1128 



SURGICAL AXD TOPOGRAPHICAL AXATOMY 



culse seminales and ejaculatorv ducts. These can rarely l)e felt unless diseased 

 and enlarged; (7) it is within this triangular space that a distended bladder can be 

 felt, and, if the prostate is not enlarged, punctured, the trocar being driven in the 

 direction of the long axis of the distended viscus, i.e. towards the umbilicus. As 

 a rule, the recto-vesical pouch is reflected at a distance of three and a half or even 

 four inches (87 to 100 mm.) from the anus. In the female the distance is only 

 tliree inches, or even less. (8) Sometimes the lowest of the folds of Houston, on 

 al)()ut the same level as the prostate, semilunar in form and about half an inch in 

 width, can be made out (fig. 694). 



The position of this and the other two folds of Houston should be remembered, 

 as their presence, if well developed and if the liowel be empty, may interfere with 

 the passage of instruments. 



In addition to the structures which can be felt, those which can be seen 

 with a speculum, especially if the body be seen in the semiprone or genu- 

 pectoral position, must l)e noted. Starting from immediately within the anus are 

 some six or eight vertical folds of mucous membrane, the columns of Glisson. 



Fig. 697. — Diagram of the Pelvic Fascle. 



Transversalis fascia 



Obturator fascia 



' White line' 



Becto-vesical fascia 



Obturator fascia 

 Ischio-rectal fascia 



Aleoek's canal writh 

 pudic vessels 



Abdominal muscles 



Psoas 



BORDER OF ACETABULUM 



Apex of isehio-rectaf 

 fossa 



Levator ani 



ISCHIAL TUBEROSITY 



Sphincter ani 



Between these columns lie little pockets or lacunae, the sinuses of Morgagni, just 

 above the external sphincter. In the above-mentioned columns the hasmorrhoidal 

 vessels ascend and descend, intercommunicating l^y numerous transverse branches. 

 The above examination refers chiefly to_ the male. It remains to refer to rectal 

 examination in the female. Anteriorly, the soft perinatal body and recto- 

 vaginal septum will be met with, and, through the latter, the cervix and os uteri, 

 and, higher up, the lower part of the cervix uteri. ]More laterally tlie ovaries may 

 be felt, but the Fallopian tubes, unless enlarged and thickened, are not to be made 

 out. The student should he familiar with the feel of a healthy recto-uterine or 

 recto-vesical pouch, according to the sex, and the coils of intestine which it may 

 contain, so as to be able to contrast this with any collection of inflammatory or 

 other fluid or mischief descending from the upper pelvis, e.g. from the vermiform 

 ap]iendix. Posteriorly, certain structures are met with in either sex. After a very 

 short interval (sphincter and ano-coccygeal body), the finger reaches the tip of the 

 coccyx and explores the hollow of the sacrum. On each side is the ischial tuber- 

 osity and wall of the true }ielvis. The finger, hooked outwards and ujiwards, comes 



