Landmarks, medical and surgical / by Luther Holden.

  • Luther Holden
Date:
1877
Catalogue details

Licence: Public Domain Mark

Credit: Landmarks, medical and surgical / by Luther Holden. Source: Wellcome Collection.

    53/116 (page 41)
    easily recognised in the living body. It shows the junction of the skin and mucous membrane, and is of especial in- terest because it marks with great precision the linear interval between the external and internal sphincter mus- cles. It is an exact and truthful landmark, and can be relied upon. From this line the internal sphincter extends upwards, beneath the mucous membrane, for about an inch, becoming gradually more and more attenuated. The wTinkled appearance of the anus is caused by the contraction of the external sphincter. At the bottom of these cutaneous folds, especially towards the coccyx, we look for '■ fissure of the anus.' 92. Many valuable landmarks may be felt by intro- Land- ducing the finger into the rectum, with a catheter at the the rectum. same time in the urethra. The principal of these land- marks are the following :— a. You can feel the extent and pow^erful grasp of the internal sphincter for about one inch up the bowel. b. Through the front w^all of the bowel you can most Urethra. distinctly feel the track of the membranous part of the urethra, exactly in the middle line. This is very impor- tant, because you can ascertain with precision whether the catheter has deviated from the proper track. c. About an inch and a half or two inches from the Prostate anus, the finger comes upon the prostate gland. The gland lies in close contact with the bowel, and can be de- tected by its shape and hard feel. The finger, moved from side to side, can examine the size of its lateral lobes. d. The finger, introduced still farther, can reach beyond the prostate, as far as the apex of the trigone of the bladder. More than this, it can feel the angle betw^een the ductus communes ejaculatorii, which forms the apex of the trigone. This is the precise spot where the distended bladder should be punctured through the rectum. The more distended the bladder, the easier can this spot be felt. Fluctuation is at once detected by a gentle tap on the bladder above the pubes. The trochar must be thrust in the direction of the axis of the distended bladder ; that is, jland.