Transactions of the American Gynecological Society Volume 39 (Paperback)

This historic book may have numerous typos and missing text. Purchasers can usually download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1914 edition. Excerpt: ...the surface of the pelvic peritoneum, and accordingly a system of units has been adopted to take the place of customary notations in pounds, ounces, etc. 1 This was illustrated by an adjustable picture too complicated to print. In this matter effects must be reckoned with respect to the centre around which the uterus rotates in backward and downward displacements. It is located near the internal os at the attachment of the uterosacral ligaments, its axis lies transversely in the base of the broad ligaments. I have called it the pivotal point. As the uterus is balanced on this point, by reason of its posterior ligamentous attachments, comparison of pressure upon its lower and upper poles must be made with this centre as a line of demarkation between the two extremities. Parts of the uterus exposed to pressure coincide with its peritoneal coverings. Its area on the lower pole is represented by units 1, 2, and parts of 0 and 3, while 4, 5, 6, 7 (Fig. 4) stand for the upper pole, there being one unit excess on the latter. It is the longest, and its forward tilting has been described as a lever-like action. This action is much increased when the superior borders of the broad ligaments are sufficiently relaxed to let the corpus uteri lie upon the bladder, for the pressure area of these ligaments is greater behind than in front; stress, therefore, would force the body of the uterus and bladder against the levator muscle and over the vaginal orifice. But when the bladder is distended or when intestines lie between it and the uterus, abdominal pressure is transmitted through them to the anterior part of the uterus; thus the four units 10, 11, 12, and 13 (exerting a lifting effect) neutralize units 4, 5, 6, and 7 behind the corpus. The lever-like...