Pubis

“ In the female sex this association between the face, throat, nose, and pubis does not exist; whence no hair grows on their chins at the time of puberty, nor does their voices change, or their necks thicken. This happens probably from there being in them a more exquisite sensitive sympathy between the pubis and the breasts. Hence their breasts swell at the time of puberty, and secrete milk at the time of parturition. ”

“ In the female the iliac fossæ are larger, the interval separating the angle of the pubis from the acetabulum is greater, causing the prominence of the hips and wider separation of the thighs, the superior straight is larger and more elliptical, the curve of the sacrum deeper and more regular, the tuberosities of the ischii are further apart, and the arch of the pubis broader. ”

“ Thus, when the bladder is full, its upper part may be felt rising above the pubis, that portion of the lower part of the belly that is covered with hair. In very fat persons the bladder is flattened by the weight of the intestines, and obliged to find room where it can, as in pregnant women. Anatomists, when describing the bladder, speak of its body, base, or upper part, sides and neck, where the urethra or water passage begins, and which is surrounded by the prostate gland. ”

“ In hairy individuals the malady is often persistent, due to the fact that ova have become attached to the hair and a new progeny soon hatched out. Continued treatment over a few weeks will usually suffice to rid the patient of their presence.
Pediculosis Pubis.
Describe the symptoms of pediculosis pubis.
Pediculosis pubis is a condition due to the presence of the pediculus pubis, or crab-louse. It is characterized by more or less itching about the genitalia, together with papules, excoriations, and other inflammatory lesions. The amount of irritation varies ”

“ Preparation of the External Genitals and Vagina.—The pubis and the external genitals should be shaved. The woman should be drawn down to the edge of the bed, and the anus, the external genitals, and the vagina should be scrubbed with green soap. The vagina should be washed throughout. The nurse may do this by inserting one or two fingers, or she may retract the perineum with the Sims speculum, and scrub the vagina, the fornices, and the vaginal cervix with cotton held in forceps. ”

“ Operation.—A large curved staff with a central groove is to be held firmly hooked up against the symphysis pubis, and then steadied by the left forefinger in the rectum. The operator pierces the raphe of the perineum with a long straight bistoury about half an inch above the verge of the anus, enters the groove of the staff, and cuts inwards, almost, but not quite, into the bladder. In withdrawing the knife the wound in the urethra is enlarged upwards towards the scrotum. ”

“ With those however is love’s pleasure most exquisite, whose testicles, when they are lusty and fully matured, are delivered to the surgeons, the pubis being already black with hair. The organs are spared till they are full and ready ”

“ Il, ilium ; a, b, its anterior and posterior extremities; Is, ischium, Pb, pubis; Tr, trochanter of the femur of the Dinosaur; T, tibia; F, fibula; As, astragalus; Ca, calcaneum; 1, the distal division of the tarsus; I, II, III, IV, V, the digits. Thus the ischia of a Dinosaurian are more bird-like than those of any existing reptile, but retain the reptilian union in a symphysis. 3. In all reptiles the pubis is inclined forwards as well as downwards towards the ventral median line. In all except the Crocodile it takes a considerable share in the formation of the acetabulum ”

“ There being four varieties of it, according to Leonides; three of them occur in men and one in women. In men, sometimes about the perineum and sometimes about the middle of the scrotum, there is the appearance of a female pudendum with hair; and in addition to these there is a third variety, in which the discharge of urine takes place at the scrotum as from a female pudendum. In women there is often found above the pudendum and in the situation of the pubes the appearance of a man’s privy parts, there being three bodies projecting there, one like a penis, and two like testicles. ”

“ Motion, particularly jolting as in rough riding, causes pain. This pain is referred to the lower part of the belly, to the perineum, to the end of the penis, the urethra, the anus. The straining after urination may be absent or of the most intense character, leading to prolapse of the rectum and causing excruciating torture. The urine always contains pus scattered through it, and generally also more or less pus in that semi-solid condition known as stringy mucus. Stringy mucus is pus gelatinized by the ammonia of the decomposing urine. ”

