Book - An Atlas of Topographical Anatomy 17

From Embryology

XVII. Transverse section of the same body through the pelvis at the level of the upper portion of the head of the thigh bone

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Braune W. An atlas of topographical anatomy after plane sections of frozen bodies. (1877) Trans. by Edward Bellamy. Philadelphia: Lindsay and Blakiston.

Plates: 1. Male - Sagittal body | 2. Female - Sagittal body | 3. Obliquely transverse head | 4. Transverse internal ear | 5. Transverse head | 6. Transverse neck | 7. Transverse neck and shoulders | 8. Transverse level first dorsal vertebra | 9. Transverse thorax level of third dorsal vertebra | 10. Transverse level aortic arch and fourth dorsal vertebra | 11. Transverse level of the bulbus aortae and sixth dorsal vertebra | 12. Transverse level of mitral valve and eighth dorsal vertebra | 13. Transverse level of heart apex and ninth dorsal vertebra | 14. Transverse liver stomach spleen at level of eleventh dorsal vertebra | 15. Transverse pancreas and kidneys at level of L1 vertebra | 16. Transverse through transverse colon at level of intervertebral space between L3 L4 vertebra | 17. Transverse pelvis at level of head of thigh bone | 18. Transverse male pelvis | 19. knee and right foot | 20. Transverse thigh | 21. Transverse left thigh | 22. Transverse lower left thigh and knee | 23. Transverse upper and middle left leg | 24. Transverse lower left leg | 25. Male - Frontal thorax | 26. Elbow-joint hand and third finger | 27. Transverse left arm | 28. Transverse left fore-arm | 29. Sagittal female pregnancy | 30. Sagittal female pregnancy | 31. Sagittal female at term
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IN order to bring the pelvic organs into view, a section was made of the trunk just over the symphysis pubis, and through the lower portion of the sacrum. The section passed through the inguinal region, the outer mass of the muscles of the thigh, the head of the thigh bone near its middle, the pelvis, bladder, rectum, and some coils of intestine lying in Douglas's pouch. The ischia were divided in the tuberosity, so that the section nearly followed the sacro-spinous ligament.


The plate moreover shows, enclosed in the bony pelvis, the obturator internus and levator ani muscles, and laterally the ilio-femoral articulation with its muscles and vessels.


We notice at first that the central portion is bounded by the pubis, ischium, levator ani, sacro-spinous ligament, and the last portion of the sacrum.


The bladder, which contained about four ounces of frozen urine, appeared so contracted on its contents that its form was not affected by the pressure of the neighbouring organs, as is so frequently observed in Pirogoff's plates, whence the upper wall appears considerably fallen in. The body was perfectly fresh when brought in for preparation, and as no decomposition had set in gas had not formed, so that the forms of the cavities were not changed. The contents of the bladder were removed before the drawing was made. The internal orifice of the urethra is clearly seen in the middle of a fringe formed by folds of mucous membrane. More in front is the anterior wall of the bladder, flattened by the pressure of the symphysis. The thickness of the wall of the bladder, considering the amount of distension, is considerable. The thickness of the posterior wall, however, is due to its having been cut obliquely. In order to compare the position and form of the bladder with the section given in Plate I, the mass of ice was carefully removed and represented in profile. This could readily be accomplished, as only a small part of the upper wall of the bladder and its contents was removed with the upper portion of the section. By comparing this with the sagittal section of Plate I a close agreement in form was observed ; though they differed in the fact of the internal orifice of the urethra in Plate I being somewhat higher than in this. In both cases, however, the form and position of the bladder of a young powerful man is defined, as can be verified by injecting tallow either by the urethra or the ureters. It is, at least, certain that the spherical form represented by Kohlrausch is not a natural condition, as he omits to notice a neck to the bladder, which is a funnel-shaped contraction of this viscus towards the urethra. For a wider distension of the bladder there is, as the plate shows, ample room. The cellulo-fatty tissue on both sides of it gives way readily, and the coils of small intestine are easily lifted up and pushed on one side by the swelling bladder. The rectum will be more flattened, and room is afforded by the emptying of great venous plexuses, until at last the bladder alone almost fills the pelvic cavity. With these changes in volume of the bladder, the relations of its peritoneal coat alter. Even in the slight degree of distension shown in the present instance, only the upper wall and a small portion of the posterior were covered by peritoneum, so that there was a passage above the symphysis although but a slight one ; and it is evident that this sub-peritoneal passage must acquire breadth with the increased distension and elevation of the bladder. Behind the bladder is a flat section of the peritoneal sac containing a portion of small intestine divided behind the fold of Douglas, and behind this again is a cul-de-sac of peritoneum, the so-called pouch of Douglas. This is directed in an oblique direction forwards and downwards, and is about three fourths of an inch deep. It held about three fifths of an ounce of frozen water.


