A study of two mesial vertical sections of the female pelvis in relation to the normal support of the uterus and prolapsus uteri / by David Berry Hart.

  • Hart, D. Berry (David Berry), 1851-1920.
Date:
1879
Catalogue details

Licence: Public Domain Mark

Credit: A study of two mesial vertical sections of the female pelvis in relation to the normal support of the uterus and prolapsus uteri / by David Berry Hart. Source: Wellcome Collection.

    14/20 (page 6)
    From his paper we learn, however, that it is a mechanical quality which may be present in an extraordinary degree, diminished, or entirely absent. As to its power, Dr Duncan thinks it is considerable, for he speaks of it sucking back a 9 lb. child, and lifting a 2 lb. uterus out of the pelvis up to, or even above, the umbilicus, “ against gravitation, against the resistance of superincumbent bowels and anterior abdominal hap/’ While admitting the value of Dr Duncan’s contributions to the physics of the abdomen, I do not think he has as yet proved the existence of a special retentive power. Many of the cases in which Dr Duncan supposes it to act may be explained in other ways. Thus, the recession of the head after a pain is more easily explained as due to the recoil of the elastic lining of the female pelvis than to any sucking-back power of the abdomen. Then is not the alleged ascent of the uterus a growth of it upwards in the direction of least resistance, just as it grows down to¬ wards the perineum when retroflex ed ? It is difficult to con¬ ceive why the retentive power should act so strongly during labour or at the end of it. There is no reason for supposing that, if it does exist, it may not be as strong when the uterus is unimpregnated. If so, it could easily suck up a 2J oz. uterus to the level, or nearly so, of the thoracic diaphragm itself. The difficulties in accepting this theory are so great, and the proofs as yet advanced in support are so scanty, that I do not see how we can give it a share in the natural support of the uterus. We now pass to the clinical applications of the views of the pelvic floor already given.1 If the pelvic diaphragm of a virginal patient be watched during strong expiration or bearing down, it will be seen to become more convex^ especially at or near the base of the perineum. No part of the vaginal or anal mucous membrane is everted, i.e., the compactness of the pelvic diaphragm is not inter¬ fered with during violent efforts; or, to put it in other words, the pubic half of the floor is accurately pressed against the sacral half, and does not slip past it. The reason of this is as follows :—The intra-abdominal pressure strikes the pelvic floor in lines whose resultant coincides more or less with the axis of the brim, and thus distends it. It is therefore almost at right angles to the vaginal slit. From the accurate apposition of the vaginal walls, the anterior triangular part of the pelvic floor is, in the virgin, accurately and firmly pressed against the posterior, and thus the pelvic floor, viewed from without, only becomes more distended, but the continuity of its skin boundary is unbroken by any eversion of vaginal mucous membrane. In the case of a woman who has only had an abortion, say, violent straining even 1 Tlie clinical cases now given are all from patients attending Professor Simpson’s clinique.