368 ABDOMEN 



pierced in the centre by a circular opening or a vertical 

 slit ; again, it may be cribriform or fringed along its free 

 margin. Lastly, it may constitute a complete septum across 

 the opening of the vaginal canal. In this case awkward 

 results ensue from the retention of the menstrual fluid. After 

 it has been ruptured its position is marked by certain rounded 

 elevations which have received the name of carunculcz 

 hymenales. 



Close to each side of the vaginal orifice, in the groove 

 between it and the posterior part of the labium minus, is the 

 opening of the duct of the large vestibular (Bartholiris] gland, 

 an orifice just visible to the naked eye. 



Passage of Catheter and Examination of Os Uteri. The 

 dissector should now practise the passing of the female 

 catheter, and afterwards introduce a speculum into the vagina, 

 so as to obtain a view of the os uteri. 



In passing the catheter the forefinger of the left hand 

 should be placed in the orifice of the vagina, with its palmar 

 surface directed upwards towards the pubes. If the instrument 

 be now passed along this finger and the point raised slightly, 

 when it reaches the entrance to the vagina, a little manipula- 

 tion will cause it to enter the urethra. 



When the speculum is introduced into the vagina, the points 

 to be noted in connection with the os uteri are: (i) the 

 small size of the opening; (2) the two rounded and thick lips 

 which bound this aperture. In both the virgin and in women 

 who have borne children it is a transverse cleft, but in the 

 former it is small and its anterior and posterior lips are smooth 

 and rounded, whilst in the latter it is usually larger and its lips 

 are frequently cleft and scarred. Note further that the 

 anterior lip is the thicker and shorter of the two, whilst the 

 posterior lip is the longer. 



Reflection of Skin. The anal canal should be slightly filled with tow, 

 and the vulva and anal orifice stitched up. Incisions (i) A transverse in- 

 cision should, in the first place, be carried from one ischial tuberosity to the 

 other, in front of the anus. (2) The urogenital fissure and the orifice of the 

 anus should next be closely encircled by incisions, and these joined by a 

 cut along the middle line. (3) Lastly, carry an incision forwards from the 

 second or third piece of the coccyx along the middle line to the cut which 

 surrounds the anus. 



Four flaps are thus marked out ; the two anterior may be thrown for- 

 wards and laterally, and the two posterior backwards and laterally. 



Superficial Fascia. The superficial fascia of the perineum 



