274 Anatomy Applied to Medicine and Surgery. 



tient, about four feet for an adult and three feet for a 

 child. A serious objection to the employment of any 

 fixed amount of fluid for the purpose of distending the 

 bladder, is that, while most of the vesical fibres, when cal- 

 culi are present, are hypertrophied, yet there may be 

 some portions of the wall so thin that rupture 

 might result if certain definite amounts of fluid 

 were uniformly used for the purpose of distention. 

 By the method of Greig Smith, there is sufficient pressure 

 put on the vesical walls to distend, but not enough to rup- 

 ture the bladder. An incision about three inches in length 

 is made in the median line, above the pubes, and the skin, 

 superficial and deep fasciae are divided, the recti muscles 

 are separated from each other, the transversalis fascia is 

 incised and the areolar tissue, contained in the prevesical 

 or Retzian space, is exposed. The peritoneum forming 

 the roof of the space is avoided, raising it up with the fin- 

 ger, if necessary, and the connective tissue that occupies 

 the space is divided so as to expose the anterior wall of 

 the bladder. By keeping exactly in the median line while 

 incising the prevesical fascia there is very little danger of 

 wounding either of the large veins of this space, since 

 these veins, two in number, lie, one on either side of the 

 middle line of the bladder and about three-quarters of an 

 inch apart. It is advisable in opening up the prevesical 

 fascia to start the incision close to the symphysis and to 

 cautiously enlarge it from below upwards. The bladder 

 wall will be recognized by its pinkish color, rounded out- 

 line and muscular structure, and will be steadied by means 

 of a hook while it is being opened by the surgeon. The 

 stone is extracted and the operator sutures the vesical 

 wall or not, as he sees fit. 



The Uterus. The uterus is pyriform in shape, is 

 flattened from before backwards, and is divided into two 



