72 LANDMARKS MEDICAL AND SURGICAL. 



' We have been informed on reliable authority that per- 

 manent incontinence of faeces has occasionally followed these 

 examinations.' 



Lastly, we think it right to insist upon the important fact 

 that, in some subjects, even a small hand cannot be passed 

 up the rectum beyond the reflection of the peritoneum over 

 the second part of the gut. In such instances the peritoneum 

 offers a resistance like a tight garter, and prevents the farther 

 advance of the hand without great risk of laceration of the 

 parts. 12 



EXAMINATION PER VAGI NAM. 



For this report I am indebted to Dr. Godson, of St. 

 Bartholomew's Hospital : 



' The finger introduced into the vagina comes upon the 

 carunculae myrtiformes, which are vascular membranous pro- 

 cesses independent of the hymen, variable in number, size, 

 and form. It also feels the transverse ridges known as 

 " rugae." 



' Along the anterior wall of the vagina the finger readily 

 detects the track of the urethra, which feels like a prominent 

 cord and forms an excellent guide to the orifice of the meatus 

 urinarius in passing a catheter. The orifice is indicated by a 

 slight semicircular prominence, situated about one-third of an 

 inch above the orifice of the vagina. Behind the urethra 

 the finger comes upon the posterior wall of the bladder. But 

 the bladder is not perceptible, as such, to the touch unless 

 distended. With a catheter previously introduced it is much 

 more readily explored. 



' The septum between the vagina and the rectum is so thin 

 that, should the rectum contain faecal matter, its presence 

 becomes at once apparent to the finger. 



' The cervix uteri is felt protruding from the roof of the 

 vagina in a direction downwards and backwards that is, in a 

 line from the umbilicus to the coccyx. The os uteri is felt, 

 small and round, in the centre of the cervix. The posterior 

 lip feels a little lower than the anterior. The cul-de-sac 



