vitiated blood and
its retention in such lax tissues as those of the prepuce, through the
medium of the enlarged preputial veins, coupled with the lessened
sensibilities of the bladder and his perhaps semi-conscious or
unconscious condition, and an equally unconscious bladder, he is, to say
the least of it,--if in possession of a prepuce,--also the unconscious
possessor of a certain degree of percentage, no matter how small or
fractional that may be, of recovering from his fever without his penis.
Dr. W. W. McKay, of the U. S. Marine Hospital Service of San Diego,
attended a case of typho-malarial fever in consultation with me, where,
but for the persistent, intelligent, but delicate use of the catheter
for nearly three weeks the penis would have become gangrenous. The
subject was an uraemic, irritable, nervous, leathery-prepuced individual;
the organ was unusually large, the skin of the penis thick, and it was
only by keeping the bladder empty that prevented a state of engorgement
that would have effectually interfered with further catheterization. As
it was, the penis was often dank, livid, and discolored from the passive
engorgement.

The writer saw a similar case with the late Dr. F. H. Milligan, of
Minnesota. The congestion in this case was due to a gonorrhoeal
inflammation involving the skin of the whole penis, retention having
followed painful micturition, and the swelling of the penis following
the retention; the prepuce was enormously distended, and the penis
seemed in a state of erection as far as dimension and rigidity were
concerned. The man, a steam-boat cook, informed us that it was fully
twice as large as when rigidly erect in health. All efforts to reduce
the swelling were unavailing; neither punctures, leeches, nor
scarifications were of any avail; catheterization was impossible, but,
after relieving the bladder by the supra-pubic aspiration, the patient
experienced some relief. He, nevertheless, lost the whole skin of the
penis, with that of the pubis and on the front of the scrotum. The man
ran into a low form of fever, with uraemic symptoms; the stench was so
great that it was almost impossible to remain in the same room with him;
but he finally made a slow and very tedious recovery. In healing there
was considerable downward curvature of the penis, which, however, did
not prevent him from following his old, dissolute course of life.[102]

A calm, unprejudiced consideration of the subject of the li