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.

    4/20
    4 requisite for its nourishment, etc. As is well known, the urethra, vagina, and rectum pass through it. Now, as usually drawn, the dilated vagina and rectum appear markedly to impair the compact nature of this diaphragm. The reverse, however, is the case, and we will now attempt to show that this pelvic diaphragm in the virgin is a compact and homogeneous layer, as compact and un¬ impaired as in the male. In the first place, the anus is always, during life, closed ; and therefore the muscular sphincter, reducing it to a pucker, really adds to the strength of the floor. Then, above all, the vagina is no cavity under ordinary circum¬ stances and postures.1 In vertical section its walls are in perfectly accurate apposition. (Fig. I. Y. YI.) It has no side walls at all, only an anterior and posterior, each of a triangular shape with multiplied transverse rugosities. From this description, then, it is evident that the “ vaginal slit ” in no way impairs the strength of the pelvic floor. Were it the tube usually figured, prolapsus uteri would be the normal state in almost all women. We need not delay to prove that the urethra, practically a capillary tube, inter¬ feres as little with the efficiency of the pelvic floor as the vagina and rectum. The pelvic diaphragm is therefore a thick, compact layer, tunnelled by no cavities. Its thickness varies, being greatest at its centre, least at its sacral attachment, and intermediate near the pubis. In one of the sections (Fig. Y.) the thicknesses at the above points are 2J inches, inches, and 2 inches. The slits traversing it are all parallel, or nearly so, to the pelvic brim—a fact of importance to be again alluded to. By this “ vaginal slit ” we get the pelvic floor divided anatomically into two portions—a pubic anterior, and a sacral posterior, half. The pubic anterior half is triangular in shape, has a pubic, vaginal, and pelvic side, and is made up of bladder and anterior vaginal wall. The pubic side does not accurately hug the smooth surface of the pubis, but is Y shaped, with the apex of the Y turned to the sacrum. (Fig. Y.) This angular interspace between the pubis and bladder is filled up with loose fat. The vaginal and pubic sides are each 2 inches long, while the pelvic is 3 inches. (Fig. Y.) This triangle has, therefore, no firm bony attachments, is only feebly muscular, and is so arranged that its pubic side can freely extend round the symphysis as a centre, and in any move¬ ment downwards will necessarily drag on the uterus, since the anterior lip of the cervix is attached to its posterior angle. The sacral half of the pelvic floor is roughly oblong in its shape. As contrasted with the pubic half, it has a strong dove-tailed 1 The knee-elbow and lithotomy postures, by admitting air, render the vagina a pyramidal cavity, the apex being at the ostium vagina). The pro¬ bable cause of this will form the subject of a separate communication.