Book - An Atlas of Topographical Anatomy 18

From Embryology

XVIII. Transverse section through the pelvis of a male through the lower 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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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)


IT appears to me desirable to introduce here a frontal section of the pelvis, and one that will show the relations of the hip-joint to the best possible advantage. After many investigations, I became convinced that for this purpose a definite position of the bones is necessary, as when the subject lies on the back they are rolled outwards, and the head, neck, and shaft do not lie in the same plane. It is only when the thigh is rolled considerably inwards, so that the inner borders of both feet touch throughout their entire length, that they do so ; I made the section, therefore, with the feet tied together.


The section passed through the pelvis and hip-joint in such a manner as to render the two sides as symmetrical as possible. The upper portion of the shaft of the right femur is not divided quite in its axis, and only a portion of the great trochanter is clear, while the lesser trochanter is covered with muscles. The head and neck are fairly divided. The section passed through the middle of the acetabulum ; through the whole length of the ligamentum teres of both sides, the obturator foramen and the ilium. The promontory of the sacrum and the tuberosities of the ischium lie in the posterior half of the body.


The preparation is viewed from the front, and thus the right side of the body is to the left of the picture and the converse. It represents the lower portion of the abdominal cavity, bounded above by the three flat abdominal muscles, and more externally by the iliaco-psoae, in which are the anterior crural nerves. Within these muscular walls are the intestines, extending as far down as the bladder, the anterior portion of the cavity of which is opened. The sections of the small intestine, which above is jejunum and below ileum, as can be readily recognised from the nature of their mucous coats, indicate that in many instances they have been met with in their long axis. There are singularly few instances in which this has happened in the preceding sections, and it therefore follows that the coils of intestine have a parallel direction with the long axis of the body.


Of the individual portions of the intestine, the section of the vermiform process is seen at the upper border of the right psoas ; and on the left of the iliac vein the transverse section of the rectum. The latter was especially studied in relation to its course. It ascended behind Douglas's pouch, in the left half of the body near the middle line ; curved sharply forwards over the left psoas muscle, so that it fell in the plane of the section ; and then passed somewhat forwards towards the right half of the body as an arc of a large curve, ultimately becoming continuous with the descending colon. It shows, moreover, a deviation from the usual course, at the lower portion, as figured by Pirogoff (fasc. iii B, tab. xv, fig. 1), but does not completely correspond with the relations shown in Plates I and II; and one can easily convince oneself by injecting with tallow that, in individual cases, and those not very rare, the S-curve of the rectum is not sharply marked in a frontal direction with regard to the sacrum, variations which are owing to the inconstant length of the meso-rectum. Should this be strong and reach far back, the position of the rectum is freer, and more dependent on the condition of the neighbouring organs. Shortness and tenseness of this meso-rectum, on the other hand, contribute to a firm and constant position of the intestine.


The effect produced by the distension and by the firmness of the walls of the rectum must be taken into consideration. Great distension from faeces, and flaccidity of its walls especially, permit of considerable stretching of the original curves. It can be proved by investigation and clinical observations, that the surgeon can straighten the curved rectum by means of instruments, and introduce them as far as the iliac flexure. Foreign bodies introduced from the anus, and firmly impacted, can be seized with forceps and withdrawn.


The bladder contained a little urine, and was firmly contracted : it is separated from the section of the levator ani by a little fat ; on both sides of the levator ani lie the sections of the obturator internus, bounded below by the obturator membrane, and laterally by the pelvic bones. If the space between the intestines and the pelvis be followed upwards on both sides from the bladder, beneath the peritoneum, we meet with two whitish oval sections, which represent the lateral ligaments of the bladder. They lie thus far removed from the bladder, because it was small and contracted ; a distended bladder would carry them upon its upper surface, and at the same time occupy the entire space of the inferior aperture of the pelvis, as several of Pirogoff's plates show. Farther outwards, and in the same space, between the peritoneum and the pelvis, is the vas deferens, and above it the obturator vein and nerve and a small artery. The main trunk of the artery passes through the obturator foramen.


Finally, we arrive at the external iliac artery and vein ; both vessels lie on the inner wall of the psoas, as the preceding sections show, not side by side, but behind each other ; hence the artery lies over the vein, and not to its inner side as appears by this frontal section.


The relations of the hip-joint, which have been already briefly alluded to, afford many points for examination. It has been already mentioned that the section has traversed the entire length of the ligamentum teres of both sides. It is evident that this ligament limits extreme adduction, and by simultaneous stretching, assists in maintaining the firm position of the pelvis and trunk. As the section passed through the acetabular notch the course of the articular artery is exposed.


The articular cartilage, ligamentous apparatus, and the extent of the cavity of the joint are well seen in the plate.


The architecture of the upper portion of the thigh bone is well worthy of study, as much so for its general disposition as for its structure. Meyer has the merit of having first called attention to the arrangement of the cancellous tissue, especially in the neck of the bone, which essentially increases its weight-bearing power. The individual laminae and interlacements of bone arrange themselves in rows, which are detached from the borders of the compact tissue, and cross each other in the middle line. In the section of the left thigh bone especially these indications of its structure are shown.


