File:Operative gynecology - (1906) (14596937037).jpg

Identifier: operativegynecol001kell (find matches)
Title: Operative gynecology :
Year: 1906 (1900s)
Authors: Kelly, Howard A. (Howard Atwood), 1858-1943
Subjects: Gynecology Gynecology Gynecologic Surgical Procedures
Publisher: New York and London : D. Appleton and company
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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to form a muscular sling,attached to and embracing the lower end of the rectum, so directed as to pull COURSE OF THE INTERNAL PUDIC ARTERY. 77 the rectum upward and forward. The anterior thick bundles of fibers, arisingfrom the upper inner part of the pubic rami, serve to draw the lowTer part ofthe bowel well forward, and so act indirectly as closers of the vagina. Theaction of the posterior fibers is simply that of holding the bowel up. Thecoccygens, pyriformis, and psoas muscles are also well seen as described inFig. 39. Fig. 43 shows the exact course of the internal puclic artery as it arisesfrom the anterior branch of the internal iliac, passes out of the pelvis throughthe great sacro-sciatic foramen, and crosses the spine of the ischium, to re-enterthe pelvis through the lesser sacral foramen. From this point it arches forwardin a gentle curve, giving off its various branches, which course over the innersurface of the tuberosity of the ischium and cross from under the pubic arch
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Fig. 43.—The Course and Distribution of the Internal Pudic Arteries. about halfway between the symphysis and the tuberosity, to the outer surfaceof the descending pubic ramus; it terminates on the anterior surface of thesymphysis and the dorsum of the clitoris. The various trunks of origin of theinferior hemorrhoidal, superficial perineal artery, artery of the bulb, and corpuscavernosum are all shown. Fig. 44 shows the arterial vascularization of the floor of the pelvis as seenfrom without. The various arterial branches drawn are the derivatives of theinternal pudics already indicated in their origin in Fig. 43. 78 TOPOGRAPHICAL ANATOMY. Within the bony framework of the pelvic outlet, as formed laterally and pos-teriorly by the great sacro-sciatic ligaments, are seen the three pelvic outlets—the urethral, vaginal, and anal—corresponding to the same outlets seen fromwithin in the complementary picture (Fig. 42). It is important again to

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