The Petineum. 293 



can be felt, while about half an inch above the internal 

 sphincter, i.e., from one and a half to two inches above 

 the anus, the prostate gland, about the size of a horse 

 chestnut, can be readily identified. Immediately behind 

 this gland the soft elastic feel of the bladder is evident 

 and the portion that can be felt is the triangular in- 

 terval, that is bounded, on either side, by the vesiculae 

 seminales. These vesiculse seminales extend backwards 

 and outwards, for about two inches, and are about half an 

 inch in thickness. Immediately in front of the apex of 

 the prostate gland, i.e., about one inch above the anus, the 

 membranous part of the urethra, especially if distended 

 with a catheter, or a sound, will be recognized. Poste- 

 riorly, the curve of the sacrum and coccyx, and, laterally, 

 the roots of the sacral nerves and the internal iliac vessels 

 may be felt. In the female, the uterus can be mapped out, 

 while, on bimanual examination, displacements, especially 

 retro-flexion, will be evident; and, further, any sensitive- 

 ness of the ovaries may be elicited, if the hand on the ab- 

 domen be pressed down in the semilunar line, about two 

 inches from the iliac spine, as in the examination per vagi- 

 nam. 



As a guide to the situation of the ovary, when examin- 

 ing per rectum, the utero-ovarian ligament may be em- 

 ployed. This is felt as a prominent fold on the posterior 

 surface of the broad ligament just below the cornu uteri 

 and by following this fold outwards for about an inch, the 

 inner border of the ovary may be felt, while the tube 

 above it may be identified and any abnormality of the va- 

 gina, in front of the rectum, recognized. 



Diseases and Reflex Disturbances of the 

 pelvic viscera. Hemorrhoids may be either exter- 

 nal, or internal. In the external variety, the radicles of 

 the inferior hemorrhoidal veins are dilated, whereas, in 

 internal hemorrhoids, the middle and superior hemor- 



