Читать книгу Porneiopathology - Robert James Culverwell - Страница 5

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The diseases known by the general term of syphilis or venereal disease, and arising from impure coition, appear generally in three forms, gonorrhœa, chancres, and bubo. These sometimes exist alone, and sometimes together. As they affect the genital organs and their appendages, a description of these organs is necessary to a full understanding of the subject.

Genital organs and appendages in the male.—This term embraces the penis, testicles, bladder, and kidneys. The form of the penis is familiar to every one. It commences at the bladder, is of a spongy nature, and is composed of three different parts; the two upper and larger are called the cavernous bodies, and the lower the spongy body; these bodies are covered by the skin which comes over the head of the penis, and forms the prepuce. When this skin is drawn back, the head of the penis, or the glans penis is seen, which is a development of the spongy body, and is extremely sensitive. A whitish secretion, with a peculiar odor, forms at the end of the glans, where the prepuce seems to join it. The object of this secretion is to preserve the sensitiveness of the glans, and to facilitate the withdrawal of the prepuce in coition and in urinating. This material sometimes collects, irritates, hardens, and causes much inconvenience. This can be done away with by circumcision, which is performed as follows:—draw an inked line on the skin of the prepuce, corresponding to the base of the glans penis; draw the prepuce forward, and have the inked part held firmly by an assistant with a pair of forceps. Then the surgeon takes that part of the prepuce projecting beyond the forceps with his left hand, and with a bistoury cuts the prepuce at the inked line with his right. When this is done, the lining skin of the prepuce, which cannot be drawn forward, remains entire, and covers the glans; this lining is divided by a single cut with the scissors: then the flaps are removed round to the frenum, and then the two flaps are held together and removed, with the frenum, at one cut. The mode of holding the prepuce, &c. is seen in the cut.

View larger image

On the under side of the glans, near the mouth of the water passage, or urethra, the prepuce is attached by a fold called the frenum, or bridle, or martingale of the penis. The use of this frenum is to confine the movements of the prepuce, and to draw down the mouth of the water passage to direct the flow of the urine. Sometimes the frenum is too short, and confines the prepuce too much; it may be slit down with a pair of scissors as far as is considered expedient. The frenum is frequently ruptured in a first coition. The frenum is very elastic, and protects the sensitive surface beneath it as the eyelid does the eye. Sometimes, however, it becomes permanently contracted;—the glans is then denuded, but soon loses its sensibility. The person is sometimes born with this formation.

The cavernous bodies form two tubes, united in most of the length of the penis, separated only by a thin partition, and enveloped in a firm sheath; they are composed of an immense number of cells, principally formed by dilated veins, which communicate with each other; these, when the penis is erected, become filled and even distended with blood. The cavernous bodies terminate abruptly and form rounded points under the glans penis. At the other extremity they separate, and form the crura or legs of the penis.

The spongy body forms the lower and under body of the penis, terminates at one end at the point in the glans, whilst it extends the whole length of the penis, again becomes enlarged, and forms the bulb. The urethra or water passage extends through the spongy body, and connects the penis with the bladder. This cut is a section of the penis showing the three bodies:

a. Corpora Cavernosa. b. The division or Septum. c. Corpus Spongiosum. d. Urethra. e. The great vein of the Penis. View larger image

a. Corpora Cavernosa.

b. The division or Septum.

c. Corpus Spongiosum.

d. Urethra.

e. The great vein of the Penis.

The cut below shows a section of the cavernous body, showing the blood vessels that go to it and cause a distension or erection of the penis:

a. Urethric part. b. Glans. c. Dorsal Artery serving the Glans. d. Dorsal Artery serving the interior of the Corpus Cavernosum. e, f. Deep-seated Arteries. View larger image

a. Urethric part.

b. Glans.

c. Dorsal Artery serving the Glans.

d. Dorsal Artery serving the interior of the Corpus Cavernosum.

e, f. Deep-seated Arteries.

a. Urethra. b. Glans. c. Dorsal Vein. d. Septum. e. Vessels. View larger image

a. Urethra.

b. Glans.

c. Dorsal Vein.

d. Septum.

e. Vessels.

In the cut above we see the septum or division of the cavernous bodies, in which are seen the vessels by which, when the erection of the penis subsides, the blood passes into the dorsal vein of the penis.

