THE BONES OF THE PELVIS


The most useful homeopathy remedies for Pelvic Bone symptoms from the book The diseases peculiar to women and young children by H.N.Guernsey. …


THE APPLICATION Of The Principles And Practice Of Homoeopathy To OBSTETRICS And the Disorders Peculiar to Women And Young Children by Henry N. Guernsey

THE science and the art of Obstetrics have relation to the phenomena of pregnancy and parturition, considered as purely physiological functions. This study naturally includes both the processes which precede pregnancy and represent its conditions, and those which,-succeeding parturition, -become its consequences. While at the same time, all inequalities in form and function; all difficulties and disorders attendant upon, connected with, or subsequent to these processes, and their proper treatment, must be thoroughly understood,-in order that the student may become an accomplished Accoucheur, and successful of Physician.

Thus the anatomy and Physiology of the pelvis and of the parts of which it is composed of the organs which it contains, and of those which are functionally connected with them, demand the first attention. Next to this study of the natural and normal states, and in immediate connection with it, comes the consideration of the unnatural or abnormal. The healthy and the morbid conditions must be placed, as it were, side by side, in order that the latter may be the more clearly discriminated and understood; -and at the same time immediately associated means of treatment.

The PELVIS is composed or four bones; the sacrum, coccyx, right and left os innominatum. The sacrum and coccyx form the posterior part of the pelvis; the two ossa innominata the sides and front. These bones unite to form a basin or cavity, which affords place of attachment to many of the muscles of the body, and general support to the contents of the abdomen. In the female pelvis are found the womb with some portion of its superior and inferior appendages; the urinary bladder, and the rectum. The pelvis forms the base of the trunk, articulating on the upper surface of its sacral portion with the last lumbar vertebra. Below and on each side it articulates with the femoral bones, by which it is itself supported. In the erect position it is placed obliquely with regard to the trunk of the body; the pelvic surface of the symphysis pubis looking upwards and backwards; the concavity of the sacrum looking downwards and forwards; the base of the sacrum, in the well-formed female, being nearly four inches above the upper border of the symphysis, and the apex of the coccyx a little more than half an inch above its lower border. In the adult it occupies the centre of the body.

A brief description of the several bones which compose the pelvis will prepare the way for a move particular account of its symphyses, size, diameter, cavity, circumference, axes and planes.

The SACRUM is the largest bone in the vertebral column; of which-with the coccyx, it forms the terminal base. If presents for consideration a base, an apex, an anterior and a posterior surface, two lateral borders, and a central canal. Its length is from four inches to four and a half; and its breath is about four inches. From being spongy in structure, its specific gravity is small; and it is known as the lightest bone, for its size, in the whole body. It is triangular in shape, wider at its base than at its apex, and broader on its anterior than on its posterior surface; and being inserted like a wedge, between the two ossa innominata, it forms the keystone of the double arch of the pelvis. Its base inclines upwards and forwards to articulate with the last lumbar vertebra, the anterior surface of the base projecting so as to form with this vertebra the promontory of the sacrum, or sacro-vertebral angle. Its apex is directed downwards and forwards, and presents a small oval, concave surface for articulation with the coccyx.

The anterior surface is smooth, and concave from above downwards. This concavity, or hollow of the sacrum, forms an important feature in the construction of the pelvis. It is marked by four transverse ridges, which slow the line of union of the five separate pieces of which the sacrum was originally composed. At the end of these ridges are found the eight anterior sacral foramina,-four on each side, through which pass the anterior branches of the sacral nerves. Opposite to the extremities of these ridges the foramina are bevelled, so that on the outer side the nerves are protected from being injured by the descending head in parturition, by being thus sunken in the substance of the bone. While on the inner side, the raised, transverse ridges answer the same purpose of preventing any undue pressure upon the nerves transmitted as it were beneath them. Superiorly and externally to the foramina, are the wings and lateral masses, which complete the anterior surface of the sacrum.