“ In the male it may spread over the penis, involve the glans, scrotum, and upper part of the thighs. In either sex it may spread in the course of years to the pubes, over the perineum, and into the rectum, the recto-vaginal septum in the female ultimately breaking down. At times a profuse watery discharge exudes and even drips from the surface of the new growth, soiling the clothes, soddening the skin, and emitting a peculiarly offensive odour. ”

“ In consequence of prostatic enlargement, pain is felt in the perineum, with occasional throbbing, and a sense of weight; there is frequent desire to make water, the bladder is irritable, and discharges ropy mucus. There is more or less irritation of the lower bowels; there is an almost constant desire to empty the rectum, from a feeling of fulness there, and pain, often severe, is felt on going to stool; when the enlargement is great, the bowel is considerably compressed, and the feces, when solid, are passed flattened like portions of tape. ”

“ The finger will enter a quantity of brick-dust coloured pus in the cellular substance around the bladder, and if considerable force has been used in the extraction of the stone, will readily find its way towards the wound in the perineum; the barrier between the adipose structure of the perineum and the reticular texture of the pelvis being broken down, the suppurative inflammation spreads rapidly along the latter, and may be traced in some cases, between the peritoneum and abdominal muscles, as high as the umbilicus ”

“ He particularly directs the operator to make an incision in the left side of the perineum and to open the neck of the bladder, as a wound of the body of the bladder seldom unites. When the stone is large he recommends him to seize it with strong pincers and break it into pieces. When a stone sticks in the urethra he directs him to tie one ligature behind it and to secure the prepuce before the glans with another, and then to cut down upon the stone. ”

“ Temporary relief is experienced when the urethra gives way by ulceration, and the urine becomes extravasated into the cellular texture; the patient gets up, and, if in the dark, thinks that the stricture has yielded, and that he is passing urine naturally. But soon he feels a glowing heat in the perineum; the parts swell and become livid; violent constitutional symptoms come on, the discoloration advances, the integuments slough, ill formed matter is discharged, and disorganised cellular tissue mixed with putrid sanies is exposed. ”

“ The elevated position of the hips is an essential part of this method of examination; it permits the intestines to gravitate out of the pelvis, and, as soon as the urethra is opened, the bladder becomes distended with air, so that all of its interior may be readily inspected, and applications to the surface may be directly made through the speculum. In some cases it is difficult to produce the requisite distention of the bladder by elevating the hips. This difficulty may arise in the case of very fat women. ”

“ Orifices of the Body. The mouth, nose, ears, anus, urethra and vagina are to be examined with special regard to their condition and contents (open, closed, gaping, torn, bleeding, discharge of pus, blood, mucus, féces, stomach contents, semen, urine, foreign substances, parasites, ear-wax, etc.) . In cases of suspected rape an especial examination of the orifice of the vagina or anus is indicated.
35. Percussion and Palpation. The external examination may be closed by the percussion of the heart, lung, spleen, liver and stomach boundaries, and by the palpation of the abdomen. ”

“ During convalescence they ought to use rubefacients, and natural baths in a cold state. Cases occurring from a wound of the spine, from a fall and dislocation of a vertebra, if there be a concurrence of fatal symptoms, it is impossible to remedy. If the penis is paralysed, we must apply the remedies recommended for the bladder to the same parts, and also to the groin; and medicines which excite to erections ought also to be used. Milk, cheese, and the other cakes are improper, likewise lettuces and the other pot-herbs. ”

“ A diseased action is set up which results in enlargement and hardening. It is felt as a hard body just anterior to the anus, and becomes by pressure the source of much additional mischief. Sometimes the disease progresses to dangerous ulceration. It is attended by heat, pressure, and pain between the anus and the root of the penis.
Urinary Diseases.—The same congestion and irritability extend to the bladder and thence to the kidneys, producing irritation and inflammation of those organs. Mucus is often formed in large quantities; sometimes much is retained in the bladder. ”

