Correlative anatomy of the pelvic floor and the viscera which traverse it
Feci quod potui: Fa ciant meliora potentes ( I did what I could, allow others to do better) Inscriptions on graduation dissertations in old Russia.This work began with a search for the pubo-recto-analis muscle at the instigation of Professor J.H. Louw. Requests followed from surgeons and urologists for information about, and demonstration of, structure related to the pelvic floor in infants and adults, these encouraged me to go more and more deeply into the anatomy of this region in Man. I found that welding of viscera to their fascial,muscular and bony environs is not described in current textbooks. The absence of clear-cut boundaries between some of the muscles, in areas where they are contiguous,is likewise never emphasised. The beautiful drawings in atlases and textbooks have a comforting way of reassuring us that all has been revealed about the pelvic floor and its viscera. However, when the time-consuming expedient of removing the superior fascia of the levator had already yielded dividends,in that failure to do this, had led generations of anatomists to misrepresent the commonest form of the origin of the pubo-coccygeus, it seemed worthwhile to pursue the fascia,muscles and terminal viscera and their nerves, in order to fully understand their complex interwoven relationships. The unusual electrical activity of the musculature was especially intriguing and demanded an explanation. My findings,many of which fully corroborate the findings of others, led me to a consideration of the factors which combine to produce the remarkably efficient functioning of intestinal and genito-urinary outlet mechanisms. It then appeared essential to adopt a correlative approach. Accordingly I have aimed to present a selective account of the soft tissues of the pelvis and perineum which is comprehensive and I hope useful. From it certain aspects,which appear of primary importance,should emerge clearly.
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Department of Public Health and Family Medicine