4i S SURGICAL APPLIED ANATOMY, [chap. XVIIL 



producing a kind of spennatorrhrea, Def?ecation also 

 often causes much pain in inflammatory affections of 

 the prostate and adjacent parts. 



The anterior surface of the rectum in the female 

 is in relation, so far as the finger can reach, with the 

 vagina, and in examining the lower part of the 

 rectum, it is convenient to protrude its mucous mem- 

 brane through the anus by means of the finger intro- 

 duced into the genital passage. 



The rectum is dilated, and is very distensible just 

 above the anus. In faecal accumulations it may be dis- 

 tended to a considerable size, and strange foreign 

 bodies of large dimensions have been found in the 

 ampulla. Among the latter may be mentioned a 

 bullock's horn, an iron match-box, and a glass tumbler. 

 Experiment has shown that when the rectum is dis- 

 tended in the male, the recto- vesical fold of peritoneum 

 is raised, and the bladder is elevated and pushed for- 

 wards. In the female the fundus uteri is raised and 

 pushed towards the symphysis. The rectum is arti- 

 ficially distended in suprapubic lithotomy, in order to 

 bring the bladder into better position (page 392). 



If the sphincter be very gradually dilated, the 

 entire hand, if small, may be introduced into the 

 rectum in both males and females. The circumference 

 of the hand should not exceed eight inches. By a 

 semi-rotary movement, and by alternately flexing and 

 extending the fingers, the hand can be insinuated 

 into the commencement of the sigmoid flexure. 

 Owing to the mobility of this part of the bowel a 

 large extent of the abdomen may be explored through 

 the bowel wall. The structures that can be readily 

 felt are the kidney, the aorta, the iliac vessels, the 

 uterus and ovaries, the bladder and its surroundings, 

 the pelvic brim, the sacro- sciatic foramina, the ischial 

 spine, the sacrum, etc. In some subjects even a 

 small hand cannot be passed beyond the reflection of 



