Regional and surgical anatomy of the human body / A. Velpeau.

  • Alfred-Armand-Louis-Marie Velpeau
Date:
[1829?]
Catalogue details

Licence: Public Domain Mark

Credit: Regional and surgical anatomy of the human body / A. Velpeau. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    APONEUROSIS. lied with Uie concave margin of the triangular ligament of the pubis, and appears to form the latter. Perhaps it would be better to describe it as dividing, so as to cover the symphisis pubis, anteriorly and posteriorly. Its form must be triangular, as it is attached to the internal margin of the pubic arch, which it completely closes up: it is prolonged upon the urethra, while passing through anteriorly to the prostate gland; the rectum perforates the posterior portion in a similar manner : so that the deep or superior layer is separated from the superficial by the interposition of the crura penis, the bulbous portion and anterior half of the membranous portion of the urethra, together with the perineeal muscles: or, rather, it is an aponeurosis, between the two layers of which these several organs are interposed : this membrane is very irregular, yellowish, and elastic ; just as the urethra passes through it, before the prostate gland it is con- tinued into the pelvis, forming a capsule for this body, and more posteriorly in the false perinseum. Mr. Colles, in describing this fascia, calls it the triangular ligament of the urethra; it is the perineeal ligament of Car- cassone; it constitutes the septum which closes up the anterior half of the inferior outlet of the pelvis ; so that pus and fluids, forming in this cavity, are not conducted by the cellular struc- ture to the perinaeum, as occurs elsewhere. Becoming continu- ous with the obturator fascia, it binds down the internal pudic artery; its chief use is to give support to the origin of the urethra, and preserve it in its proper position, and also to anta- gonize the diaphragm and abdominal muscles : the levator por- tion supports the rectum, and is sometimes so strong as to resist the introduction of the hand into this intestine. The prostate gland, the prostatic portion of the urethra, and the neck of the bladder in connexion with this gland, the levator ani, and ante- riorly some vessels and cellular tissue, are interposed between the posterior production of the triangular ligament of the urethra, (which we have described as forming the capsule of the prostate gland,) and the levator fascia; in the lateral operation of lithotomy, the knife must pass through and above the latter, while the safety of the patient demands that it shall enter the bladder below, and not divide the former. From the foregoing considerations, Ave can readily understand the consequences attending on, and resulting from fistula in ano, and several accidents taking place after lithotomy; and why acute phlegmonous inflammation, engaging the structure in the depression between the tuberosity of the ischium and rectum, occupies the whole space between the obturator and levator fasciae: the suppuration and detachment of the cellular structure makes this a vacuum; so that, when the destruction of the integument is commensurate to the deep seated burrowing, cicatrization is difficult, from the immobility of the external, and the alternate approximation and separation of the internal,