Pelvis

“ Pelvis.—The chief points of difference between the male and female skeleton, beside the disparity in the size and the greater smoothness of the bones, lie in the pelvis. In the female this is less strong and thick, and contains less osseous matter than that of the male. In the female, the arch of the pubis is much the greatest, and the long diameter of the brim of the pelvis is from side to side; in the male it is from before backward; in the female, the brim is more of the oval shape, in the male more triangular; in the female, the ilia are more distant ”

“ As the pelvis occupies an oblique position in the body, the plane of this brim is not horizontal, but slopes up and back from the symphysis-pubis to the promontory of the sacrum. Being swung upon the heads of the femora, the relation of the pelvis to the entire body differs in the sitting and standing positions. When a woman stands upright, her pelvis is so markedly oblique in its position that she would tip backward but for strong tendons attached to the pelvis and running down the front of the thighs. ”

“ The normal female pelvis, on the other hand, is light, broad, shallow, smooth and large, giving evidence of the infinite wisdom and skill that entered into constructing it for the high purpose it was designed to serve. ”

“ And what are we to say of the pelvis, that part of the skeleton in which, if anywhere, striking sexual differences exist? It is almost universally believed that in the one case the pelvis is adapted for the act of parturition, in the other case is not so adapted. And yet the character of the pelvis cannot be taken as an absolute criterion of sex. There are to be found, and the wayfarer knows this as well as the anatomist, many women with narrow male-like pelves [4] and many men with the broad pelves of women. ”

“ USES OF THE PELVIS. One function of the pelvis is to inclose and protect the bladder, rectum and seminal vesicles of the male, the uterus, Fallopian tubes and ovaries, as well as the bladder and rectum in the female. During labor it affords a passage for the child. ”

“ We find, therefore, that although the pelvis constitutes a rigid, bony, ringlike structure, there are four joints: the symphysis pubis, the sacro-coccygeal, and the two sacro-iliac articulations. As the cartilages in these joints become somewhat softened and thickened during pregnancy, because of the increased blood supply, they all permit of a certain, though limited amount of motion at the time of labor. ”

“ The pelvic walls are formed by bones and ligaments that are covered by heavy muscles. As previously mentioned, the ligaments and muscles relax toward the end of pregnancy in order to prepare the way for the passage of the foetus. Before entering the pelvis it is necessary for the foetus to be forced through the inlet to this cavity. This is the most difficult part of the birth, as the bones that form the framework of the pelvis completely enclose the entrance to it. It is only in the young mother that the pelvic bones give way slightly to the pressure on them by the foetus. ”

“ The very remarkable differences that are found between the adult male and the adult female pelvis begin to appear with puberty and develop rapidly, so that no one could mistake the pelvis of a properly developed girl of sixteen or eighteen years of age for that of a boy. These differences are due in part to the action of the muscles and ligaments on the growing bones, in part to the weight of the body from above and the reaction of the ground from beneath, but they are also largely due to the growth and development of the internal organs peculiar to the woman. ”

“ No doubt the female type of pelvis can be recognised in childhood, and even before birth, but the differences of male and female pelves before puberty are so slight that it requires the eye of an expert to distinguish them. ”

“ The Pelvis, or bony girdle of the hips, of Man is a strikingly human part of his organization; the expanded haunch bones affording support for his viscera during his habitually erect posture, and giving space for the attachment of the great muscles which enable him to assume and to preserve that attitude. ”

“ Again, when in a recumbent posture on the back, the breast of the man will be the highest part, but the pubes in the woman. The female loins are also the broadest, and the hollow of her back the greatest, in order that the due inclination may be given to the pelvis. ”

“ The false pelvis ordinarily serves simply as a support for the abdominal viscera, which do not occupy the true pelvis unless forced down by some such pressure as that caused by tight, or poorly fitting corsets. The false pelvis is of little obstetrical importance, its function during pregnancy being to support the enlarged uterus, while at the time of labor it acts as a funnel to direct the child’s body into the true pelvis below. ”

“ The Generative or Reproductive Organs. The pelvis is an interesting structure but not nearly so interesting as the generative organs which lie within it: the uterus (or womb) , tubes and ovaries. These, with the vagina, are often called the internal genitalia because they are inside the body. The pelvis practically remains rigid and inactive throughout pregnancy and labor, but the ovaries and the uterus are constantly active and are concerned with an undertaking which is so utterly amazing that it is far beyond 23our powers of understanding. We can only look on and wonder. ”

“ If the hands are on the pelvic bones the object of the work is defeated; hence the bones of the pelvis are first located in order to avoid them. The hands must be free from the pelvis and resting on the lowest rib. ”

“ The pelvis (fig. 13) , consisting of the sacrum (already described) and the pelvic arch, namely ilium, ischium and pubis, it follows that only birds and mammals possess a pelvis proper, whilst such is entirely absent in the Amphibia and in reptiles with the exception of some of the Dinosaurs. The ventral inner margin of the preacetabular portion of the ilium is attached to the pre-sacral vertebrae, whilst the inner and dorsal margin of the postacetabular portion is attached to the primary sacral and the postsacral vertebrae. ”

“ An expert and knowing hand will never fail of ascertaining the discovery of them. I say, an expert and knowing hand, for without an exact knowledge of the figure of the whole pelvis, the situation of the bladder, of the rectum, the vagina, and the uterus, before and after pregnancy, the situation of the orifice with respect to the pelvis, there is no distinguishing for example, an over-elevated orifice 347from one too low, nor a direct from an oblique one. ”

