FIGURE 41. Civiale's urethrotome.... 42. Maisonneuve's urethrotome, Bumstead's modification... 43. Maisonneuve's urethrotome, Voillemier's modification.. 44. Otis's dilating urethrotome... 45. Blunt grooved staff for perineal section.... 46. Blunt grooved staff for perineal section, with guide.... 47. Gouley's catheter-staff..... 48. Dieulafoy's small aspirator.... 49. Soft-rubber tube to be worn in suprapubic puncture.. 50. Silver tube to be worn in suprapubic puncture.. 51. Pocket at inferior commissure of the meatus.. PAGE 120 121 121 122 123 123 123 127 129 131 132 54. Hypertrophy of the prostate, with false passage. 55. Hypertrophy of upper portion of prostate.... 56. Posterior median hypertrophy.. 57. Posterior median hypertrophy.. 58. Healthy prostate... 59. Sacculated bladder.... 60. Long-curved silver catheters.. 61. Thompson's curve for soft catheter.. 62. Mercier's catheter coudée (A).. 62. Mercier's catheter bi-coudée (B). 63. Soft-rubber catheter.. 64. Otis's stylet....... 65. Keyes's stylet.... 66. Squire's vertebrated catheter.. 67. Gross's spiral catheter... . . 68. Mercier's false-passage catheter.. 69. Thompson's stone-searcher... 173 174 176 177 177 179 185 187 188 188 188 189 189 190 190 190 191 MAY 23 141 LIBRABL PART I. DISEASES OF THE GENITO-URINARY ORGANS. CHAPTER I. DISEASES OF THE PENIS. Anatomy.-Anomalies; Double Penis; Absence of Penis.-Fracture, Dislocation.-Cutaneous Affections. Tumors.-Cancer.-Amputation of Penis.-The Prepuce; Circumcision.-Phimosis; Remote Results of Phimosis.-Paraphimosis.-The Glans Penis; Herpes Progenitalis, Balanitis, and Posthitis, Vegetations, Epithelioma.-The Corpora Cavernosa; Inflammation, Ossification, Calcification, Gummy Tumor, Circumscribed Chronic Inflammation. THE penis is a genital organ. Its urinary function is purely secondary. It is conformed anatomically to subserve the genital function. In the adult it measures, when at rest, from the root of the scrotum to the meatus urinarius, from two and a half to four inches; when erect, from five to seven inches. It consists essentially of three segments-the two corpora cavernosa, lying together like the barrels of a gun, and the corpus spongiosum-like the ramrod-beneath them, the whole surrounded by integument. THE CORPORA CAVERNOSA arise on either side from the tuberosities and ascending rami of the ischium. They come together under the symphysis pubis, and continue side by side, forming the main bulk of the penis. They terminate anteriorly in a conical extremity, over which the glans penis (the terminal expansion of the corpus spongiosum) fits like a cap. There is no vascular communication between the tissue of the corpora cavernosa and that of the glans penis, nor with that of any part of the corpus spongiosum. Each corpus cavernosum is surrounded by its own fibrous sheathtunica albuginea-which, together, are so dense and strong that they will support the weight of the cadaver without giving way. The * * Cruveilhier, “Traité d'Anatomie descriptive," Paris, 1865, vol. ii, part i, p. 386. sheath is, however, plentifully supplied with elastic fibers, which allow it to accommodate itself to the variable size of the organ. The partition between the corpora cavernosa is perforated by numerous apertures, to insure thorough and symmetrical erection. The tissue proper of the corpora cavernosa is known as spongy, or erectile. Erection takes place when the areolæ of this tissue become distended with blood, as shown in Fig. 2. THE CORPUS SPONGIOSUM URETHRE is also composed of erectile tissue. It surrounds all that portion of the urethra lying in front Б 8 FIGS. 1, 2 (Cruveilhier). TRANSVERSE SECTION OF PENIS.-Fig. 1. Flaccid. Fig. 2. In erection. 1, 2. Borsal vein and artery. 3. Erectile tissue. 4. Tunica albuginea. 5. Integument. 6. Tunica albuginea of corpus spongiosum. 7. Erectile tissue. 8. Urethra. of the triangular ligament, anteriorly forming the cap over the conical extremity of the united corpora cavernosa -known as glans penis-posteriorly terminating in the bulb, which lies just in front of the triangular ligament in the angle of the converging crura penis. THE GLANS PENIS is covered by a semi-mucous membrane endowed with peculiar sensibility, especially around the raised posterior border-the corona glandis. The epithelium covering the glans is fine; the papillæ minute. (Home); the sebaceous glands (of Tyson) large and numerous, and most plentiful about the frænum. These glands secrete the white, badly-smelling material which collects, in uncleanly persons, behind the corona. The func tion of the glans penis is to furnish a soft-skinned expansion for the distribution of the terminal filaments of the nerves of sexual sensibility. One important function of the corpus spongiosum is acquired through its bulb-namely, that of assisting in the expulsion of the last drops of urine or semen from the urethra. The prostate, levator ani, and deep urethral muscles-especially the compressor urethra-contract upon the fluid remaining in the canal after micturition, in that spasmodic effort called by the French the "coup de piston." This forces the last few drops beyond the bulb of the urethra. Now the middle fibers of the accelerator urinæ-those which surround the bulb and adjacent portions of the corpus cavernosum-contract and forcibly drive the blood, which was contained in the areola of the bulb, forward along the corpus spongiosum, forcibly distending that body, and thus bringing the walls of the urethra more closely into contact in a progressive wave. This helps to explain, as |