The Urethra, or water passage, is the canal that passes through the spongy body to the bladder. The urine and semen pass through it. It is very elastic, and may be dilated so as to admit a large instrument to be passed into the bladder, and it contracts on the smallest. It is supported in its course by the spongy body and the prostate gland, between which is a portion unprotected, called the membranous portion. The passage varies in its size in different parts: thus it is rather contracted at the orifice, enlarges within, and for an inch again contracts, dilates nearer the bulb, diminishes at the membranous portion and near the prostate gland, and finally enlarges into the bladder. The cut opposite will show these parts.

a. Bladder, or receptacle of urine. b. Ureters, or passages through which the urine comes from the kidneys, where it is formed, to the bladder. c. Vas Deferens, through which the semen passes from the testicle, where it is formed, to the seminal vesicles, where it is matured. d, d. Openings of Ureters into the bladder. e. Prostate Gland. f. Orifices of excretory ducts. g. Openings of the seminal ducts. h. Ischio-cavernous muscles. i. Bulb of Urethra divided. k. Cowpers Glands. l. Wide part of Urethra. m. Narrow part. n. Fossa Navicularis, usually affected in gonorrhœa. o, p. Prepuce. View larger image

a. Bladder, or receptacle of urine.

b. Ureters, or passages through which the urine comes from the kidneys, where it is formed, to the bladder.

c. Vas Deferens, through which the semen passes from the testicle, where it is formed, to the seminal vesicles, where it is matured.

d, d. Openings of Ureters into the bladder.

e. Prostate Gland.

f. Orifices of excretory ducts.

g. Openings of the seminal ducts.

h. Ischio-cavernous muscles.

i. Bulb of Urethra divided.

k. Cowper’s Glands.

l. Wide part of Urethra.

m. Narrow part.

n. Fossa Navicularis, usually affected in gonorrhœa.

o, p. Prepuce.

The urethra is constantly moistened with a mucous secretion,—from the membrane itself, the glands, and the folds which yield to the pressure of the urine as it flows, or from other altered conditions of the urethra pour out their contents. The inner surface of the urethra is very vascular and sensitive, as is shown by the slightest laceration by the bougie or by chordee, when considerable bleeding often takes place. Its sensitiveness is well known in the first passing of the bougie, or in inflammation, when the pain of the former and the act of urinating in the latter, often causes fainting.

The bladder is the reservoir of the urine, which is formed in the kidneys, comes into the ureters, passages leading from the kidneys to the bladder, and thence flows, drop by drop, into the bladder. The bladder is shaped somewhat like a pear, but this shape is varied by its contents, and the relative condition of its adjacent parts. 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. These parts are seen in the first engraving on the opposite page.

The bladder is composed of several coats. There is a peculiar membrane investing the important structures in the abdomen called the peritonœum. The base and back part of the bladder is covered by a portion of this peritonœum, which in a measure supports the bladder in its position, and also exercises certain properties which may hereafter be alluded to.

a. The inner surface of the Bladder, showing the direction of the Muscular Fibres. b. The opening of the right Ureter into the Bladder, whence the urine issues. c, c. The Prostate Gland cut through, and its sides exhibited. d. The Urethra. e. Verumontanum. f, f. Orifices of the Seminal Ducts, marked by twigs inserted therein; the other points mark the orifices from the Prostate and other Glands. View larger image

a. The inner surface of the Bladder, showing the direction of the Muscular Fibres.

b. The opening of the right Ureter into the Bladder, whence the urine issues.

c, c. The Prostate Gland cut through, and its sides exhibited.

d. The Urethra.

e. Verumontanum.

f, f. Orifices of the Seminal Ducts, marked by twigs inserted therein; the other points mark the orifices from the Prostate and other Glands.

The position of the perineum is seen in the following cuts in which the skin has been removed, disclosing—

1. The superficial fascia of the Perinœum. 2. The fascia lata, or shiny covering of the muscles of the thighs. 3. The tuberosity of the ischia, or part whereupon we sit. 4. The last portion of the spine, called the Coccyx, easily to be felt posteriorly to the rectum. a. The Sphincter muscle of the Anus. b. The inferior border of the great muscles of the buttock, called the Gluteal. c. The Levator Ani, or muscles which elevate the rectum. View larger image

1. The superficial fascia of the Perinœum.

2. The fascia lata, or shiny covering of the muscles of the thighs.

3. The tuberosity of the ischia, or part whereupon we sit.

4. The last portion of the spine, called the Coccyx, easily to be felt posteriorly to the rectum.

a. The Sphincter muscle of the Anus.

b. The inferior border of the great muscles of the buttock, called the Gluteal.

c. The Levator Ani, or muscles which elevate the rectum.

