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fossæ for the passage of the anal canal, and characterised by looseness and distensibility; and an anterior or ventral part,—the urethral triangle for the genitourinary passages, and characterised by firm fixation to the pubic bones; so also from the abdominal aspect it is found that, while in the posterior part of the pelvis a rectal channel exists, in which the rectum is free to collapse and distend, in the ventral part of the basin the genito-urinary passages are firmly fixed by means of
Recto-vaginal layer Lateral pubo-prostatic
ligament Urethro-vaginal layer Lig. puboprostati.
cum medium Cavum Retzii
Bulb of the
Rectal channel Pubo-urethral fascia (pubo-vesical ligament)
EXTERNAL SPHINCTER ANI
INTERNAL SPHINCTER ANI
Junction of rectum and anal canal
EXTERNAL SPHINCTER ANI
the pelvic fascia, which gives rise to a special suspensory ligament for the prostate gland and the prostatic urethra in the male, and for the urethra and vagina in the female.
A crescentic fold of pelvic fascia (suspensory ligament) arises in the neighbour1 hood of the sciatic spine from the general fascia covering the pelvic wall. It has a posterior free edge, through which the ductus deferens, vesical vessels, and nerves pass. Sweeping across the median plane, this border is continuous with the fold of the opposite side, the two together constituting the anterior limit of the rectal
channel. The fascial fold is composed of two layers, posterior and superior, between which is a large plexus of veins. They have separate attachments laterally to the general pelvic fascia. The posterior (recto-vesical) layer passes across the pelvis between the prostate gland and the rectum. Its inferior edge is attached to the perineal body between the base of the fascia of the urogenital diaphragm and the beginning of the anal canal. It forms a sheath for the vesiculæ seminales and ductus deferentes. This is rather in the form of a septum than a complete sheath; it effectually separates the vesiculæ seminales and the bladder from the rectum, forming the anterior wall of the rectal channel, but it allows the vesiculæ seminales to rest directly against the bladder. The superior layer extends forwards to the symphysis pubis. It has a lateral origin from the arcus tendineus in its whole length, and sweeping over the prostate gland, it is inserted along its line of junction with the bladder, and constitutes the so-called lig. puboprostaticum laterale (lateral true ligament of the bladder). It contains numerous bundles of muscular fibres in its anterior part, and forms a sheath for the passage of the inferior vesical vein along the lateral surface of the prostate gland. In front the fascia stretches from the back of the symphysis pubis, the arcuate ligament of the pelvis, and the superior fascia of the urogenital diaphragm to the neck of the bladder and the prostate gland, forming the lig. puboprostaticum medium. It is continuous across the median plane with the ligament of the opposite side. In the median line, where the two ligaments unite, a hollow occurs behind the symphysis pubis, known as the cavum Retzii. This ligament is composed of several layers separated by large veins (the pudendal plexus), which connect the inferior vesical vein with the dorsal vein of the penis and the hypogastric vein.
The sheath of the prostate gland (fascia prostata) is formed by (1) the superior fascia of the urogenital diaphragm on which it lies, (2) by the general pelvic fascia covering the intra-pelvic surfaces of the levatores ani on each side, and (3) it is completed above and behind by the two special layers of pelvic fascia just described. By these means the prostate gland and prostatic urethra are given a firm attachment to the anterior part of the pelvic walls and floor.
In the female an essentially similar arrangement of the pelvic fascia occurs in relation to the vagina and urethra. A crescentic fold of the fascia springs from the pelvic wall in the neighbourhood of the spina ischiadica, and sweeping medially to the lateral fornix of the vagina and in front of the rectum, separates into two layers, posterior and superior. Between the layers are numerous vessels, which, along with the visceral nerves, pierce its free edge. The posterior (recto-vaginal) layer passes medially behind the vagina, and gaining the median plane between the vagina and rectum, gives rise to the anterior wall of the rectal channel, and is attached below to the perineal body in the floor of the pelvis. The superior layer, taking origin from the arcus tendineus, is attached medially to the neck of the bladder, and constitutes the lateral pubo-vesical ligament. It is continuous in front with the anterior pubo-vesical ligament, which, as in the male, is divisible into several layers separated by veins. An intermediate (urethro-vaginal) layer of the fascia passes between and separates the urethra and vagina.
