42 LANDMARKS MEDICAL AND SURGICAL. 



c. Prostate gland. About an inch and a half or two 

 inches from the anus, the finger comes upon the prostate 

 gland. The gland lies in close contact with the bowel, and 

 can be detected by its shape and hard feel. The finger, 

 moved from side to side, can examine the size of its lateral 

 lobes, their consistence and sensibility. 



d. The finger, introduced still farther, can reach beyond 

 the prostate, as far as the apex of the trigone of the bladder. 

 More than this, it can feel the angle between the 'ductus 

 communes ejaculatorii,' which forms the apex of the trigone. 

 This is the precise spot where the distended bladder should 

 be punctured through the rectum. The more distended the 

 bladder, the easier can this spot be felt. Fluctuation is at 

 once detected by a gentle tap on the bladder above the pubes 

 (86). The trochar must be thrust in the direction of the 

 axis of the distended bladder ; that is, roughly speaking, in 

 a line drawn from the anus through the pelvis to the um- 

 bilicus. 



e. The fold of peritoneum, called the recto-vesical pouch, 

 is about four inches from the anus, therefore it is not within 

 reach of the finger ; and we run no risk of wounding it in 

 tapping the bladder if the trochar be introduced near the 

 angle of the trigone. 



f. The finger can feel one of the ridges or folds of mucous 

 membrane which are situated at the lower part of the rectum. 

 This fold projects from the side, and sometimes from the 

 upper part of the rectum, near the prostate. When thickened 

 or ulcerated, this fold occasions great pain in defaecation ; and 

 great relief is afforded by its division. 



g. Lastly, the finger can examine the condition of the 

 spaces filled with fat on either side of the rectum, called the 

 ischio-rectal fossae, with a view to ascertain the existence of 

 deep-seated collections of matter, or the internal communica- 

 tions of fistulae. 



Introduction of catheters. In the introduction of 

 catheters the following are good rules. Keep the point of 

 the instrument well applied against the upper surface of the 

 urethra ; depress the handle at the right moment (90) ; 



