944 
The peritoneum passes over the anterior sur- 
face of theikidstige and suprarenal capsules, but 
is not usually in immediate contact with them ; 
a large quantity of loose areolar and adipose 
tissue being in . 
Lhe jejunum and ilium have a complete in- 
vestment of peritoneum, except along the little 
= space where the mesentery is attached to 
em. 
The cecum and the ascending and descending 
colon are always invested with a peritoneal coat 
in front, and this extends to a variable distance 
around their sides, sometimes completely cover- 
ing them except at the little posterior linear 
spaces where their respective mesenteries, in 
such cases existing, are attached to them. 
The transverse portion of the colon is com- 
nag covered by peritoneum except along two 
ittle linear spaces on the opposite sides of it, 
namely, on its anterior and posterior aspects, 
where the great omentum and transverse meso- 
colon respectively, as described above, are 
attached. 
The sigmoid flexure of the colon and the first 
portion of the rectum are invested completely 
with peritoneum, except along the line of at- 
tachment of their respective mesenteries. 
The second portion of the rectum has a peri- 
toneal investment on its front only: its lateral 
and posterior aspects are destitute of such co- 
vering. The peritoneum, as above stated, 
passes across from the rectum to the bladder 
without descending low enough to afford any 
investment whatever to the lowermost or third 
portion of the rectum. The conventional divi- 
sion of the rectum into three portions is, in 
fact, founded upon this circumstance of its 
being first completely, then partially, and lastly 
not at all invested with peritoneum, as you 
proceed from above downwards. Thesummits 
of the recto-vesical fclds landmark the point of 
junction of the upper and middle portions. 
The whole of the posterior aspect, the fundus 
and the three upper fourths of the anterior as- 
pect of the uterus are invested with a peritoneal 
coat. Theos uteri, which projects into the va- 
gina, the lower fourth of the anterior aspect, 
which is in immediate contact with the bladder, 
and the little lateral lmear spaces where the 
broad ligaments are attached, are destitute 
of it. 
The peritoneum reaches the vagina behind 
the uterus, and invests a small portion of it in 
that situation, but does not come into relation 
with it in front of the uterus. 
The ovary is very closely and completely 
surrounded with peritoneum, which reaches it 
at its attachment to the broad ligament; we 
must in this case as heretofore describe a little 
linear space, at the point of attachment, as des- 
titute of peritoneal vestiture. 
The b is covered by peritoneum over a 
different extent in the two sexes. In both male 
and female its anterior aspect is destitute of 
peritoneal covering; and its fundus, in both 
sexes, has a peritoneal investment equally com- 
lete: with regard to the posterior aspect, 
omen in the male, the peritoneum covers it 
often as far down as the prostate, whilst it leaves 
PERITONEUM. 
uncovered a large portion of the lower part of 
this aspect of the bladder in the female. . ’ 
The parietal portion of the peritoneum in- 
vests the anterior and lateral abdominal walls — 
completely, except at the lower part, where it 
is borne off from the anterior walls by the 
bladder and along the linear attachment of the 
falciform ligament of the liver; the under 
surface of the diaphragm, except between the 
layers of the coronary ligament of the liver, and 
along the linear attachments to it of the falei- 
form and triangular hepatic ligaments, the 
phrenico-gastric ligament, and the splenic 
omentum ; the posterior parietes, except where 
the viscera, ducts, and vessels enumerated 
above as invested with the peritoneum on their 
front only, intervene. It does not, however, 
reach the inferior abdominal parietes, that is to 
say the levator ani, at any point, a quantity of 
loose cellular tissue occupying the inters 
of the pelvic viscera between that muscle and 
the lowest point to which the peritoneum 
extends, a 
We now come to the last of our propositions. 
THE EXTERNAL OR ADHERENT SURFACE OF 
THE PERITONEUM is attached to the apposed 
tissues with different degrees of intimacy in — 
different situations—a circumstance of great 
importance with regard to certain i 
operations. This attachment is intimate or 
otherwise, according as the areolar tissue that 
constitutes the connecting medium is abundant — 
or scarce, loose or compact, in different situa~ 
tions. The connecting areolar tissue is con- 
tinuous through the openings in the abdominal 
eg me the pee cri) —_ of the 
y- e parietal portion o peritoneum: 
is Ailes. by S  hheoas layer, so that 
abscesses seldom burst through it; whilst the 
visceral portion, being destitute of this layer, 
is not unfrequently burst through by abscesses 
of an abdominal viscus, as the liver. The 
peritoneum lining the under surface of the 
diaphragm is the most firmly attached of all 
the parietal portion. That which lines the 
anterior abdominal parietes is intimatel 
adherent along the linea alba and sheath of th 
rectus, but very loosely just above the pu 
and about the internal abdominal ring. It 
extremely loosely attached to the poster 
abdominal parietes and immediately superjacet 
organs, and in the lumbar and pelvic regi 
and iliac fosse—a very fortunate cireumsta 
with regard to placing ligatures on the 
abdominal and pelvic vessels without k 
open the peritoneal cavity. ; 
The visceral portion, as it covers the | 
and spleen and the alimentary tube, is 4 
intimately adherent to them except at_ 
middle portion of the rectum. That wi 
partially covers the bladder adheres very lot 
to it; owing to which, together with the I 
ness of the peritoneal attachment above 
pubis in front, to the rectum behind, an 
itself in the recto-vesical folds, the bla 
when distended rises high above the pu 
between the abdominal parietes and pel 
neum, pushing the latter up so as to dim: 
the depth of the recto-vesical cul-de-sac _ 
