A System of midwifery

THE Pelvis, as the frame-work which, in great measure, contains, supports, and protects, the complicated apparatus of the generative organs, first claims our attention; since an accurate knowledge of the form, size, and uses, of its different parts is indispensably necessary, not only to understand the situation of the viscera it contains, but also to form a correct view of the mechanism upon which the process of parturition depends.

This osseous canal or circular archway, consists essentially of three bones, the right and left os innominatum, which form the sides of the arch, with the sacrum between them, acting as a keystone, and supporting the whole weight of the trunk above.

Ossa innominata. The ossa innominata in early life consists of three distinct bones, the iliac or hip bones at the sides, the ischia or lower portion, upon which we sit, and the ossa pubis, which meet each other anteriorly to form the front part of the pelvis. In the adult these are consolidated into one bone, merely leaving irregular lines and ridges here and there to mark their previous existence.

These bones present several striking points of resemblance with those which belong to the upper extremities, viz. the scapula and clavicle; and in the early stages of development, this similarity is much more distinctly seen: it is remarkable, that although the ischia and ossa pubis are formed later than the ilia, yet they unite with each other much sooner than with the ilia, so that the two consolidated bones bear the same relation to the ilium, which is separated from them, that the clavicle does to the scapula: many other points of resemblance between the bones of the shoulder and pelvis might be noticed if necessary. (Meckel, Anat. vol. ii. p. 239.) The ossa innominata meet each other in front, forming the symphysis pubis, having layers of fibro-cartilage interposed between their extremities, and bound together by ligamentous fibres, constituting the ligamentum arcuatum, or annulare ossium pubis, and by which a more rounded appearance

is given to the pubic arch. They are united to the sacrum posteriorly, one on each side of it, forming the right and left sacro-iliac symphysis or synchondrosis; this differs in many respects from the symphysis pubis, the cartilaginous coverings of the opposing bones being much thinner, especially those of the ossa innominata; the surfaces are extremely uneven from the deep indentations which each bone presents at this part, locking, as it were, into each other, and thus contributing greatly to increase the firmness of the joint, which is also still farther strengthened by the support of powerful ligaments.

Between the ligamento and cartilaginous layers which cover the surfaces of the bones at the pubic and sacro-iliac symphyses, a minute collection of synovial fluid may be detected, like that found in the fibro-cartilages between the vertebræ; it serves to lubricate their surfaces, and separates them more or less, thereby increasing the thickness of the intervening cartilaginous structure; and separating also the edges of the bones, to a certain extent, more especially at the symphysis pubis. (Portal, Anat. Méd.) These lamina of intervening fibro-cartilage are thicker in the female than in the male, although of smaller extent; and this is still more remarkable during pregnancy, this ligamento-cartilaginous structure becoming now more cushiony and elastic, while in the latter months we can easily distinguish blood-vessels ramifying through it, which are branches of the pudic arteries and veins.

Sacrum. The sacrum, which forms the upper and posterior portion of the pelvis, contributes greatly to the general solidity of the whole bony circle. From its wedge-like shape, it is admirably adapted to support the entire weight of the trunk, and acts, as we have before observed, as a kind of keystone to the arch which is formed by the ossa innominata. It is of a triangular shape, being concave before and convex behind. In the fœtus it consists of five distinct pieces of bone, separated by intervening layers of cartilage, like the vertebræ of the spinal column, and from their resemblance to those bones they have been called false vertebræ. These cartilages, after a time, gradually disappear; bony matter is deposited in their place; so that by the period of puberty the five sacral vertebræ become united into one solid bone, although they may be distinguished, until an advanced period of life, by the ridges which their edges form.

The upper surface of the sacrum, having to sustain the whole weight of the spinal column, is broad and flat, and corresponds to the lower surface of the last lumbar vertebra. Its anterior surface forms with that of the other mentioned bone a considerable angle, which projects forwards and more or less downwards towards the symphysis pubis, and is called the promontory of the sacrum. Beneath this point, the sacrum takes a considerable sweep backwards as it descends, gradually advancing again forwards, as we approach its inferior extremity, forming an extensive concavity upon its anterior surface: this is termed the hollow of the sacrum.

Coccyx. The lower end is prolonged by a small bone, called Coccyx or os Coccygis, from its supposed resemblance to a cuckoo's beak. It usually consists of four, and sometimes (especially in women) of five portions; they are much smaller than the bones of the sacrum, and are very imperfect rudiments of vertebral formation; like these, they are at an early period little else than cartilage, and even when the bones are fully formed,

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