222 LITHOTOMY IN THE FEMALE. 



limited ; moreover, in this condition the openings of the 

 ureters are brought very low down, and might be im- 

 plicated in the incision, which is on no account to be 

 transverse. The length of the female urethra is about 

 an inch and a half, curving slightly below the symphysis, 

 with its concavity upwards, and having an average 

 diameter of about a quarter of an inch, and being highly 

 distensible, very frequently calculi can be extracted 

 through it. There is a good deal of difficulty experi- 

 enced generally in using a lithotrite in the female blad- 

 der, owing to the fact of its muscular coat being so thick 

 and strong and its urethral sphincter so weak, that the 

 urine or water injected for the purpose of operation, es- 

 capes past the instrument, leaving no cavity ; moreover, 

 the bladder forms a fossa on both sides of the neck of 

 the uterus. 



The arrangement of the perineal aponeuroses in the 

 female is as follows : The superficial layer of superficial 

 fascia is continuous with that of the nates, thigh, and 

 abdomen ; whilst the deeper layer is firmly attached to 

 Poupart's ligament, the ischio-pubic rami, and to the 

 lower border of the perineal septum. These fasciae cover 

 in the labia majora, which are very analogous to the 

 scrotum in the male, and being attached above to the 

 external abdominal ring, hernise pass in them, known as 

 pudendal or labial hernise. This deeper layer of fascia is 

 continuous over the ischio-rectal fossae. Where the two 

 layers of superficial fasciae unite with the lower borders 

 of the perineal septum to form the perineal body, they 

 are joined by the ischio-perineal ligament, and it forms 

 a support, or point d'appui, for the perineal muscles. 



Abscesses in the female perineum are of two kinds, 

 diffuse, in the superficial perineal fascia, which readily 



