

The Pelvis. 281 



and, in the case of the two last situations, the cavity rare- 

 ly heals, since the opening lies, generally, at a higher level 

 than the bottom of the abscess cavity. Vaginal puncture 

 is performed by means of a pair of long, sharp-pointed 

 scissors which have been introduced, guarded by the index 

 finger, to the situation in which it is intended to puncture 

 the abscess. This latter point should be posterior to the 

 cervix and in the median line, or immediately to the right, 

 or left, of the median line, since, if the scissors were in- 

 troduced at the side of the vagina there would be a danger 

 of wounding the uterine artery or veins. The scissors 

 should be made to point, i.e., should be directed towards 

 the promontory of the sacrum, otherwise, there would be 

 danger of wounding the rectum if the puncture were made 

 directly backwards. 



Structures felt per Vaginam. Posteriorly the 

 rectum can be felt and easily moved from side to side, or, 

 the presence of foecal masses may be ascertained. Anterior- 

 ly, the base of the bladder and the urethra may be recog- 

 nized, while, antero-laterally, the ureters passing along the 

 side of the vagina near the cervix can be identified. The sit- 

 uation of the knob-like cervix and of the fundus of the uter- 

 us, may be recognized, and any departure from the normal 

 position, such as ante-flexion or retroposition may be ap- 

 preciated, especially if the finger in the vagina be assisted 

 by the other hand, externally, on the abdomen, i.e., if the 

 combined or bimanual method of examination be em- 

 ployed. By means of the finger in the vagina the exam- 

 iner may inform himself as to the condition of the tube* 

 and ovaries as well as the presence and extent of adhesions 

 affecting the uterus. The landmark for the ovary is a 

 point about two inches from and a little below the level of 

 the anterior iliac spine, and, bimanually, it may be felt in 

 the manner described by Kelly, viz., by means of one fin- 



