File:The practice of surgery (1910) (14776595204).jpg

Identifier: practiceofsurger00mumf (find matches)
Title: The practice of surgery
Year: 1910 (1910s)
Authors: Mumford, James Gregory, 1863-1914
Subjects: Surgery
Publisher: Philadelphia and London, W. B. Saunders company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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Text Appearing Before Image:
Fig. 139.-—Relations of the ureters and the cervix uteri (Kelly). regarded as in the field of major surg•er3^ Sometimes the approach frombelow is regarded as in the field of minor surgery. If one remembersthat the important structures in the pelvic floor—the anus, vagina,and urethra—are passages for elimination, and that they form weakpoints at the bottom of the abdominal cavity, one will comprehend theimportance of weaving about them a muscular and aponeurotic network 260 FEMALE ORGANS OF GENERATION which shall support the great weight of abdominal viscera pressing fromabove, but at the same time shall allow the urethra, vagina, and anusproperly to functionate. In this connection it is interesting to observethat much of the damage and disease which occur in these dependentregions are concerned, on the one hand, with the breaking down of thepelvic floor and a dropping out of viscera, and, on the other hand, withobstructions or i)artial closures of the three channels of vent.
Text Appearing After Image:
Fig. 140.—Distribution of lymphatics of the uterus (Kelly). So observe the perineal supports. There is the sphincter ani, closelyassociated with the two trans versus perinei and constrictor vaginaemuscles. These four form a delicate external network of muscles, whosefunction it is to control and regulate the outlets of the anus and vag-ina. These muscles have no great supporting strength. Above them,however, lies the true strength of the pelvic floor, the levator ani muscle,the powerful hammock in which rest the pelvic viscera. So one sees thatdamage to the external layer of muscles means damage of dehcate func- INFLAMMATIONS 261 tion only; while injury to the levator ani muscle results in serious de-rangements of the pelvic and abdominal viscera. Bearing in mind these important facts,—that in approaching theuterus from below the vagina offers an ample passage usually for opera-tion, and that the ureters and uterine vessels lie low in the pelvis, againstthe upper portion of the va

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