File:The practice of surgery (1910) (14798809963).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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owing deep and superficial muscles of the perineum (after Sobotta). two courses—either along the round ligaments and so to the inguinalnodes, or along the ovarian vessels, the suspensory ligament of the ovarj^.and thus up to the lumbar nodes. Se we see that lymphatic channelsfrom the lowest portion of the vagina, as well as from the fundus of theuterus, deposit their material eventually in the lumbar nodes, whichlie high in the abdomen, upon the front of the aorta, in the region of thekidneys. The reader will recall our brief discussion of the-se lumbarlymph-nodes in Chapter VHI, when we dealt with the retroperitoneal ANATOMY 259 space. So much, in rough outhne, for the relations of the pelvicorgans, and their blood and lymph connections when viewed from above.In approaching the uterus from below by the perineal route, one en-counters another interesting series of relations, concerned mainly withthe supports of the pelvic floor. The approach from above may be Sup. ves. Hypof^^istric
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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. K

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