The urethra and vagina are by means of these layers of fascia firmly bound to the pelvic walls and floor, while the uterus and bladder are free to distend in the pelvic cavity.
MUSCLES OF THE PELVIS.
Diaphragma Pelvis.—The pelvic diaphragm is formed by the levator ani and coccygeus muscles, which serve to uphold the pelvic floor, and are related to the rectum and the prostate gland or vagina.
M. Levator Ani.—The levator ani arises from (1) the inferior part of the posterior surface of the body of the pubis, (2) the general pelvic fascia above or along the arcus tendineus, and (3) the pelvic surface of the spine of the ischium.
Its fibres are directed downwards and backwards, to be inserted into (1) the central point of the perineum (perineal body), (2) the external sphincter around the origin of the anal canal, (3) the ano-coccygeal raphe behind the anus, and (4) into the sides of the lower coccygeal vertebræ.
The levator ani muscle fills up and completes the pelvic floor on each side of the median plane. Enclosed in a sheath derived from the general pelvic fascia along the arcus tendineus, the muscle presents an upper concave surface in relation to the pelvic cavity, prostate gland (or vagina), and rectum, and an
Fig. 437.—THE FASCIAL AND Muscular WALL OF THE PELVIS AFTER REMOVAL OF PART OF THE
LEFT Hip BONE.
inferior convex surface which appears in the perineum and forms the medial wall of the ischio-rectal fossa.
The levator ani is divisible into four parts-puborectalis, pubococcygeus, iliococcygeus, and iliosacralis. The puborectalis (levator prostata) is the part inserted into the central point of the perineum. The pubococcygeus is the part inserted into the anus and the ano-coccygeal raphe, and the iliococcygeus and ischiococcygeus are represented by the fibres attached to the sacrum and coccyx. The first two are best developed ; the last two series of fibres are the most rudimentary. These several parts of the muscle represent the remains of the flexor caudæ of tailed animals.
Nerve-Supply. The levator ani is supplied from two sources : by the perineal (muscular) branch of the pudendal nerve, and, on its pelvic surface, by special branches from the third and fourth sacral nerves.
Actions.-(1) The levator ani muscle serves to uphold and slightly raise the pelvic floor. (2) It is likewise capable of producing slight flexion of the coccyx. (3) The anterior fibres of the levator ani, in the female, sweeping round the vagina, compress its walls laterally, and along with the sphincter vaginæ, help to voluntarily diminish the lumen of the tube. _(4) The same part of the muscle in the male elevates the prostate gland (levator prostatæ). (5) The chief action of the levator ani is in defæcation. Along with the external sphincter it acts as a sphincter of the rectum, closing the anal canal. During defæcation the muscle draws upwards the anus over the fæcal mass, and so assists in its expulsion. (6) In parturition, in the same way, the muscle, contracting below the descending fætal head, retards delivery, Contracting on the fætal head, it draws upwards the pelvic floor over the fætus, and so assists delivery.
M. Coccygeus.—The coccygeus is a rudimentary muscle overlapping the posterior border of the levator ani. It arises from the ischial spine and the sacrospinous ligament.
It is inserted into the sides of the lower two sacral and upper two coccygeal vertebra. The muscle is in contact by its anterior border with the levator ani. It is enclosed in pelvic fascia, assists in forming the pelvic floor, and is in contact laterally with the sacro-tuberous and sacro-spinous ligaments.
Nerve-Supply.—The coccygeus is supplied on its pelvic surface by the third and fourth sacral nerves.
Actions. The muscle is a feeble lateral flexor of the coccyx, and assists the levator ani to uphold the pelvic floor.
