

ILIAC AKTEIUES. 



The perinea! artery comes through the obtu- 

 rator fascia, and descends to the perineum, pos- 

 terior to the transverse muscle, though at times 

 before it; when it has got below the muscle it 

 changes its direction, and runs forward, up- 

 ward, and inward, superficial to the triangular 

 ligament, toward the root of the scrotum ; at 

 this part of its course it is situate along the 

 outer side of the interval which separates the 

 cms penis and the corpus spougiosum urethras, 

 internal and parallel to the crus, and covered 

 by a superficial lamina of the fascia of the peri- 

 neum, a deeper layer of which intervenes be- 

 tween it and the muscles of the crus and bulb 

 and the triangular ligament; as it proceeds it 

 gives the following branches : 1. outward, one 

 to the integument and subcutaneous structure 

 beneath the anterior part of the tuberosity of 

 the ischium ; 2. inward, one which runs to the 

 interval between the front of the rectum and 

 the bulb of the corpus spongiosum, superficial 

 and parallel to the transverse muscle ; it sup- 

 plies the integument and subcutaneous struc- 

 ture of the perineum, and the common inser- 

 tion of the superficial sphincter, the transverse 

 muscle, the bulbo-cavernous and the levator ani 

 in front of the rectum. This branch is at times 

 furnished by the pudic itself; it is denominated 

 by some " the proper perineal," by others " the 

 transverse perineal." 3. A branch to the bulbo- 

 cavernous ; 4. one to the ischio-cavernous mus- 

 cles. 



The perineal artery having reached the back 

 of the scrotum sends long branches into the 

 subcutaneous structure and integument of that 

 part, and entering the septum scroti, terminates 

 in it as the " artery of the septum." In the 

 female, the ultimate branches of the artery are 

 distributed to the labia majora. 



The perineal artery, from its superficial situa- 

 tion, is exposed to be divided on many occa- 

 sions ; in lateral lithotomy it may be cut, but 

 for the most part it escapes, its course being 

 external to the line of incision ; some of its 

 branches, however, cannot escape, the trans- 

 verse perineal particularly must, as a matter of 

 course, be divided. Having given oft' the peri- 

 neal artery, the pudic pursues its course, en- 

 closed in the triangular ligament, along the 

 rami of the ischium and pubis, toward the arch 

 of the pubis ; arrived under cover of the crus 

 penis, it gives off a considerable branch, des- 

 tined principally for the urethra and the corpus 

 spongiosum, and denominated hence by Chaus- 

 SH.T " urethro-bulbaire," by Harrison "arteria 

 corporis bulbosi vel spongiosi urethra;," but by 

 Boyer and Cloquet " artere transverse;" it is 

 short, runs transversely inward, enclosed in the 

 triangular ligament about a quarter of an inch 

 from its base, but nearer to it externally than 

 internally; at the bulb it divides into two 

 parts, of which one, the smaller, is distributed 

 to the ante-prostatic gland ; the other enters the 

 bulb and ramifies through its vascular struc- 

 ture, being prolonged through it as far as the 

 glans, supplying at the same time the mem- 

 brane of the urethra and its lacuna; ; a branch 

 from it passes into the corpus cavernosum, and 

 anastomoses with the artery of that structure. 



In the female, the branch corresponding to this 

 is distributed to the vascular plexus which sur- 

 rounds the orifice of the vagina. 



The artery of the bulb is one of much prac- 

 tical importance ; it is liable to be wounded in 

 lithotomy in the act of opening the urethra; 

 this accident is incurred when the canal is 

 opened too high, i. e. too near to the arch of 

 the pubis, or too much from the side rather 

 than from beneath, and in either case is pretty 

 certain to occur ; the proceeding by winch to 

 avoid both the artery and the bulb itself, is to 

 cut into the urethra as far back, i. e. from the 

 surface, and as far from the arch as the gui- 

 dance of the staff will assure the operator to be 

 safe, the point of the knife being directed as 

 much from below as the interference of the 

 bulb and the lateral line of incision will permit; 

 further, it is the design of the operator to open 

 the canal in the membranous portion and be- 

 hind the bulb; and in order to effect this, the 

 incision should be made as near as may be to 

 the base of the triangular ligament, or, if possi- 

 ble, behind it. If divided, the artery of the 

 bulb may be tied, though not without some 

 difficulty ; it is prevented from retracting by 

 being enclosed in the triangular ligament, but 

 it is situate deep ; its distance from the anterior 

 surface of the ramus of the pubis being about 

 three-fourths of an inch ; its shortness as well 

 as its being concealed by the crus penis and 

 by the bulb with their muscles, and being in 

 the superior angle of the wound, must also 

 increase the difficulty of securing it. 



The pudic artery having reached the base of 

 the subpubic ligament divides into its two 

 final branches, the artery of the corpus caverno- 

 sum and the dorsal artery of the penis. 



3. The urlcrif of the corpus cavernosum arises 

 from the pudic between the crus penis and the 

 ramus of the pubis and immediately enters the 

 crus obliquely; it is prolonged through the 

 vascular tissue of the corpus cavernosum to its 

 extremity, distributing branches to either side, 

 and communicating with that of the other. 

 For the peculiar distribution of the arteries of 

 the corpus cavernosum and spongiosum, accord- 

 ing to Miiller, see the article ERECTILETISSUE. 



4. Tlie dorsal artery of the penis, which ap- 

 pears in direction the continuation of the original 

 vessel, comes through the triangular ligament 

 and ascends in front of the subpubic ligament 

 through the angle formed by the crura penis at 

 their junction ; having surmounted the crus it 

 attaches itself to the dorsal aspect of the penis 

 and runs forward upon it on either side of the 

 suspensory ligament parallel to the artery of 

 the other side, and contained together with it, 

 the dorsal vein, and nerves, in the groove 

 formed by the apposition of the crura, internal 

 to the nerve and external to the vein ; it is 

 prolonged to the anterior extremity of the 

 corpus cavernosum, where it breaks up into 

 branches, which uniting with those of the other 

 form an arterial zone behind the corona glandis, 

 and .-^inking into the glans are distributed to its 

 tissue. 



During their course along the dorsum of the 

 pom< the arteries arc tortuous, comimmicatv 



