PALPATION BY THE RECTUM. 71 



' The projecting spine of the ischium on each side of the 

 pelvis is a valuable landmark. From this point the outlines 

 of the greater and lesser sacro-ischiatic foramina can be 

 traced by the fingers ; and any new growth, encroaching on 

 the pelvic cavity through these apertures, could be easily 

 detected. 



' If the hand be now pushed farther up the gut, the pro- 

 montory of the sacrum is reached ; the pulsation of the iliac 

 vessels becomes manifest, and the course of the external iliac 

 can be traced along the brim of the pelvis to the crural arch, 

 the loose attachments of the rectum permitting very free 

 movement in this direction. The internal iliac artery can 

 also be followed to the upper part of the great sacro-ischiatic 

 foramen. 



' By semi-rotatory movement, and alternately flexing and 

 extending the fingers, the hand can gradually be insinuated 

 into the commencement of the sigmoid flexure. In the 

 sigmoid flexure the fingers can explore the whole of the 

 lower part of the abdomen, the loose attachment of this por- 

 tion of the gut permitting the hand to travel freely over the 

 iliac and hypogastric regions. 



' The parts that can here be felt are the bifurcation of the 

 aorta, the division of the common iliac arteries, the iliac fossa, 

 and the crest of the ilium. 



' In the female, the uterus in the middle line, and the 

 ovaries on either side, can be readily distinguished. 



' In the introduction of the hand into the rectum, in 

 a patient under chloroform, the dilatation of the sphincter 

 ani should be very gradual : first two fingers, then four, 

 and finally the thumb should be passed. It is necessary 

 to use considerable force, and unless care be taken, 

 not only the integumentary edge of the anus, but the 

 sphincter itself, may be lacerated. The introduction is 

 facilitated by the application of the other hand upon the 

 abdomen. 



' When the dilatation has been gradual and the hand not 

 too large, no incontinence of faeces and no very considerable 

 amount of pain has resulted. 



