Journal : Photographic review of medicine & surgery ; vol. 2., no. 2.
Philadelphia : J. B. Lippincott & Co., 1871-72.
Description : p. 11-12,  pl. ; ill.: 1 photo. ; 24 cm.
Photograph : mounted albumen.
Subject : Prepuce — Genital warts; Balanitis.
WILLIAM FRIEND, aged 21, English, came to my service, at the New York Dispensary, November 12th, 1869, complaining of warts upon his penis. Upon examination, I found that the distal end of the organ was surrounded and nearly enveloped in a huge mass of sessile and pedunculated warts, and that the prepuce was situated under the glans penis, in the position it usually assumes after its perforation by chancroids. The weight of this mass must have been about ten or twelve ounces, and it was of the size of a small clinched fist. When closely inspected, it could be seen that the prepuce had been perforated upon its dorsal aspect, and that from the posterior portion of the glans penis, from the margins of the rent in the prepuce, as well as from its internal surface, these warts had sprung. The anterior portion of the glans was free, except just at the lips of the meatus urinarius, where a quite large wart was situated. The mass presented the usual rosy-red appearance, but the warts, though many of them were pedunculated, were larger at their base than they usually are, forming a more solid mass than they do when they grow in the form of spearlike processes. Those which grew from the perforation were wholly sessile, and so thoroughly obscured the relation of the parts that it could only be determined by carefully examining the organ. The mass emitted a very foul and diffusive smell, which was due to ulceration occurring between the closely packed warts, and upon their surfaces and between them, a thick purulent matter was seen. So offensive was this smell that the other patients complained of the man's presence. Besides this odor, the mass was the source of extreme annoyance from its great bulk.
The history of the case is as follows: The patient naturally had a long, tight prepuce, and had for some years been troubled with balanitis. He never had syphilis or any ulcer upon his penis, and had not cohabited for nearly a year previous to his coming under my observation. Three months before he applied to me, he had had a very severe attack of balanitis, at which time he embarked for America in a sailing vessel. In the early days of the voyage he noticed some warts upon the back part of the glans, and also at the meatus urinarius, and though at that time he was able to retract the prepuce, in consequence of want of cleanliness, the warts grew so rapidly that retraction was very soon rendered impossible. In about three weeks a perforation was produced by the warts confined under the prepuce, and through it the glans was thus liberated. As there was no physician upon the vessel, he received no treatment, and the warts rapidly grew until they reached the size already described. The patient thinks that the whole process was accomplished in less than two months. Fearing the excessive hemorrhage which would inevitably occur if the mass was removed at one operation, I intended to gradually remove it, as circumstances would indicate, by such measures as escharotics, excision, and perhaps by ligation. But I was unable to do this, as the patient failed to receive a remittance from England with which he could pay for comfortable lodgings while under treatment, and as I then had no hospital wards into which I could place him, he was necessitated to go to the Immigrants' Hospital. During the time he was under my care, I ordered him to apply a weak solution of carbolic acid, which had the effect of materially lessening the odor. About six months afterward, he returned to the dispensary and showed me his penis in a normal condition, minus its prepuce. From what I could learn from him, he had been treated in the manner in which I had proposed to treat him. The case is interesting, as showing the advisability of operation in cases in which the prepuce is long and tight, particularly if attended by any balanitis, and it also shows the necessity of early interference in such cases, when the warts are situated about the fossa glandis.