70 LANDMARKS MEDICAL AND SURGICAL. 



first phalanges, and so forth. In amputations of the fingers 

 it is well to remember that in all cases the line of the joints 

 is a little in advance of the knuckles, that is, nearer the end 

 of the fingers. 



Long and graceful fingers, coupled with thickness and 

 breadth of the sentient pulp at their ends, and too great 

 arching of the nails, have been regarded, ever since the days 

 of Hippocrates, as not unlikely indications of a tendency to 

 pulmonary disease. 



PALPATION BY THE RECTUM. 



The following report is from Mr. Walsham, of St. 

 Bartholomew's Hospital, who, having a small hand (somewhat 

 less than seven and a half inches round), has had opportunities 

 of introducing it up the rectum, in the living subject, for the 

 purpose of diagnosis : 



' It is possible to introduce the hand (if small) into the 

 rectum ; in many cases into the sigmoid flexure, and in rare 

 instances into the descending colon. 



' Once beyond the sphincter, the hand enters a capacious 

 sac, and the following important parts can be felt through its 

 walls : 



' Through the anterior wall the hand first recognises the 

 prostate, which feels like a moderately large chestnut. Im- 

 mediately behind the prostate, the vesiculse seminales may be 

 distinguished as two softish masses situated one on either 

 side of the middle line. Internal to them, the whipcord-like 

 feel of the vasa deferentia can be readily traced over the 

 bladder to the sides of the pelvis. 



' The bladder is easily recognised, when moderately dis- 

 tended, as a soft fluctuating tumour behind the prostate ; 

 when empty it cannot be distinguished from the intestines, 

 which then descend between the rectum and the pubes. The 

 arch of the pubes can well be defined when the bladder is 

 empty. 



' Through the posterior wall of the bowel the coccyx and 

 sacrum can be felt, the curve of the sacrum being readily 

 followed by the hand. 



