Treatise on gynæcology : medical and surgical . ure-ters are found at the posterior angles of the trigone, and the anterioris occupied by the urethra. Each of the three orifices is at the top ofa papilla, which is more or less prominent, of an irregular cylindricalform, made by a thickening of the muscular coat and invested bymucous membrane. These papillae serve as land-marks. They are,,moreover, connected by a marked band of the same formation, convexforward, thick and resistant enough to hold the point of a sound nt 124 CLINICAL AND OPERATIVE GYNAECOLOGY. its middle (Pawlik), where it is so
Treatise on gynæcology : medical and surgical . ure-ters are found at the posterior angles of the trigone, and the anterioris occupied by the urethra. Each of the three orifices is at the top ofa papilla, which is more or less prominent, of an irregular cylindricalform, made by a thickening of the muscular coat and invested bymucous membrane. These papillae serve as land-marks. They are,,moreover, connected by a marked band of the same formation, convexforward, thick and resistant enough to hold the point of a sound nt 124 CLINICAL AND OPERATIVE GYNAECOLOGY. its middle (Pawlik), where it is somewhat thinned, and to be appreci-ated by direct palpation (Simon). This fold is called the inter-ureteralligament, the pad or muscle of the ureter; it forms the curved baseof Lieutauds triangle, the other sides being indicated by less markedfolds which point toward the urethra and become thinner. The di-mensions of this triangle are naturally inconstant, but it is usuallyalmost equilateral. Its base is estimated at 2 cm. 6 mm. to 4 cm. (f to. Fig. 87.—The Vesical Trigone (Pawlik). L, L, Labia minora; O, urethral orifice; O, 0, urethral?cushion; V, os externum; B, fold of mucous membrane, behind inter-ureteral ligament, forming base oftriangle; S, S, lateral fold, converging and corresponding to the sides of the triangle. li in.) (Simon, Quain, Hyrtl); its sides, at 2 cm. 7 mm. (Simon), 2 cm.,and 2 cm. 8 mm. (Warnoots) or at 4 cm. (Hart) (1 to 1|- in.). The dis-tance between the urethral opening and the middle of the base isgiven as 1 cm. to 2 cm. (Warnoots) to 3 cm. (Hart) (f to l| in.). Pawlik has the patient put in the genu-pectoral position, but onecan quite as well do the operation in the dorso-sacral; it is only nec-essary in the latter position to have the head well lowered and thebuttocks strongly raised, that the viscera may fall toward the dia- METHODS OF GYNECOLOGICAL EXAMINATION. 125 phragm. -A Simons speculum, as large as possible, is put into thevagina and the
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Keywords: ., bookcentury1800, bookdecade1890, booksubje, booksubjectgynecology