The vesiculae seminales, which lie immediately below the section, were exposed by taking away some cellular tissue ; towards the middle line the vasa deferentia take a sharp curve forwards and upwards, and are divided in the section ; their small calibre and thick walls are well seen. Anteriorly and somewhat externally, are the ureters in section. The rectum, which contained a little faeces, was divided shortly before its final curve. The anal extremity was fully 3-8 inches distant from it. If the peritoneum leaves the anterior surface of the rectum entirely free, and, under the form of Douglas's pouch, descends here externally and internally rather more than half an inch ; this pouch is about three inches from the anal aperture, and it follows that at this level an operation on the rectum might be undertaken, without fear of wounding the peritoneum. These relations correspond with those of Plate I.


The question arises with regard to the rectum, as in the case of the bladder, what changes of form it assumes with its varying degrees of distension ; that it is capable of very great changes in volume, both experience and experiments by means of injection show us. The requisite space is provided for in the same way as for the bladder ; the cellular tissue and fat are pushed aside, Douglas's pouch and the intestines are lifted up, and in fuller distension of the rectum the bladder is raised somewhat upwards and forwards. The following woodcut from Pirogoff's atlas is instructive on this point.


There is little here that needs explanation ; the great similarity in form with my plates will facilitate the description. More than half the cavity of the pelvis is occupied by the distended rectum, which is cut through about two inches above the anus, and is considerably distended with air. The semi-lunar fold has not been obliterated by this distension, but springs up sickle-shaped into the cavity. The contour of the pelvic cavity is worthy of notice. The section passes as above mentioned through the spines of the ischia, and partially through the sacro-spinous ligaments, and between the ischiatic notches. Corresponding with it, a process of bone springs from the body of the ischium on both sides, tolerably far backwards, and terminates in the whole length of the sacro-spinous ligament as far as the sacrum. On the right side this band is only to be followed for a certain distance from the sacrum, and does not reach to the apex of the ischium as on the left ; while the sacro-spinous ligament has a horizontal direction, the tuberoso-sacral ligament has a more vertical one, and a small portion only of the latter is seen. It is shown near the sacrum at the edge of the gluteus, where it deviates from the other ligamentous band and lies deep.


Between these fasciculi, on the left side, lie the internal pudic vessels and nerves ; on the right they are further off, and are to be looked for near the spine of the ischium. Internally on either side from the sacro-spinous ligament is a dark band, partly prolonged to the spine of the ischium and partly associated with the fascia of the obturator internus; this is the superior portion of the levator ani. This muscle closes-in the cavity of the pelvis like a muscular funnel, and consequently may not be inaptly compared to the diaphragm. All sections which divide the bladder further downwards must therefore fall within the region of this muscle, and expose it as a muscular ring limiting the pelvic organs. Such a section is shown in the following figure.


Fig. 1. Transverse section of the pelvis of a boy, set. 15. Pirogoff, fasc. iii, tab. xvi, fig. 1. 1,1. Head of femur. 2,2. Great trochanter. 3. Tip of coccyx. 4. Rectum distended with. air. 5. Bladder. 6. Upper border of symphysis pubis. 7, 7. Spermatic cord. 8, 8. Femoral vessels. 9, 9. Obturator internus. 10, 10. Gluteus maximus.


Fig. 2 represents a section that I made on the pelvis of an old man. It passes through the symphysis; on the left side through the lesser sacrosciatic foramen ; on the right somewhat lower, through the tuberosity of the ischium ; and posteriorly through the tip of the coccyx. The levator ani is seen bounding the pelvic cavity, which contains behind the rectum a coil of small intestine, the vesiculse seminales, and the neck of the bladder and urethra.


Since this section is taken considerably deeper, the left gemellus inferior is seen running in direct relationship with the obturator internus muscle ; notwithstanding this, Douglas's pouch with its peritoneum is present. It thus appears that the position of the peritoneal sac is deeper in the present one than on the young subject shown in fig. 1.


If we consider, moreover, that in new-born children the position of the peritoneum relatively within the pelvis is particularly high this relation must be described as natural and corresponding with advanced age ; and hence one must be particularly careful, in operations on the rectum in old people, not to wound the peritoneum, which extends lower down than in younger individuals.



FIG. 2. Transverse section of the pelvic cavity. 1,1. Head of femur. 2. Rectum. 3. Bladder. 4,4. Femoral vessels. 5. Apex of coccyx. 6. Gluteus maximus.


