There are a few surgical operations appertaining to gonorrhoea and syphilis, which require to be ad verted to. In both of these diseases, phymosis, which is a swollen condition of the prepuce, with inability to denude the glans penis, frequently occurs, and when it takes place in syphilis, and the surgeon suspects chancres beneath it, it ought to be cut up, by inserting the curved sharp-pointed bistoury, with a button of wax, between the prepuce and glans, until its point reach the angle of reflec tion between them, when the operator, retracting the skin, pushes the point of the bistoury through the prepuce in the mesial line, and opposite the frenum, or by the side of the frenum, and cuts at once outwards. The two sides should be stitched individually, to accelerate their healing. A con tracted state of the free margin of the prepuce is a frequent congenital affection, and should always be divided, so that the individual may be able to denude the glans; for, as Mr. Roux observes, such a condition predisposes to cancer of the penis.
Paraphymosis is a contracted condition of the prepuce behind the glans, preventing the latter from being covered, and frequently happens to boys in their innocent gambols. In this affection, the glans becomes tumefied, and both it and the pre puce are infiltrated with serum; sometimes giving a peculiar twisted shape and appearance to the organ. If recent, it may be reduced; and, in general, a few punctures of the lancet, followed by fomentations or poultices, subdue the swelling, and allow the pre puce to be brought forward; but in some cases it is requisite to divide the strictured integuments and mucous membrane of the prepuce with a bistoury. Abscesses sometimes occur in the lacuna of the urethra, which require to be freely opened from without, otherwise they are liable to produce reten tion of urine, fistula in perineo et ano, and if into the scrotum, they prove fatal. When a chancre affects the frenum prxputii, the latter should be di vided with a bistoury.
The prepuce, glans, and even the body of the penis sometimes become indurated, and the glans ultimately cancerous or fungous, either sponta neously or in consequence of repeated attacks of syphilis, and sometimes from neglected warty ex crescences. The discharge in such cases is ex tremely fetid and sanious. If the remedies recom mended under syphilis fail to cure it, the diseased portion ought to be removed by laying hold of the penis, and cutting it off at once, at a healthy por tion of the member; then instantly inserting a flex ible catheter in the urethra, securing the arteries, approximating the edges of the wound, from above downwards with suture and adhesive plaster, but leaving the catheter free. The wound to be dressed
on the third or fourth day.
The testis is extremely liable to be affected in gonorrhoea, and when inflamed, swollen, and pain ful, it is termed hernia humoralis: and is treated by antiphlogistic remedies, with the injection of warm water into the urethra, to reproduce the discharge which is ordinarily checked, or to mitigate the irri tation of the canal, the source of the disease of the testis. If the patient cannot procure leeches, he should immerse the scrotum in warm water, or stand before a fire until the veins become turgid, when they should be lanced in several points, and the scrotum again immersed in warm water; the patient standing all the time, for whenever he sits the bleeding ceases. After the activity of the in flammation has been subdued, and if the swelling remains, the scrotum should be fumigated with mercury, or anointed with mercurial ointment, having ultimately camphor mixed with it. In some cases an alterative course of mercury, with sarsa parilla, is requisite, with a succession of blisters, and the insertion of the bougie into the urethra, and the patient ought to be confined to the hori zontal position for a considerable period. The testis sometimes suppurates, and should then be freely opened, as recommended under acute and mammary abscesses. Occasionally a fungus shoots forth, which requires to be removed either with the knife or the caustic. At other times wasting, or a total disappearance of one or even both testes occa sionally takes place, and generally occurs between 14 and 20 years of age; and sometimes from the most simple accidental causes.
The different species of sarcomy, and the theory of their formation, have been described under dis eases of the mamma; and the medullary, and carci nomatous of the testis, in no respect differ from these affections of the mamma, either in character or treatment. The medullary very soon contami nates the spermatic cord and lymphatic glands in the region of the kidney, the latter appearing in the form of a tumour in the short space of a few weeks, so that unless castration be performed very early in this species of sarcoma, it soon becomes incurable. It attacks the constitution so early as four years of age, but more commonly between fifteen and thirty five.