Anatomical review of various descriptions of the fascial and muscular visceral supports of the female pelvis, including both the extrinsic and intrinsic musculature of the urethra: submitted for the Gunning Victoria Jubilee Prize in Obstetrics (Simpson Prize)

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