le
organ, and then attacks the corpora cavernosa; it may even extend as
high as the umbilicus. This disease spares no age; it attacks young and
old alike.

There is not a case recorded of this disease that particularized any
other starting-point than the swelling, tension, active or passive
congestion that takes place in the integument of the penis. By this it
must not be understood that the initial disease or inflammatory action
that produces the gangrene must necessarily have its seat in the
integument, but that it is the integument of the penis (and especially
that of the prepuce) in which, through the laxity of its tissues,
passive congestion is favored that the gangrenous action begins. That
this is the actual case there can be but little doubt about, as, even
where the gangrene invades the body of the penis itself, even where the
inflammatory action may have started from a violent urethritis, that
condition of blood which favors gangrenous results will be found to
have begun during its state of stasis, where it has parted with much of
its watery element, as well as considerable of its vitality, while in
its slow, tedious, and obstructed passage through the prepuce. Some of
this dark, thickish blood, finding its way from the integumentary return
circulation to that of the deeper structure, becomes there a mechanical
as well as a pathological cause for that impediment to the free
circulation of the parts, through its altered physiological condition.
The deeper structures of the penis, besides their own blood-supply,
carry back into the deeper or systemic circulation a large supply from
the integumentary tissues, when in the latter, owing to the greater
supply due to any inflammatory action, the blood-current is delayed and
impeded in its lax and easily-dilatable tissues, and blood-changes occur
favoring the gangrene in the deeper tissues, so that, whether the
gangrene first takes place in the body of the penis or in the scrotum,
it will be in the prepuce or adjoining integument that its real
originating causes will be found.

Baron Boyer, in speaking of the inflammation of the penis, observes that
the intensity of the swelling, great pain, and difficulty of urination
that follow have led many to believe that the inflammation of the deeper
structures really always formed a part of the disease. In otherwise
healthy and vigorous subjects it does not, however, extend beyond the
skin, as has been demonstrated where the