DISLOCATION OF THE PENIS.—This in jury results from a severe blow to the penis when in a flaccid state, tearing the subcutaneous cellular tissue at its root, forcing the organ to become incarcerated in the subcutaneous tissue of the abdo men, scrotum, perineum, or thigh. The mucous layer of the prepuce, which should prevent this accident, usually gives way along the line of the coronary sulcus. The urethra is occasionally rupt ured in the perineum.
There is intense pain, extensive sub cutaneous limmorrhage, and also bleed ing from the meatus. Occasionally there is urinary extravasation and abnormal position of the root of the penis.
Treatment.—The penis should be re turned to its normal position by traction when possible, or by means of a hook introduced into the meatus. Failing in this, it is proper to make incisions to permit of sufficient manipulation that the organ can be reduced. Extravasa tions of urine should be opened and drained, and an external urethrotomy or perincal section performed. Unless re duced early, adhesions may form from which it is not always easy to free the dislocated organ.
Inflammatory Affections of the Penis. —PENms.--An inflammation of the penis, which may be acute and due to gonorrhoeal folliculitis, erysipelas, rupt ure of the urethra with urinary extrav asation, and wounds; or chronic, due either to the rheumatic or gouty diathesis or to syphilis. It is also ascribed to old areas of blood-extravasation which have undergone organization.
When superficial, all the signs of in flammation are present associated with a rapid, inflammatory oedema. In the circumscribed variety the inflammatory symptoms are local and followed by the formation of a tumor, which finally softens, indicating pus-formation. The diffuse form is rapidly followed by gan grene.
The chronic variety is characterized by slow-growing, painless areas of in duration scattered through the cavernous bodies. The erect penis is bent at the seat of induration, and erections are usu ally incomplete in that part anterior to the node.
Treatment.—In the acute diffuse va riety early free and multiple incisions are necessary to prevent gangrene; drainage should be provided for, and antisepsis maintained. Where gangrene has al
ready developed, the treatment should be that appropriate for gangrene in other parts of the body. When spreading slowly, hot antiseptic fomentations should be applied until the slough sep arates, and the remaining simple ulcer treated on general principles. In the rapid-spreading form of gangrene the sloughs should be cut away, and the raw surface left touched with the thermocau tery. Circumscribed abscesses of the cavernous bodies should be opened early and thoroughly drained. The function of the penis may be somewhat interfered with after healing.
In the chronic form of the trouble lit tle can be done. Iodide of potassium and other remedies indicated in rheuma tism and gout should be administered internally, while locally mercurial or ichthyol ointment should be applied. Occasionally pressure with a fine-rubber bandage will bring about a cure.
LYMPHANGITIS.—LyMplIallgitiS iS al ways secondary to peripheral inflamma tion and may be simple or venereal in origin. The vessels feel like fine wires beneath the skin and usually lead to the nearest lymph-glands, which will be found enlarged. Occasionally small nodules form which may soften, break down, and ulcerate, leaving small which may persist for a long time. The condition must be distinguished from phlebitis by the smallness of the vessels, the fact that they are not in the median line, and the much lessened oedema.
Treatment.—Rest, elevation, and the application of evaporating lotions. When they arc dilated without inflammation, pressure or the use of mercurial ointment may cause them to disappear, otherwise excision or a seton is required to bring about a cure.
PHLEBITIS.—ThiS is a rather uncom mon condition and is usually secondary to diseases of the penis or urethra. There is usually considerable pain and cedema, and a quite large indurated cord is felt along the dorsum of the penis exactly in the median line. Occasionally suppura tion takes place.
Treatment.—Best, elevation, and the use of evaporating lotions or mercurial ointment are usually sufficient.