Zbe Bristol
flftebtco^Gbmtrotcal Journal. "
Scire est
nescire, nisi id
me
Scire alius sciret
1906.
JUNE,
RELATION OF THE PELVIC sFLOOR TO DISPLACEMENTS AND PAIN IN
THE
PELVIC
THE
Ernest W. Hey
FEMALE.
Groves, M.D., M.S., F.R.C.S.,
Assistant-Surgeon to the Bristol General Hospital ; Demonstrator of Anatomy at University College, Bristol. of literature has been written about
pelvic displacements, and an endless number of instruments and operations have been devised for the treatment of these conditions; and the more is written the more compli-
A
vast
pain
amount
and
uterine
cated and obscure does the
subject become,
of the theories and methods of treatment another. caused
It
by
might minor
indeed be said that
displacements
methods of treatment
nothing
is
as
because
so
many to one
opposed regards the symptoms are
of the uterus
definitely
and the
established.
best Some
authorities say that flexions of the uterus matter nothing, but that versions require treatment. Others consider the flexions are
proposed that the kept straight by an intra-uterine find in the operation of sewing the Others, again,
the conditions
crooked uterus stem.
to be
attacked,
should be
8 Vol. XXIV.
No. 92.
and have
DR.
uterus
And
of active
HEY
GROVES
the abdominal wall the
to
ments.
W.
there
lastly
disease,
cure
those
are
for
operate for the relief of
never
displace-
most
in the
who,
absence
pain,
mere
and find in the pessary the remedy for all these ills: and in this class must be reckoned the vast majority of practitioners who fit
pessary for every woman who has a displacement, her there it stays for months or years ; and if suits and if it it does not she is fitted with a larger and yet larger size, a
until both doctor
and
patient give
attempt will
an
present paper
the
principles underlying
ments on the basis of
be
In the up in despair. made to establish the
of uterine and vesical
cause
anatomical
simple
displace-
and to deduce
facts,
therefrom the general rules which should determine treatment. It is obvious that a correct estimate of the factors concerned in
the uterus and bladder in their normal
maintaining
must be the
guide
to
position displacements. connected to the pelvic walls
understanding
The uterus and bladder
are
their
by folds of peritoneum, between which folds are contained strands of vascular connective tissue and some unstriped muscle. fascial
But
plane
intimately so
by
also
they
known
securely
rest
the
on
pelvic floor.
the
muscular
and'
Further,
they are one another and to the vaginal vault, derives additional attachment to the pelvis as
connected to
that each viscus
the structures which support the other two. Peritoneal and "Ligamentous" Attachments.?Behind,
peritoneum
is
intimately
from the cervix and thence
and
much
loosely,
more
invests the
bladder.
peritoneum forming and
backwards
peritoneum lining portant
contains, bands.
the
the
it leaves the
broad
junction
of this viscus
body
sides the double layer of broad ligament stretches outwards
pelvic and
continuous
with the
and
covers
ligaments
body
with
the
lymphatics three
stretch of the
parietal
besides the im-
And
walls.
nerves
ligament
The utero-sacral
close to its
vault
At the
become
to
bloodvessels the
vaginal
the rectum, forming the recess known as In front, where the peritoneum invests the
Douglas's pouch. uterus
the posterior wall of the
to
on
to
on
the
attached to the uterus, and is reflected
which
it
fibro-muscular from the
cervix
uterus, along the
PELVIC
ON
base of the broad attached the
to
ligament the
to
ligament,
cornu
the
from
runs
brim
of the
of
the
the
PAIN.
99
Douglas's pouch, on
runs
from
the
ovary.
to
the
posterior
The round
anterior part of the uterine
pelvis,
be
each side of
cornu
it
emerges
through the
inguinal
canal to
be
where
attached
pubes.
The pelvic floor is stretches
across
and from
one
pairs
AND
sacrum
to
uterus
internal abdominal ring and to
round
third piece of the The ovarian ligament
the
rectum.
part of the
DISPLACEMENTS
the
muscular and fascial
a
pelvic cavity,
ischial
spine
to
of muscles and the fascia
from the
the other.
diaphragm
which
to the coccyx It consists of two
pubes
covering them,
viz. the
coccygei
and levatores ani.
The former may be ignored, as they do not concern the present subject. The floor on which the uterus, vagina and bladder rest, is formed then, by the two levatores
fascia arising from the greater part of pelvic basin and joining one another in the mid line. It is perhaps unfortunate that these muscles are so named and described as though they only lifted the anus and
ani,
with their
covering
the walls of the
were are
therefore the
vertically disposed.
representative
As
a
matter of
fact
they
of the flexor caudae muscles of tailed
./^a^u/rn. -\SaJbs?
flftebtco^Gbmtrotcal Journal. "
Scire est
nescire, nisi id
me
Scire alius sciret
1906.
