15. Lymphatic Vessels. Inflammation, obstruction, rupture, tuberculosis and invasion by malignant neoplasms are the most important conditions. (See also Thoracic Duct, Chapter VIII, Page [130].)
16. Lymphnodes. The retroperitoneal lymphnodes and hæmolymph nodes are described as to their number, size, color, consistence, occurrence of hyperplasia, lymphadenitis, atrophy, congestion, œdema, hæmorrhage, pigmentation, tuberculosis, metastatic tumors, primary tumors (lymphosarcoma), leukæmic hyperplasias and Hodgkin’s disease.
17. Sympathetic. The solar plexus, semilunar ganglia and adrenal plexus should be examined, particularly in Addison’s disease, for atrophy, degenerations, involvement in inflammatory processes, hæmorrhages, tumor-infiltrations, etc.
18. Psoas Muscles and Diaphragm. Examine for purulent, phlegmonous or gangrenous inflammations, tuberculosis, actinomycosis, trichinosis, atrophy and scar-tissue. Pus from carious processes in the thoracic and lumbar vertebræ burrows downward along the psoas muscle.
19. Vertebrae. Fractures, dislocations, curvatures, deviations, tuberculosis, caries, actinomycosis, etc.
CHAPTER XI.
THE EXAMINATION OF THE PELVIC ORGANS.
I. METHODS OF EXAMINATION.
1. Male Pelvis. When the removal of the external genitals is permitted the fundus of the bladder is taken in the left hand and pulled toward the head of the cadaver while the anterior wall is separated from the pubis. This can be done with the fingers of the right hand or the point of the knife. The loose connective-tissue is torn on both sides around the urethra and rectum until the hand can be passed beneath the rectum, completely encircling it and the prostate which must be freed as far as its anterior border. The legs of the cadaver are then separated, and an incision is made with the large section-knife, through the skin, beginning above at the root of the penis, at the termination of the main incision, and following the arch of the pubis around the external genitals down to the left, passing around the anus to the coccyx. A similar incision is then made on the right side of the external genitals to meet the first incision behind the anus. The outer genitals are then held in the left hand and pulled downward between the legs while they are dissected from the pubis, cutting the suspensory ligament of the penis, to the level of the posterior border of the symphysis. The knife is then run through into the pelvis just beneath the symphysis, and while traction is made upon the external genitals toward the right, a sweeping cut is made downward to the left along the pubic arch, severing the insertion of the cavernous portion of the penis on that side. A similar cut is then made on the right side. The penis thus freed is then pushed up beneath the symphysis into the pelvis and the scrotum pulled up after it, putting the perineum on the stretch and pulling up the anus so that it can be seen. While the external genitals are forcibly pulled upward in the pelvic cavity toward the head, the encircling incision behind the anus is deepened, cutting the fat-tissue, connective-tissue, and muscle around and behind the rectum, until the whole mass of genital organs and rectum is so loosened that it strips up easily to the brim of the pelvis, where any remaining attachments of peritoneum or blood-vessels are severed and the entire mass removed for examination on the board.
The mass is laid upon the board with rectum uppermost. The latter is then opened from the anus, using the intestinal shears, and scraping off the contents into a pail so as not to contaminate the other tissues. The rectum is then separated from the base of the bladder and prostate, guiding the incision along the outer muscular layer of the rectum, and stripping off the latter until the seminal vesicles are wholly exposed. These are then examined by means of transverse cuts, or are opened longitudinally with the knife or fine probe-pointed scissors. The prostate may also be sectioned from its posterior surface, if it is desired to preserve the urethral side intact. Cowper’s glands are also accessible from this incision. The organs are then turned over, the penis put on a stretch and the anterior wall of the urethra cut in the median line from the meatus to the bladder. A pair of strong, medium-sized probe-pointed scissors should be used. The incision is extended through the anterior wall of the bladder. The mouth of the ureters, ejaculatory ducts and ducts of Cowper’s glands are examined. If the prostate has not been examined from the rectal side it may now be examined by means of transverse incisions across the urethra and extending entirely through the gland. The section of the genitalia is then finished by the examination of the testicles. The latter are removed by enlarging the inguinal canal on each side, slipping the testicles up through them, and bisecting each gland so that the incision falls through the head of the epididymis. The testicles may also be examined by means of incisions made in the scrotum over the glands, which are forced through the incisions and then bisected. If the vasa deferentia are to be preserved they should be dissected out before the semicircular cuts on each side of the external genitals are made.
When the kidneys have been removed, and the ureters left uncut, to be examined in connection with bladder and external genitals, they are usually left lying on the thighs until the abdominal examination is finished. They are then laid in the abdomen until the pelvic organs have been separated up to the brim of the pelvis. At this point care should be taken to see that the ureters are not cut when the whole mass of pelvic organs, ureters and kidneys is removed. When placed upon the board the ureters are laid straight and the kidneys placed in their respective positions. The ureters are sounded from the bladder and when desired opened upward from the bladder to the kidneys. The section of the kidneys may then proceed according to the directions given in the last chapter.