Abstract
In this essay, I have lingered over a host of anatomical
minutiae, and a few more general principles, rather than drawn any
very sweeping conclusions as to the supporting role of any particular
tissues. But this is as it should be, since an intimate survey of
the anatomy must precede any theories of the dynamics of visceral
support. Further, much of the evidence presented has been of a
rather iconoclastic sort, more of value in showing what does not and
cannot support the pelvic viscera than in describing positively the
supportive mechanism. Certainly many accounts, both recent and old,
of the supports of the pelvic urogenital organs, and of the aetiology
of prolapse, lack an accurate anatomical foundation.
A few general observations are worthy of re-emphasis
The pelvic floor must be considered as a whole. The
structure of a building may include several different frameworks,
pillars, and buttresses of different materials - steel, wood, stone,-
but the strength of the building lies in the unity of them all.
There is no single anatomically outstanding visceral support. The
position of the organs is maintained by the whole of the surrounding
tissues, and no one part should be singled out or considered in
isolation.
The fact is often lost sight of that the pelvic connective
tissue follows the same anatomical principles of development and
disposition as does the connective tissue of the rest of the body.
The anatomy, physiology, and pathology of micturition
require much further elucidation.