The posterior surface is very rough, irregular, convex and much narrower than the anterior surface. Along the median line it is studded with eminences, -rudimentary spinous processes, -which afford greater surface and security to the muscles that originate from, and that are inserted into the sacrum. These processes and tubercles, form an irregular tubercular ridge, whose projections afford greater firmness of attachments to the numerous ligaments which unite this bone to the os innominatum of either side. While the general contour of the ridge itself renders the convexity of this posterior surface even greater than the corresponding concavity of the anterior surface. This convexity presents in both directions, longitudinally and laterally; so that the slope from the posterior surface inclines towards each lateral border, as well as towards the base above and the apex below. Just without the spinous processes, on each side, are the laminae. Externally to these appears a series of indistinct tubercles, which correspond to the articulating processes of the lumbar vertebrae. Four posterior sacral foramina open externally to these tubercles, through which are transmitted the posterior branches of the sacral nerves. Outside these foramina appears a second series of indistinct tubercles, which constitute the rudimentary posterior transverse processes of the sacral vertebrae.

The sacral canal extends through the upper and central part of the bone, in its lower part this canal is often uncovered by the failure of development of the fourth and fifth laminae. This canal is triangular above follows the curvature of the sacrum, and is both narrowed and flattened from before backwards in its descent towards the apex.

Each lateral border is divided into two distinct parts, a superior or iliac, and an inferior part. The superior, auricular or ear-shaped part is covered, anteriorly, by a cartilage for articulation with the ilium. Posteriorly it is marked by irregular expansions, to which the posterior sacral iliac ligaments are attached. The inferior part of the lateral border is thin and curved, and gives attachment to the sacro-sciatic ligaments and to some portions of the glutaeus maximus. The fifth sacral nerve passes through a small indentation at the lower edge of this border and at its angle of junction with the coccyx.

In the female, the sacrum is broader than in the male; less curved, especially in its upper part; and directed more obliquely backwards: thus at the same time increasing the projection of the promontory of the sacrum, and the capacity of the cavity of the pelvis.

The pyriformis and coccygeus muscles are attached to the sacrum on either side; the glutaeus maximus and erector spinae, behind.

The COCCYX corresponds to the sacrum in general appearance, shape and mode of constitution. From the gradual diminution of the four rudimentary segments of bone of which it is composed, it presents the form of an inverted pyramid. The point of the coccyx is usually higher than the inferior margin of the symphysis pubis. Its anterior surface is concave and marked by three transverse grooves. The posterior surface is convex, marked by similar grooves, and presents on each side a row of tubercles. The superior and largest pair of these, the cornua of the coccyx,-project upward to articulate with the cornua of the sacrum. The coccyx gives attachment on its narrow borders to the sacro-sciatic ligaments and to the coccygeus muscle; posteriorly the glutaeus maximus; anteriorly to the levator ani; and to the sphincter ani, at its apex. The only articulation of the coccyx is with the sacrum above.

The OS INNOMINATUM, or unnamable bone, is so called from the impossibility of giving it a truly descriptive and significant name. In the young it is divisible into the three distinct bones: the ilium, the ischium, and the pubis; and in the maturer subject the same names are employed to designate the respective portions of this large, irregular, and anomalous bone.

The ilium, coxal or hip bone, occupies the side; the ischium, the inferior and posterior portion, and the pubis the anterior part of the pelvis. These three bones on either side coalesce, uniting in the acetabulum at the ilio-pectineal eminence and at the junction of the ascending and descending ischio-pubic rami, and thus form the os innominatum.

H.N. Guernsey
Henry Newell Guernsey (1817-1885) was born in Rochester, Vermont in 1817. He earned his medical degree from New York University in 1842, and in 1856 moved to Philadelphia and subsequently became professor of Obstetrics at the Homeopathic Medical College of Pennsylvania (which merged with the Hahnemann Medical College in 1869). His writings include The Application of the Principles and Practice of Homoeopathy to Obstetrics, and Keynotes to the Materia Medica.