THE DEVELOPMENT AND MORPHOLOGY OF THE SKELETAL
The mesoderm on either side of the embryonic medullary tube separates into three main parts—the myotome, nephrotome, and sclerotome or lateral plates (somatopleure and splanchnopleure).
The myotomes are probably directly or indirectly the source of the striated muscles of the whole body. Each consists at first of a quadrilateral bilaminar mass, resting against the medullary tube and notochord on either side. The cleft between its two layers represents the remains of the colomic cavity. In the early stages of embryonic life the growth of the myotome is rapid. On its medial side masses of cells arise, which grow medially and surround the medullary tube and notochord to form the foundation of the vertebral column. On its lateral side cells appear to be given off which participate in the formation of the cutis vera. At the same time the dorsal and ventral borders of the myotome continue to extend, and present extremities (growing points) with an epithelial structure for a considerable period. On the dorsal side it overlies the medullary tube, and gives rise to the muscles of the back ; while by its ventral extension, which traverses the somato-pleuric mesoderm in the body wall, it produces the lateral and ventral muscles of the trunk. By a medial extension it probably gives rise also to the hypaxial muscles of the neck and loin. The cells of the medial layer of the myotome are responsible for the formation of the muscle fibres. The cells elongate in a direction parallel to the long axis of the embryo, and give rise, by fusion with the cells of neighbouring myotomes, to the columns and sheets of muscles of the back and trunk. For the most part (e.g. back and abdomen) the originally segmental character of the muscular elements is lost by the more or less complete fusion of adjacent myotomes. The intercostal muscles, however, are the direct derivatives of individual myotomes.
Muscles of the Limbs.-In fishes and (doubtfully) reptiles there is evidence that the myotomes are concerned in the formation of the limb-muscles by their extension into the limb-bud in a manner similar to that described for the trunk. In birds and mammals, however, in which the limb-bud arises as an undifferentiated, unsegmented mass of mesodermic tissue, partly from the mesoderm surrounding the notochord, and partly from the somato-pleuric mesoblast, the myotomes stop short at the root of each limh, and do not penetrate into its substance. Instead, the muscular elements of the limb take origin independently as double dorsal and ventral strata of fusiform cells on the dorsal and ventral surfaces of the limb-bud. These strata are unsegmented ; they are grouped around the skeletal elements of the limb, and they gradually become differentiated into the muscle masses and individual muscles of the limb.
Muscles of the Head.-Notwithstanding the obscurity and complexity of this subject, it appears certain that at least two series of elementary structures are concerned in the formation of the muscles of the head and face—the cephalic myotomes and the muscular structure of the branchial arches.
The number of myotomes originally existing in the region of the head is not known, although it is stated with some authority that nine is the complete number. The first three are described as persisting in the form of the ocular muscles, the last three in relation to the muscles of the tongue, while the three intervening myotomes disappear.
Fig. 438.-SCHEME TO ILLUSTRATE THE DISPOSITION OF THE MYOTOMES IN THE EMBRYO IN RELATION TO
THE HEAD, TRUNK, AND LIMBS. A, B, C, First three cephalic myotomes ; N, 1, 2, 3, 4, Last persisting cephalic myotomes ; C., T., L., S., Co.,
The myotomes of the cervical, thoracic, lumbar, sacral, and caudal regions ; I., II., III., IV., V., VI., VII., VIII., IX., X., XI., XII., refer to the cerebral nerves and the structures with which they may be embryologically associated.
| Muscles connecting the cranium and shoulder girdle.
The following table shows the possible fate of the cephalic myotomes :
Muscles of the tongue.
The mesoblastic tissue of the branchial arches is probably concerned in the production of the following muscles of the face and neck : First (mandibular) arch
Muscles of mastication.
Platysma and facial muscles.
Muscles of the soft palate.
Stapedius, stylo-hyoid, and digastric.
Middle and inferior constrictors.
(Muscles of the larynx.