“ I have seen great harm result from such attempt having been made on the supposition that the symptoms were due to the displacement rather than to the parametritis.
ANATOMY, PATHOLOGY, COURSE, AND TERMINATION.—Everywhere in the pelvis, below the peritoneum, connective tissue is found in sufficient [p. 211] abundance to serve the purposes for which it exists—viz. first, as a bond of union between the pelvic viscera and organs, bladder, uterus, rectum, ovaries, and Fallopian tubes ”

“ The pelvic girdle is made up of three bones as follows: the ilium, the ischium, and the pubis, all of which are fused in adult life. They are separate in the baby chick (Fig. 5, Part II, 6) . The pelvis together with the lumbo-sacral vertebræ forms a thin, irregular, shell-like structure extending superiorly from the tail to the thoracic region. The sacrum is broad posteriorly and together with the ilium forms the pelvic roof. The ilium and ischium are its lateral walls.
The top surface of the pelvis shows the fovea ilio-lumbalis dorsalis, which is bounded mesially by the crista ilii. ”

“ Gray is right, they must admit the violation of a physiological law: that the organs within the pelvis have outgrown the capacity of the cavity containing them; that there exist adult organs in an infantile pelvis. Such a state of things in a healthy animal is impossible, if we accept the evidence of universal experience. The cavities of the cranium, the thorax, and the pelvis, have a steady and relatively equal development. ”

“ I do not intend to bring into evidence the peculiar position and nature of the organs contained within the pelvis, but to call attention to the peculiar structure of the knee, and the shallowness of the pelvis, and the delicate nature of the foot as part of a sustaining column. The knee-joint of woman is a sexual characteristic. ”

“ He must know the form and size of the bones of a woman, how large a hole the three bones of the pelvis make, for the reason that the child's head will soon come through that hole. He must know a normal head cannot come through a pelvis that has been crushed in so much as to bring the pubis within one and one-half to two and one-half inches of the sacrum. ”

“ The arm is generally very easily brought down, or it may remain and come with the head. The delivery of the head is effected the same as in presentations of the pelvis, and is seldom attended with much difficulty, the parts having been so much distended. The body always rotates so that the back comes in front, and the chin passes into the curve of the Sacrum. ”

“ The cavity of the pelvis contains the bladder, the rectum, and some of the generative organs peculiar to each sex and some windings of the small intestine; they are partially covered by the peritoneum (lining membrane of the abdominal cavity) .
Anatomy of the Female Genital Organs.—The external genital organs, to which the term vulva is usually given, consist of the mons veneris, labia majora, labia minora, clitoris, vestibule, meatus urinarius, hymen, fossa navicularis, fourchette and perineum. ”

“ Pelvis is broad and limbs loosely hung, as in a woman, and fingers and hands rather feminine in their general fineness of texture, comparative absence of hair, absence of prominent bones and veins, and the softness and pleasing tint of skin. Features are small like a woman's, but nose, lips, and ears large in proportion, indicating sensuality. I possess mammary glands and sacral dimples. While my breasts are as large as in some women, the nipples are small, even for a man. I am small-boned, of delicate build, and my muscular system is soft. ”

“ The descent of the enlarged and congested uterus in the pelvis, which always precedes the expulsion of any body from its cavity, frequently causes dragging pains in the pelvis, a fulness, heaviness with pressure upon the bladder and rectum, and an uneasiness at the pubes and coccyx or lumbar and vesical tenesmus. ”

“ Minimum of pain requires well-developed pelvis, normal position of organs, strong abdominal muscles, previous good hygiene, moderate-sized baby, with normal presentation. Narrow, ill-shaped pelvis may be caused by rickets, tight binders or diapers in infancy, or to indoor life, long sitting, and tight clothing in girlhood, especially from twelve to sixteen years. Abnormal position of organs or of infant may be caused by tight clothing, heavy clothing supported from the waist, incorrect posture, long hours of standing during girlhood or womanhood. ”

“ Primates. In Man and the Anthropoid Apes the pelvis is very large and wide, and the ilium has much expanded iliac and gluteal surfaces. The symphysis is rather short and formed by the pubis alone. The acetabulum is deep and the obturator foramen large, and there is frequently a well-marked ischial tuberosity. ”

“ All these conditions cause a complete immobilization of the thorax on the pelvis, so that the movements of the upper part of the body are characteristic in corseted women, and she moves all in one piece. ”

“ During the years of childhood the female pelvis has a general resemblance to that of the male, but with the advent of puberty the vertical portion of the hip bones becomes expanded and altered in shape, it becomes more curved, and its inner surface looks less directly forward and more towards its fellow bone of the other side. ”

“ Represents a pelvis which resembles that of the male in its form, and is therefore called masculine. It is deeper, and less capacious altogether than the standard one. This form is occasionally met with in females of a peculiar general conformation, and temperament, approaching that of the other sex. It is not a sufficient deviation from the natural form to create any great difficulty, though it may cause delay. ”

“ When the disease begins in childhood it may induce a permanent deformity of the pelvis, the conjugate diameter at the brim being increased, while the transverse diameter at the outlet is diminished—kyphotic pelvis, and, in females, this may lead to complications in parturition. ”

“ Broad Hips.—A woman with a large pelvis gives her a superior and significant appearance, while a narrow pelvis always indicate weak sexuality. The other portions of the body however must be in harmony with the size and breadth of the hips. ”

“ This explains why in two women with pelves of the same size and shape, one will have a spontaneous delivery and one will require a section. The former has a relatively small child which can pass through her pelvis; while the second woman’s baby is too large, or the head not sufficiently mouldable, to pass through hers. ”

“ Since each patient’s pelvic measurements are considered from the standpoint of their comparison with normal dimensions, it is manifestly important that the obstetrical nurse have a clear idea of the structure of the normal female pelvis, and also of its commonest variations. ”