Outlines of the diseases of women / by John Phillips.

  • Phillips, John.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Outlines of the diseases of women / by John Phillips. Source: Wellcome Collection.

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    that its cavity is not subject to direct abdominal pressure, the axis of the pelvis being backwards and downwards, while that of the abdomen is perpendicular. The uterus undergoes certain changes of position which must not be considered pathological—viz.: (1) During inspiration the pelvic floor descends, owing to increased abdominal pressure and descent of the diaphragm. This can be well observed by inserting a Sims's speculum and observing the anterior vaginal wall: the converse occurs during expiration, while violent straining produces further bulging. (2) A distended bladder pushes back the whole uterus (retro- ponation); it tends to retroversion of the fundus, and the intestines will be found pushed out of Douglas's pouch. (3) Distension of the rectum pushes the uterus forwards (ante- ponation) and to the right. General Considerations of the Pelvic Floor. TL e pelvic floor may be considered as a diaphragm with three faults or slits in its under surface: 1. The urethral slit; 2. The vaginal slit; 3. The anal slit. The first and second have their long axes parallel to the plane of the pelvic brim : the former is governed by sphincteric action, and may be considered as closed, except during micturition or the passage of a catheter. The anal slit runs at right angles to the pelvic brim, but being protected by a sphincter it must only be looked upon as a weak spot during the act of defecation (Fig. 17). The vaginal slit or fault is of great importance; it may be con- sidered as dividing the pelvic floor into two parts : (1) An Anterior or Pubic Segment, consisting of— 1. The bladder and its peritoneal covering; 2. The urethra joining it at right angles j 3. Anterior vaginal wall; 4. The retro-pubic fat (Fig. 16). This segment is attached to the symphysis pubis loosely. (2) A Posterior or Sacral Segment, composed of— 1. The posterior vaginal wall and the perineal body; 2. The rectum; 3. Tendinous and muscular tissue. This is firmly attached to the coccyx and sacrum by a dove- tailing process around which it rotates. During labour this latter is pushed clown in front of the pre-