JUNE,
RELATION OF THE PELVIC sFLOOR TO DISPLACEMENTS AND PAIN IN
THE
PELVIC
THE
Ernest W. Hey
FEMALE.
Groves, M.D., M.S., F.R.C.S.,
Assistant-Surgeon to the Bristol General Hospital ; Demonstrator of Anatomy at University College, Bristol. of literature has been written about
pelvic displacements, and an endless number of instruments and operations have been devised for the treatment of these conditions; and the more is written the more compli-
A
vast
pain
amount
and
uterine
cated and obscure does the
subject become,
of the theories and methods of treatment another. caused
It
by
might minor
indeed be said that
displacements
methods of treatment
nothing
is
as
because
so
many to one
opposed regards the symptoms are
of the uterus
definitely
and the
established.
best Some
authorities say that flexions of the uterus matter nothing, but that versions require treatment. Others consider the flexions are
proposed that the kept straight by an intra-uterine find in the operation of sewing the Others, again,
the conditions
crooked uterus stem.
to be
attacked,
should be
8 Vol. XXIV.
No. 92.
and have
DR.
uterus
And
of active
HEY
GROVES
the abdominal wall the
to
ments.
W.
there
lastly
disease,
cure
those
are
for
operate for the relief of
never
displace-
most
in the
who,
absence
pain,
mere
and find in the pessary the remedy for all these ills: and in this class must be reckoned the vast majority of practitioners who fit
pessary for every woman who has a displacement, her there it stays for months or years ; and if suits and if it it does not she is fitted with a larger and yet larger size, a
until both doctor
and
patient give
attempt will
an
present paper
the
principles underlying
ments on the basis of
be
In the up in despair. made to establish the
of uterine and vesical
cause
anatomical
simple
displace-
and to deduce
facts,
therefrom the general rules which should determine treatment. It is obvious that a correct estimate of the factors concerned in
the uterus and bladder in their normal
maintaining
must be the
guide
to
position displacements. connected to the pelvic walls
understanding
The uterus and bladder
are
their
by folds of peritoneum, between which folds are contained strands of vascular connective tissue and some unstriped muscle. fascial
But
plane
intimately so
by
also
they
known
securely
rest
the
on
pelvic floor.
the
muscular
and'
Further,
they are one another and to the vaginal vault, derives additional attachment to the pelvis as
connected to
that each viscus
the structures which support the other two. Peritoneal and "Ligamentous" Attachments.?Behind,
peritoneum
is
intimately
from the cervix and thence
and
much
loosely,
more
invests the
bladder.
peritoneum forming and
backwards
peritoneum lining portant
contains, bands.
the
the
it leaves the
broad
junction
of this viscus
body
sides the double layer of broad ligament stretches outwards
pelvic and
continuous
with the
and
covers
ligaments
body
with
the
lymphatics three
stretch of the
parietal
besides the im-
And
walls.
nerves
ligament
The utero-sacral
close to its
vault
At the
become
to
bloodvessels the
vaginal
the rectum, forming the recess known as In front, where the peritoneum invests the
Douglas's pouch. uterus
the posterior wall of the
to
on
to
on
the
attached to the uterus, and is reflected
which
it
fibro-muscular from the
cervix
uterus, along the
PELVIC
ON
base of the broad attached the
to
ligament the
to
ligament,
cornu
the
from
runs
brim
of the
of
the
the
PAIN.
99
Douglas's pouch, on
runs
from
the
ovary.
to
the
posterior
The round
anterior part of the uterine
pelvis,
be
each side of
cornu
it
emerges
through the
inguinal
canal to
be
where
attached
pubes.
The pelvic floor is stretches
across
and from
one
pairs
AND
sacrum
to
uterus
internal abdominal ring and to
round
third piece of the The ovarian ligament
the
rectum.
part of the
DISPLACEMENTS
the
muscular and fascial
a
pelvic cavity,
ischial
spine
to
of muscles and the fascia
from the
the other.
diaphragm
which
to the coccyx It consists of two
pubes
covering them,
viz. the
coccygei
and levatores ani.
The former may be ignored, as they do not concern the present subject. The floor on which the uterus, vagina and bladder rest, is formed then, by the two levatores
fascia arising from the greater part of pelvic basin and joining one another in the mid line. It is perhaps unfortunate that these muscles are so named and described as though they only lifted the anus and
ani,
with their
covering
the walls of the
were are
therefore the
vertically disposed.
representative
As
a
matter of
fact
they
of the flexor caudae muscles of tailed
./^a^u/rn. -\SaJbs?