Fig. 3 is reduced from Pirogoff's atlas. It is stated in the text (fasc. iii, p. 59) that it was from the body of a full-grown man, whose bladder and rectum were full. The section passed through the lowest portion of the symphysis, about seven lines below its upper border, through the foramen ovale, the tuber ischii, near the lesser sciatic notch and the insertion of the sacro-sciatic ligament, and included the coccyx posteriorly. The lower half of the section is represented, so that it is viewed from above downwards.


In such a section, a clear view of the levator ani cannot be given, at least not with respect to its physiology, as only a small portion of its fibres would be divided. It will be clearly seen at the same time that when the rectum is full Douglas's pouch and the lower coils of the smaller intestine are lifted up. Between the bladder and rectum lie the sections of the vesiculse seminales. Outside the pelvic cavity, are the thigh bones divided through the neck, with the ligaments and their corresponding vessels and muscles. As the head of the thigh bone presents a spherical form only internally and above, so each transverse section which passes through it near its middle includes a portion of its neck, and therefore produces externally a cut surface very far removed from a circle. The inner contour only would present a portion of a circle, namely at the point of insertion of the ligamentum teres. The component portion of the joint is better seen higher up somewhat higher than Plate XVII, and is therefore useful in comparison with it, since it traverses the entire length of the sacro-sciatic ligament.


FIG. 3. Section of the lower portion of the pelvis of a full-grown man, with distended rectum. Pirogoff, iii, 16, 3. 1,1. Head of femur. 2. Rectum. 3. Bladder. 4. Femoral vessels. 5. Tip of coccyx. 6, 6. Gluteus maximus.


Fig. 4 is taken from a series of sections on the body of an old man, Section of the pelvis of an old man at the level of the great sacro- sciatic ligament.

1,1. Head of thigh bone. 2. Rectum. 3. Apex of bladder. 4,4. Femoral vessels. 5. Lower end of sacrum. 6, 6. Gluteus maximus.


The acetabula are divided nearly through their centre. Nothing more of the symphysis pubis is to be seen, as in consequence of the greater inclination of the pelvis it lies considerably deeper. The relation of the vasa deferentia to the femoral vessels is well shown. Corresponding with the deeper position of the viscera in old persons already mentioned, a quantity of coils of small intestine are here shown, whereas on Plate XVII there is merely a small flat section of the ileum.



Historic Disclaimer - information about historic embryology pages 
Mark Hill.jpg
Pages where the terms "Historic Textbook" and "Historic Embryology" appear on this site, and sections within pages where this disclaimer appears, indicate that the content and scientific understanding are specific to the time of publication. This means that while some scientific descriptions are still accurate, the terminology and interpretation of the developmental mechanisms reflect the understanding at the time of original publication and those of the preceding periods, these terms and interpretations may not reflect our current scientific understanding.     (More? Embryology History | Historic Embryology Papers)
Braune Plates (1877): 1. Male - Sagittal body | 2. Female - Sagittal body | 3. Obliquely transverse head | 4. Transverse internal ear | 5. Transverse head | 6. Transverse neck | 7. Transverse neck and shoulders | 8. Transverse level first dorsal vertebra | 9. Transverse thorax level of third dorsal vertebra | 10. Transverse level aortic arch and fourth dorsal vertebra | 11. Transverse level of the bulbus aortae and sixth dorsal vertebra | 12. Transverse level of mitral valve and eighth dorsal vertebra | 13. Transverse level of heart apex and ninth dorsal vertebra | 14. Transverse liver stomach spleen at level of eleventh dorsal vertebra | 15. Transverse pancreas and kidneys at level of L1 vertebra | 16. Transverse through transverse colon at level of intervertebral space between L3 L4 vertebra | 17. Transverse pelvis at level of head of thigh bone | 18. Transverse male pelvis | 19. knee and right foot | 20. Transverse thigh | 21. Transverse left thigh | 22. Transverse lower left thigh and knee | 23. Transverse upper and middle left leg | 24. Transverse lower left leg | 25. Male - Frontal thorax | 26. Elbow-joint hand and third finger | 27. Transverse left arm | 28. Transverse left fore-arm | 29. Sagittal female pregnancy | 30. Sagittal female pregnancy | 31. Sagittal female at term

Reference

Braune W. An atlas of topographical anatomy after plane sections of frozen bodies. (1877) Trans. by Edward Bellamy. Philadelphia: Lindsay and Blakiston.


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Cite this page: Hill, M.A. (2019, September 17) Embryology Book - An Atlas of Topographical Anatomy 17. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Book_-_An_Atlas_of_Topographical_Anatomy_17

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