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Reference models of the female pelvis.

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AUTHOR’S ABSTRACT OF THIS P A P E R ISSUED
B Y T H E B I B L I O G R A P I i I C B E R V I C E , F E B R U A R Y 26
REFERENCE MODELS OF THE FEMXIE PELVIS
13. SPECTOR
Anatomical Laboralory, Bellevup Medical Cdley-, New York UnaversLty
SEVEN FIGURES
Bellevue Model No. III consists of casts of five dissections
of a female pelvis. It js the third of a series planned by Prof.
H. D. Senior, and the dissections for it were executed, with the
exception of that reproduced in cast D, figure 3, by Dr. S. Rrock
in 1917.
The subject which served for this model was twenty-two years
old and had had one child. The date of parturition was not given
in the hospital record, which states that she died of septicemia.
Upon pelvic examination shortly before death, the uterus was
found t o be freely movable and there was no evidence of adnexal
pathology. Prof. W. E. Studdiford noted that the pelvic floor
was well formed, and suggested that it would make an excellent
specimen for demonstration. After having injected the cadaver
with 50 per cent formalin, the pelvic floor was dissected and cast
(fig. 1, A). This cast proved so successful that it was decided
t o make others in order t o show the arrangement of the viscera, the
peritoneum, the fasciae, and the muscles of the pelvis. Therefore the viscera which were removed in order to make cast A
were replaced and the whole pelvis divided in the midsaggital
plane Models B, C, and E were then cast from dissections of
the right half and model D of the left half of the bisected pelvis.
The features of each of the casts belonging t o the series are
as follows: I n cast A, figure 1, the pelvic floor is dissected from
both sides. The postero-inferior aspect of the right and left
ischiorectal fossae and the antero-inferior aspect of the urogenital
triangle is shown in figure 1. The internal pudendal artery, the
95
T H E ANATOMICAL R E C O R D , Y O L U M E
25,
NUMBER
3
APRIL
1023
96
B. SPECTOR
perineal nerve, and the dorsal nerve of the clitoris were dissected
out of the canal on the lateral wall of the left jschiorectal fossa.
The right ischio- and bulbocavernosus muscles were removed
and the crus clitoridis and vestibular bulb displayed. The irregularity at the left side of the vaginal orifice is probably the
result of a tear which occurred during the time of labor; there
is no evidence, however, that the tear involved the levator ani
muscle.
The bladder and vagina were cut transversely and removed;
the former at its base, the latter about an inch below its fornices.
The large vascular area in this region, namely the pudendal, the
vesical, and the uterovaginal plexuses of veins, and the common
place of origin of the vesical, the rectovesical, and the rectal
divisions of the visceral pelvic fascia are clearly in evidence.
Cast B, figure 6, is made from the right side of the bisected
pelvis with the viscera and peritoneum in situ. The uterosacral
ligament is recognized easily as a ridge runnjng posterolateral
from the cervix of the uterus to the sacrum. The round ligament
comes well into view. The fundus of the uterus is about on a
level with the upper margin of the symphysis pubis, the external
0s of the cervix’on a level with the ischial spine and directed
towards the posterior vaginal wall. While this topographical
relationship of the uterus holds for the average case and is considered the usual one, the uterus itself appears somewhat subinvoluted. The fimbriated end of the uterine tube is prolapsed
into the recto-uterine pouch-the result, in all probability, of
a previous gonorrheal salpingjtis, regarding which a definite
history is obtainable. The plane of separation of the bladder
wall from the anterior vaginal wall is well indicated.
Cast C, figure 7, also represents tha right half of the bisected
pelvis. It is similar to cast B except that the peritoneum was
removed locally to display the following : the ovarian artery, the
pampiniforni plexus of veins, the suspensory ligament of the
ovary, and the lower end of the right ureter. The uterus was
cut transversely at the level of the internal 0s and removed; a
separate cast, figure 5 , was made of the body and fundus. Along
the lateral aspect of the cervix, a thick mass of cellular tissue
REFERENCE MODELS OF FEMALE PELVIS
Figures 1 t,o 7
97
98
B. SPECTOR
can be seen; this surrounds the great vessels in this area and
constitutes the parametrium. The uterine artery crosses the
ureter obliquely, just before reaching the side of the uterus at
the level of the internal os of the cervix.
Cast D, figure 3, demonstrates the general arrangement of
the parietal pelvic fascia and the component layers of the visceral pelvic fascia, arising in common from the arcus tendineus,
the thickened portion of the obturator fascia; it also shows
definitely the area occupied by the pudendal, the vesical, and
the uterovaginal plexuses of veins and the structures which
pierce the pelvic diaphragm. This cast is really made up of two
parts, an anterior and a posterior, made after the prepared
specimen was cut through vertically from the left iliopectineal
eminence to the middle of the ischial tuberosity.
Figure 2 is a cast of the anterior segment of the preparation
viewed from behind and shows the obturator fascia, the obturator
internus muscle having been removed, with two laminae arising
from it; the superior lamina covers the upper surface of the
levator ani muscle, while the inferior lamina covers its lower
surface. 1he left vestibular bulb and the left ischio- and bulbocavernosus muscles also were removed to display the inferior
layer of the urogenital diaphragm.
Cast E, figure 4,is made from the right half of the pelvis and
illustrates the muscles which constitute the pelvic floor, devoid
of their fascia and peritoneum. d very striking example is
afforded of the manner in which the urogenital diaphragm bridges
the interval that exists between the free anteromedjal margins
of the right and left levator ani muscles when casts D and I3
are placed together.
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