“ And if the penis is pressed between the finger and thumb, matter or pus exudes. As the inflammatory stage commences, the formation of pus is increased, which changes from a thin to a thick yellow color, accompanied by a severe scalding on making water. The inflammation increases up to the fifth day, often causing such pain, on urinating, that the patient is tortured severely. When the disease reaches its height, the erections become somewhat painful, when the discharge may be streaked with blood. ”

“ The cavity of the pelvis contains the bladder, the rectum, and some of the generative organs peculiar to each sex and some windings of the small intestine; they are partially covered by the peritoneum (lining membrane of the abdominal cavity) .
Anatomy of the Female Genital Organs.—The external genital organs, to which the term vulva is usually given, consist of the mons veneris, labia majora, labia minora, clitoris, vestibule, meatus urinarius, hymen, fossa navicularis, fourchette and perineum. ”

“ Malignant disease of the bladder is almost always the warty form of cancer known as epithelioma. It springs as a sessile growth from the mucous membrane of the floor near the opening of one of the ureters, and, worrying the sensory nerves, causes irritability of the bladder and incontinence of urine. In due course septic germs reach the bladder, either from the urethra, the bowel, the kidneys or the blood-stream, and cystitis sets in. When ulceration has taken place, blood occurs in the urine, and the patient—generally beyond middle age—suffers dull or lancinating pains. ”

“ That economical adaptation of a portion of a vesicular organ, originally formed for purposes of communication between the embryo and the mother, appears to entail sometimes a defect in the wall of the abdomen just above the pubes, and a defect in the anterior wall of the bladder itself. This is the distressing congenital condition of fissure of the urinary bladder, in which its interior is exposed through an opening in the skin; the pubic bones are separated by an interval, and the reproductive organs are ill-formed ”

“ With paralysis of the bladder the penis may be pendent out of the sheath, or being retained within it, the urine may dribble constantly into and from that cavity, and the vulva may be soft and flaccid. When the anus is involved, the adjacent part of the rectum usually participates becoming overloaded, the sphincter is soft and lax and allows a constant oozing, and the exposure of the mucosa. The paralytic tail hangs between the thighs, limp and flaccid, and becomes saturated with manure and in females with urine. ”

“ If a boy has a clear and watery urine after it has been sandy, if he frequently scratches his foot, has involuntary erections and finally obstruction in micturition, I say that he has a stone in the neck of his bladder. If now he be laid upon his back with his feet well elevated, and his whole body be well shaken, if there is a stone present it is possible that it may fall to the fundus of the bladder. ”

“ The penis can then be shelled out, the prepuce being first cut through around the corona glandis. If lateral flaps can be formed of sound skin they are then dissected up. The perineal and pubic incisions are now deepened and, assistants holding the testes and penis well out of the way, the neck of the tumour is cut through close to the perineum and pubes. Gaping vessels are all carefully ligatured, redundant tunica vaginalis—if hydroceles be present—being excised. ”

“ It is most common in persons of a nervous, irritable temperament, from the age of thirty to forty-five or fifty, and who are subject to similar attacks in other parts of the body, particularly the face, stomach, testicle, or mamma. It is characterised by paroxysms of pain, which is usually described as of a tearing, burning, or lancinating nature, situated at the extremity of the rectum, from which it frequently extends to the sacrum, the loins, pubes, and genito-urinary organs. Defecation is painful, and the urine is discharged in jets or drops, attended with a burning or scalding sensation. ”

“ The anus may be puffy and swollen with mucopurulent secretion from the anal glands, which soils the hair of the hips and tail. If the abdomen is flaccid, manipulation with both hands on opposite sides usually detects a solid mass representing the impacted rectum and colon, and extending from the pelvis forward, often to the sternum. ”