1042 



SURGICAL ANATOMY OF THE PERIK3EUM. 



according as the erectile tissue is more or less distended. The part of the 

 rectum now under consideration narrows to its end under the influence of 

 the sphincters. It is supported by the levatores ani, which are fixed to its 

 sides, and by the pelvic fascia on the inner surface of those muscles. 



From this, its shortest and narrowest part, the intestine sweeps into the 

 hollow of the sacrum, widening considerably at the same time so as to form 

 a large pouch. This part, which is known as the second division of the 

 rectum, has before it the prostate and the urinary bladder with the seminal 

 vesicles, and above these the recto vesical pouch of the peritoneum. The 



Fig. 717. 



Fig. 717. THE PROSTATE GLAND AND BASE OP THE BLADDER EXPOSED IN THE 



PERINEUM. 



Besides the superficial fascia and the perineal muscles, by the removal of which the 

 spongy erectile tissue and the crura penis were uncovered, the anterior layer of the deep 

 perineal fascia was cut away in the preparation for this sketch, and thus the pudic 

 arteries with their branches for the bulb, and Cowper's glands, have been laid bare. The 

 rectum, too, having been dissected from its connections and drawn back, the prostate 



vesicula seminalis and vas deferens of left side ; 8, a small part of the urinary bladder ; 

 J>, right dorsal artery, with the artery of the bulb aud Cowper's gland resting against the 

 inner layer of the deep perineal fascia. The last-named parts are at considerable depth, 

 but the size within which it was necessary to restrict the drawing, did not admit of the 

 appearance of depth being sufficiently represented. 



rectum and the bladder are in contact with each other only in the small 

 triangular space intercepted between the seminal vessels and the peritoneum ; 

 and in this space the bladder may be punctured, in order to evacuate its 

 contents. In performing the operation, the chief guide to the surgeon is 

 the prostate. The instrument is to be passed forwards into the bladder 

 behind this gland ; but care must be taken to regulate the distance from 

 its margin, so as to avoid wounding, on the one hand, the vasa deferentia 

 which come into apposition one with another immediately behind if; and, 

 on the other hand, the peritoneum where this membrane turns from one of 

 the organs to the other. At the same time it is to be remembered, that by 

 the inclination of the trocar to either side the seminal vesicles would be 



