FEMALE PERINEUM 185 



posterior slit; again, it may be cribriform, or fringed along 

 its free margin. Lastly, it may constitute a complete septum 

 across the opening of the vaginal canal. In that case 

 awkward results ensue from the retention of the menstrual 

 fluid. After it has been ruptured its position is marked by 

 certain rounded elevations which have received the name 

 of carunculcz hymenales. 



Close to each side of the vaginal orifice, in the groove 

 between it and the posterior part of the labium minus, is the 

 opening of the duct of the greater vestibular (Bartholiris] gland, 

 an orifice just visible to the naked eye. 



Passage of Catheter and Examination of Orificium Ex- 

 ternum Uteri. The dissector should now practise the pass- 

 ing of the female catheter, and afterwards introduce a speculum 

 into the vagina, to obtain a view of the orificium externum 

 uteri. 



Before the catheter is passed, the forefinger of the left hand 

 should be placed in the orifice of the vagina, with its palmar 

 surface directed upwards towards the pubes. If the instrument 

 is now directed along this finger and the point raised slightly, 

 when it reaches the entrance to the vagina, a little manipula- 

 tion will cause it to enter the urethra. 



When the speculum is introduced into the vagina, the points 

 to be noted in connection with the external orifice of the 

 uterus are: (i) the small size of the opening; (2) the two 

 rounded and thick lips which bound the aperture. Both in 

 the virgin and in women who have borne children it is a 

 transverse cleft, but in the former it is small and its anterior 

 and posterior lips are smooth and rounded, whilst in the latter 

 it is usually larger and its lips are frequently cleft and scarred. 

 Note, further, that the anterior lip is the thicker and shorter 

 of the two. 



Dissection. Reflection of Skin. The anal canal should be 

 slightly filled with tow, and the anal orifice stitched up, then 

 the margins of the labia minora should be stitched together. 

 Incisions (i) A transverse incision should, in the first place, 

 be carried from one ischial tuberosity to the other, in front 

 of the anus. (2) The urogenital fissure and the orifice of the 

 anus should next be closely encircled by incisions, and these 

 joined by a cut along the median plane. (3) Lastly, carry an 

 incision forwards from the second or third piece of the coccyx 

 along the median plane to the cut which surrounds the anus. 



Four flaps are thus marked out ; the two anterior may be 

 thrown forwards and laterally, and the two posterior backwards 

 and laterally. 



