File:Clinical lectures on stricture of the urethra and other disorders of the urinary organs (1878) (14595034530).jpg

Identifier: clinicallectures00harr (find matches)
Title: Clinical lectures on stricture of the urethra and other disorders of the urinary organs
Year: 1878 (1870s)
Authors: Harrison, Reginald, 1837-1908
Subjects: Urologic Diseases Urethral Stricture Urethra Urinary organs
Publisher: London : J. & A. Churchill Liverpool : Adam Holden
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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tention of urine the posterior wall of the bladdercan be explored and commanded sufficiently to admitof its being punctured without injury to the surround-ing parts. In children, not only can a stone in thebladder be felt by the finger in the rectum, but, asMr. Thomas Smith has pointed out, its removal faci-litated. 22 SECOND LECTURE. Turning to the anterior aspect of the bladder, weshould observe that the peritoneum, in its reflectionfrom the back of the abdominal muscles on to thebladder, leaves a space just above the symphysis pubis,where the bladder, when it is distended, may be punc-tured without injury to the peritoneum. We should now proceed to notice the attachmentsand connections of the various fasciae having relationwith the urethra ; for we shall find that when matterforms around the urethra, or extravasation of urinetakes place, the direction taken by these fluids isentirely influenced by the attachments of the fasciae.If you refer to a side view of the pelvic fasciae, you
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Fig. 4. will see that there are three distinct compartments SECOND LECTURE. 28 where, about the perinaeurn, fluid may collect. Ineach, the course taken by the fluid—be it urine ormatter—will be different, the difference being deter-mined by the connections of the layers of fasci*between which it is placed. When matter formsaround the prostate gland, in the compartmentmarked 1, it cannot come forwards, in consequenceof the triangular ligament; it therefore goes back-wards into the cellular tissue of the pelvis,where it will spread with great rapidity andfatality, under the name of pelvic cellulitis. Theformation of matter in this position may be occa-sioned by injuries to the prostatic portion of theurethra. Not unfrequently it is the cause of death inlithotomy, where the incision into the prostate hasbeen so free as to include its fibrous investment.When matter forms in compartment No. 2, betweenthe layers of the triangular ligament, it either burstsinto the urethra or makes its w

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