The articular cavities themselves appear merely as chinks. Their extent downwards explains to what limit intracapsular fracture of the neck of the thigh bone may reach, and where the region of extra-capsular fracture commences. Since intra-capsular fractures isolate the upper fragment, and leave it connected by the ligamentum teres and the acetabular vessels, it is evident that, apart from the difficulty of accurate adaptation and retention of the parts, union is of very rare occurrence, on account of conditions unfavourable for its nutrition.


An increase of effusion into the joint, as may happen in inflammation, will not separate the surfaces of the acetabulum and head of the thigh bone. The powerful ilio-femoral ligament, in consequence of its torsion in complete extension, presses the joint-surfaces firmly against each other. On the other hand, in flexing the joint, a corresponding separation of the two surfaces will occur from increased effusion within it ; and, as investigations show, this may be somewhat considerable. If fluid be injected through the acetabulum into the joint-cavity, after the example of Bonnet, the articulation takes successively the positions which afford the greatest amount of space ; but which ultimately place the ilio-femoral ligament in the condition of greatest relaxation. The femur is raised and somewhat rolled outwards. If the joint be frozen, sections can be made of it, and the relations of the articular surfaces to each other rendered clear. The accompanying woodcut represents such a preparation, made from the body of a normal young female.


In order to render the femur more easily movable, the upper layer of muscles was removed and the bone itself sawn through the middle.


On injecting the joint with tallow, and applying as great a pressure as possible, the femur was raised and rolled outwards. In this position it was frozen and sawn as shown in the woodcut ; the section passing not quite through the middle of the head, but slightly in "front, and including the trochanter minor in its course. The mass of tallow, which is here represented by the dark shading, was about one fifth of an inch thick, and a little farther down in the articulation somewhat thicker ; and surrounded the head of the bone like a cap, extending outwards to the attachment of the synovial membrane, which was driven forwards in the form of a bladder


FIG. 1. on its posterior wall. We should expect to find, in diseases of the hip -joint which exhibit similar positions of the articulation, an actual lengthening of the thigh, supposing that a like quantity of fluid exists in the joint cavity. To prove this by measurement is impracticable. Were it possible to measure it accurately to a quarter of an inch, which from the simultaneous displacement of the pelvis can hardly be expected, the flexion of the thigh, associated with this condition, renders such measurement impracticable.


The relations of the corpora cavernosa and urethra next demand attention. It will be seen that the section passes in front of the prostate, dividing the corpora cavernosa penis near their origins, and the urethra at the bulb. The corpus cavernosum, arteries, and muscles of the corpus cavernosum are well shown. Upon it is expanded a portion of the deep perineal muscle with a number of large veins.



Frontal section of the hip-joint injected with tallow and frozen. J.

1. Head of femur. 2. Tendon of rectus. 3. Obturator externus. 4. Pectineus. 5. Tendon of ilio-psoas. 6. Glutens minimus.


FIG. 2. Frontal section of the male pelvis through the membranous portion of the urethra. 4-

1. Prostate. 2. Wall of bladder. 3. Caput gallinaginis. 4. Deep transversus perinei muscle. 5. Bulb. 6. Ascending ramus of the ischium. 7. Obturator membrane. 8. Obturator externus. 9. Obturator internus. 10. Adductor magnus.


As it appeared to me desirable to have a section showing these structures rather farther back, I made one on the body of a normal well-built man, at such a depth as to pass through the prostatic portion of the urethra. The preceding woodcut represents the plate on a smaller scale. The head of the left femur is seen only as a small segment, and not in connection with the rest of the bone.


The body of the ischium shows a large surface in section, corresponding with its more extensive development behind the acetabulum. The obturator membrane, ascending ramus of ischium, and the obturator externus and internus, still show some resemblance to the corresponding portions on Plate XVIII, and so also do the corpora cavernosa. We have, moreover, in the section, in place of the apex of the bladder, its posterior wall, and the posterior half of the prostate, with the caput gallinaginis.


The membranous portion of the urethra and the prostate are opened. On both sides of it are the deep transverse perineal muscles, the fibres of which are expanded towards the middle line. Above is seen the anterior mass of the levator ani. Around it is a layer of fascia, the upper portion of which is continuous with the pelvic and the lower with the perineal fasciae. Both fasciae meet at the inner border of the levator ani muscle, and help to support the prostate. The upper lamina of the perineal fascia and the lower surface of the transversus perinei pass forwards.


The plate, which must not be regarded as diagrammatic, agrees in all its essential particulars tolerably accurately with Henle (* Eingeweidelehre,' p. 504, fig. 392), which should be compared with it.



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, December 11) Embryology Book - An Atlas of Topographical Anatomy 18. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Book_-_An_Atlas_of_Topographical_Anatomy_18

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