such ease. He had no beard, had never shaved, and had never exhibited amorous propensities or desire for female society. When about twenty-one he became a.s.sociated with a gay company of men and was addicted to the cup, but would never visit houses of ill-fame. On dissection no trace of t.e.s.t.i.c.l.es could be found; the s.c.r.o.t.u.m was soft and flabby. The cerebellum was the exact size of that of a female child.
Individuals with one t.e.s.t.i.c.l.e are called monorchids, and may be divided into three varieties:--
(1) A solitary t.e.s.t.i.c.l.e divided in the middle by a deep fissure, the two lobes being each provided with a spermatic cord on the same side as the lobe.
(2) t.e.s.t.i.c.l.es of the same origin, but with coalescence more general.
(3) A single t.e.s.t.i.c.l.e and two cords.
Gruber of St. Petersburg held a postmortem on a man in January, 1867, in whom the right half of the s.c.r.o.t.u.m, the right t.e.s.t.i.c.l.e, epididymis, and the scrotal and inguinal parts of the right vas deferens were absent. Gruber examined the literature for thirty years up to the time of his report, and found 30 recorded postmortem examinations in which there was absence of the t.e.s.t.i.c.l.e, and in eight of these both t.e.s.t.i.c.l.es were missing. As a rule, natural eunuchs have feeble bodies, are mentally dull, and live only a short time. The p.e.n.i.s is ordinarily defective and there is sometimes another a.s.sociate malformation. They are not always disinclined toward the opposite s.e.x.
Polyorchids are persons who have more than two t.e.s.t.i.c.l.es. For a long time the abnormality was not believed to exist, and some of the observers denied the proof by postmortem examination of any of the cases so diagnosed, but there is at present no doubt of the fact,--three, four, and five t.e.s.t.i.c.l.es having been found at autopsies.
Russell, one of the older writers on the t.e.s.t.i.c.l.e, mentions a monk who was a triorchid, and was so salacious that his indomitable pa.s.sion prevented him from keeping his vows of chast.i.ty. The amorous propensities and generative faculties of polyorchids have always been supposed greater than ordinary. Russell reports another case of a man with a similar peculiarity, who was prescribed a concubine as a reasonable allowance to a man thus endowed.
Morgagni and Meckel say that they never discovered a third t.e.s.t.i.c.l.e in dissections of reputed triorchids, and though Haller has collected records of a great number of triorchids, he has never been able to verify the presence of the third t.e.s.t.i.c.l.e on dissection. Some authors, including Haller, have demonstrated heredity in examples of polyorchism. There is an old instance in which two t.e.s.t.i.c.l.es, one above the other, were found on the right side and one on the left. Macann describes a recruit of twenty, whose s.c.r.o.t.u.m seemed to be much larger on the right than on the left side, although it was not pendulous. On dissection a right and left t.e.s.t.i.c.l.e were found in their normal positions, but situated on the right side between the groin and the normal t.e.s.t.i.c.l.e was a supernumerary organ, not in contact, and having a separate and short cord. Prankard also describes a man with three t.e.s.t.i.c.l.es. Three cases of triorchidism were found in recruits in the British Army. Lane reports a supernumerary testis found in the right half of the s.c.r.o.t.u.m of a boy of fifteen. In a necropsy held on a man killed in battle, Hohlberg discovered three fully developed t.e.s.t.i.c.l.es, two on the right side placed one above the other. The London Medical Record of 1884 quotes Jdanoff of St. Petersburg in mentioning a soldier of twenty-one who had a supernumerary t.e.s.t.i.c.l.e erroneously diagnosed as inguinal hernia. Quoted by the same reference, Bulatoff mentions a soldier who had a third t.e.s.t.i.c.l.e, which diagnosis was confirmed by several of his confreres. They recommended dismissal of the man from the service, as the third t.e.s.t.i.c.l.e, usually resting in some portion of the inguinal ca.n.a.l, caused extra exposure to traumatic influence.