272 Anatomy Applied to Medicine and Surgery. 



relaxed bladder rises and sinks, in respiration, as though 

 it were hinged. The peritoneal relations of the bladder 

 have received a great deal of attention since the revival in 

 recent years, of suprapubic lithotomy, and Greig Smith 

 states, that the perusal of most of the results of investiga- 

 tions into the relations of the bladder, convinces one that 

 its topography is the most variable in human anatomy. 

 These investigations were for the purpose of ascertaining 

 the relation that vesical distention bore to the reflection of 

 the peritoneum that passes from the summit of the blad- 

 der on to the anterior abdominal wall. The bladder when 

 distended cannot descend in the pelvis because of the re- 

 sistance offered by the rectum (the uterus and vagina in 

 the female) , and the pelvic fascia. It has to rise out of the 

 pelvis, and this it does by insinuating itself between the 

 peritoneum and the posterior surface of the abdominal 

 wall. This space into which the bladder rises, when dis- 

 tended, is termed, the space of Retzius. It contains deli- 

 cate areolar tissue with numerous veins and is formed by 

 a splitting of the transversalis fascia as it leaves the lower 

 margin of the posterior or incomplete sheath of the rec- 

 tus muscle. The manner in which this splitting occurs is 

 as follows: The transversalis fascia passes down from 

 the lower border of the sheath of the rectus and divides 

 into two layers, one going to the summit of the bladder 

 and the other passing over the posterior surface of the 

 lower part of the rectus muscle, and over the posterior 

 surface of the pubic bone, to the prostate gland, so that, 

 a more or less triangular area results for the accommoda- 

 tion of the bladder when distended. When this viscus and 

 the rectum are quite empty, the summit of the former 

 and the reflection of the peritoneum over it are a little be- 

 low the upper margin of the symphysis pubis. Greig Smith 

 states, that, when in an adult male, the bladder is distended 

 with fifteen or twenty ounces of fluid, the peritoneum will 