The following cut represents the muscles of the perinœum exposed, the superficial fascia having been removed.

1. Point in the Perinœum where the principal muscles arise or meet. 2. Covering of the Thigh. 3. Seat. 4. Corpora Cavernosa of the Penis. 5. Corpus Spongiosum. 6. Coccyx. 7. Great Sacro Sciatic ligament. a, a. Erector Muscles of the Penis. b, b. Accelerator Urinæ Muscles. c. Line whence the above Muscles take their origin. d. Transverse Muscles of the Perinœum. e, e. Sphincter Muscle of the Anus, supposed to be distended with tow or wool. f, f. Levatores Ani. g, g. Great Gluteal Muscles. View larger image

1. Point in the Perinœum where the principal muscles arise or meet.

2. Covering of the Thigh.

3. Seat.

4. Corpora Cavernosa of the Penis.

5. Corpus Spongiosum.

6. Coccyx.

7. Great Sacro Sciatic ligament.

a, a. Erector Muscles of the Penis.

b, b. Accelerator Urinæ Muscles.

c. Line whence the above Muscles take their origin.

d. Transverse Muscles of the Perinœum.

e, e. Sphincter Muscle of the Anus, supposed to be distended with tow or wool.

f, f. Levatores Ani.

g, g. Great Gluteal Muscles.

A brief description of the structures displayed in the two preceding and the following drawing (p. 14) will render this part of our subject perfect.

The Fasciæ means the coverings of muscles, such as is seen in cutting a domestic joint—a leg of mutton, for instance—a shiny surface; their use is to strengthen the action of the muscles, to bind them well together, and they mostly exist about the buttocks, back, &c.

The office of a Sphincter Muscle, of which we have several, as that of the bladder and anus, is to keep closed the aperture they surround. The sphincter ani closes the rectum, and pulls down the bulb of the urethra, by which it assists in ejecting the urine and semen.

The Levator Muscles lift up the part they are connected with. The levator ani muscles form the funnel appearance of the rectum, and help to draw it up after the fæces or stools are evacuated. They also assist in sustaining the contents of the pelvis, and help to eject the semen and urine, and contents of the rectum, and, perhaps, by pressing upon the veins, contribute to the erection of the penis.

1. Coccyx. 2. Semen. 3. Covering of the Thigh. 4. Great Sacro Sciatic Ligament. a. Bulb of the Urethra. b. Corpus Spongiosum. c. Crura of the Penis, being the conclusion of— d. Corpora Cavernosa Penis. e. Sphincter of the Anus. f. Levatores Ani, covered by a fascia or prolongation of the triangular ligament of the Urethra. g. Great Gluteal Muscles. h, h. Triangular Ligament of the Urethra. The artery of the bulb is seen on the left as it runs between the Crus Penis and bulb of the Urethra. View larger image

1. Coccyx.

2. Semen.

3. Covering of the Thigh.

4. Great Sacro Sciatic Ligament.

a. Bulb of the Urethra.

b. Corpus Spongiosum.

c. Crura of the Penis, being the conclusion of—

d. Corpora Cavernosa Penis.

e. Sphincter of the Anus.

f. Levatores Ani, covered by a fascia or prolongation of the triangular ligament of the Urethra.

g. Great Gluteal Muscles.

h, h. Triangular Ligament of the Urethra. The artery of the bulb is seen on the left as it runs between the Crus Penis and bulb of the Urethra.

The Gluteal Muscles help the rotatory motion of the thigh, and give support generally to the buttocks.

The Sacro-Sciatic Ligaments assist in the firm union of the bones of the pelvis.

The Erector Muscles of the penis propel the urine and semen forward; and, by grasping the bulb of the urethra, push the blood toward the corpus cavernosum and the glans, and thus distend them.

The Accelerator Urinæ Muscles, as their name implies, help to eject the urine and semen.

The Triangular Ligament of the urethra assists the preceding purposes.

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