932 
usually failed, for so deeply do the pudic vessels 
ran, and so firmly bound < hoo are they by the 
triangular ligament and the obturator fascia, 
that the ligature, as commonly applied, has 
proved useless in the hands of even the most 
dexterous surgeons. The open mouth of the 
artery may, however, in such cases be often 
secured by the aid of a curved needle carried 
deeply into the wound, and some practitioners 
(amongst the number M. Roux) have succeeded 
by the same means in tying the pudic artery 
itself in the vicinity of the tuber ischii, a pro- 
ceeding attended with complete success. The 
judicious application of pressure to the bleeding 
point by an a so constructed as to plug 
the wound at the same time that it permits the 
urine to escape freely, has been also followed by 
satisfactory results. The same principles of 
treatment are applicable to hemorrhage from 
accidental wounds of the arteries of the bulb in 
lithotomy. 
On dividing the triangular ligament of the 
urethra the dissector arrives at the deep com- 
partment of the anterior division of the peri- 
neum, but to examine its contents with advan- 
tage he requires a section of the pelvis, such as 
that advised in a former part of this article. 
This compartment is limited superiorly or 
towards the abdomen by the recto-vesical 
layer of the pelvic fascia; inferiorly or towards 
the surface by the back of the triangular liga- 
ment of the urethra; and posteriorly by the 
rectum ; its shape is somewhat triangular, and 
it contains Wilson’s muscles, many fibres of the 
levatores ani, a part of the membranous por- 
tion of the urethra, the prostate gland, a plexus 
of veins excessively developed in some sub- 
jects, and at times also an irregular artery justly 
dreaded by the lithotomist. 
Wilson’s muscles (the compressores urethre) 
are two triangular fleshy fasciculi, which arise 
from the back of the symphysis para each by 
a narrow tendon ; their point of attachment is 
about one-eighth of an inch beneath the ante- 
rior true ligament of the bladder, and the same 
distance above the lower margin of the cartila- 
ginous arch of the pubis. The two muscles, 
expanding as they descend, separate from each 
other at the membranous portion of the urethra, 
and ing one, on each side of that part of the 
canal they again unite beneath it in a sort of 
tendinous raphé, which extends from the pros- 
tate gland to the bulb; many of their fibres may 
be likewise traced to the central tendinous point 
of the perineum. A cellular interstice inter- 
venes between the two muscles at their origin, 
and from the levatores ani they are separated at 
each side respectively by cellular tissue and 
some small veins. Wilson’s muscles may ele- 
vate and compress the urethra so as to close 
the canal; their influence in catheterism is 
decided and has been already discussed; one 
of them, the left, is divided in the lateral, and 
both are cut in the bilateral operation of litho- 
tomy. In some subjects Wilson’s muscles are 
absent, or rather they are inseparable from the 
levatores ani; but in such cases the anterior 
fibres of these latter muscles surround the ure- 
thra, perform all the offices assigned to the 
PERINEUM. 
compressores urethre, and are similarly cireum- 
stanced as regards operations on the perineum. 
The recto-urethral space, but partially seen 
so long as the triangular ligament of the urethra 
remains in situ, becomes fully exposed after 
the division of that fibrous septum. This 
Space results from the inclination back ‘ 
of the lower extremity of the rectum, whilst 
the urethra inclines forwards through the arch 
of the pubis; its form is triangular, the base 
at the integuments of the perineum, the a) 
at the prostate gland, the membranous and the — 
bulbous portions of the urethra constituting its 
anterior wall, and the rectum bounding it pos- 
teriorly. In cutting from the integuments to 
the urethra through the recto-urethral 
the anatomist encounters, first, the superficial 
perineal fascia; next, the extremities of the 
several muscles which meet and are confounded 
with each other at the central tendinous point 
of the perineum, and also the small arterial 
anastomosis situated in the same locality, still 
deeper the peaked prolongation of the trian- 
gular ligament; and, lastly, Wilson’s museles 
at their junction beneath the urethra. 
The membranous portion of the urethra is 
situated within ten lines of the rectum, and the 
bulb projects still further backwards, lying but 
half an inch apart from that intestine, so that, 
in the lateral and also in the bilateral operations, 
the lithotomist incurs some risk of wounding 
the bowel as he lays bare the groove in the 
staff. In the bilateral method the operator 
endeavours, by a semilunar incision carried 
across the recto-urethral triangular space, to 
reach the staff as it lies in the membranous 
portion of the urethra, and from the proximity 
of the bulb to the rectum both these parts are 
endangered as the knife traverses the interme- 
diate space. In the lateral method the rectw 
is not so likely to be injured in the correspond- 
ing step of the operation, because the bowel is 
further removed from the membranous portion 
of the urethra than from the bulb, and besides 
the urethra is incised somewhat upon its later 
aspect. In either case the surgeon best ensure 
the safety of the intestine by taking care to hay 
the faeces evacuated before the pe ce 
mences, by holding the staff well up into - 
arch of the pubis, and by directing 
the knife forwards as he cuts into the ureth 
The recto-urethral triangular space is the f 
sition usually occupied by that rare form 
rupture, a perineal hernia ; in this disease | 
hernia leaves the abdominal cavity at the bott 
of the great cul-de-sac of the peritoneum, - 
drawing down the serous membrane in its 
gress it gradually insinuates itself between 
prostate gland and the rectum, and at let 
sida between the rectum and the b 
n the perineum the sac is in general er 
. 
POINE ¢ 
 aingee The tumor occasionally dev 
rom the middle line, and projects outw 
and backwards behind the transversus per 
muscle into the ischio-rectal fossa; it ram 
undergoes strangulation, being in almost é1 
instance reducible. * 
The prostate gland demands the special 
tention of the surgical anatomist, for muel 
we - 
