Uterus

“ The uterus becomes congested, and through the constant abnormal weight of the organ itself, as well as the pressing down upon it from above of the superincumbent organs, the uterus is pushed down below its normal position, the ligaments whose duty it is to hold it up become relaxed, and the unhappy woman suffers all the agonies that are attendant on the "falling of the womb." ”

“ The uterus, especially in the woman, varies extraordinarily as it is fecundated or not, both in constitution and in the results of that constitution—I mean in position, size, form, colour, thickness, hardness, and density. In the girl, before the age of puberty, the breasts are no larger than those of the boy, and the uterus is a small, white, membranous organ, destitute of vessels, and not larger than the top of the thumb, or a large bean. ”

“ The Uterus is supplied with follicles around its neck which secrete a very firm, adhesive mucus substance, which serves as a gate or door across the mouth of the womb during the period of pregnancy, and which also serves to prevent the accidental displacement of the ovum or egg. During and just after menstruation, the Uterus becomes enlarged and more vascular. During pregnancy, it largely increases in weight. After delivery, it resumes its normal size, but the cavity is larger than before conception. In old age, it becomes atrophied and denser in structure. ”

“ The uterus is situated in the center of the pelvis, between the bladder and the rectum. It is supported by certain ligaments, the chief of which are the broad ligaments; but, on account of general weakness, too hard physical labor, or lifting heavy weights, the ligaments may stretch, and the uterus may sink down low in the vagina, and we then have the condition known as prolapse of the womb. Or, the womb may turn forward, when we have a condition of anteversion. If the womb is bent (or flexed) forward on itself the condition is called anteflexion. ”

“ A careful study should be made of our illustration, in order that the relation of the vagina and uterus to the rectum behind and the bladder in front may be thoroughly understood; also the angle which is formed by the vagina and the uterus.
Notice should be taken, also, of the opening of the uterus into the upper part of the vagina; as inflammation of the uterus often causes a discharge which passes into the upper part of the vagina and finally out of the body. ”

“ The uterus is lined with a membrane in which are many blood vessels, and when the girl has reached this stage of development and becomes a woman, the vessels become very full of blood, so full that it oozes out through the walls of the blood vessels into the cavity of the uterus, and when it passes out of the vagina the girl becomes aware of it and knows that she has become a woman. ”

“ The uterus assumes a very different shape as it becomes distended with eggs, which are far too numerous to be contained in a simple straight tube; small protuberances arise from its walls, growing rapidly and bifurcating here and there, so as to produce the complicated branched appearance seen in fig, 1, F. As the uterus grows, the male, and later the female, genitalia degenerate and disappear, and in the proglottides which are ready to be liberated the only organ visible is the distended uterus. ”

“ PATHOLOGICAL ANATOMY.—The uterus, of a bluish-red color, is enlarged, especially in its upper two-thirds, to the size of a goose's egg, and is thickened in its antero-posterior diameter. Its walls, filled with venous and arterial blood, are soft and succulent from the transudation of serum. The bundles of muscular fibres are swollen, and the inter-muscular tissue is infiltrated with white blood-corpuscles and a few pus-corpuscles. Extravasations of blood, sometimes larger, sometimes smaller, are usually observed in the connective tissue. ”

“ Now that we may have a clearer idea of the uterus of the hind, I shall describe both its external and internal structure, following the uterus of the human female as my guide. For man is the most consummate of creatures, and has therefore{468} the genital as well as all other parts in higher perfection than any other animal. The parts of the female uterus consequently present themselves with great distinctness, and by reason of the industry of anatomists in this direction are believed to be particularly well known to us. ”

“ If the fundus is above the umbilicus something is wrong. Painful contractions of the uterus follow and cause a squeezing off of [Pg 181] the placenta. There is a flow of blood, the placenta follows, passes out of the vagina, dragging the membranes after it. The fundus sinks, and the uterus, hard, contracted and firm, lies in the pelvis. In some cases it becomes soft, rises up and then relaxes. If it becomes too soft, the relaxation which follows may induce hemorrhage. The uterus should be carefully massaged until it hardens. ”

“ If the prolapse of the lower vagina progresses faster than that of the uterus, then the vagina will begin to drag upon the cervix, to which it is attached, and under these circumstances the uterus will be subjected to two downward forces—intra-abdominal pressure from above, and traction of the vaginal walls acting from below. ”

“ It is chiefly by the influence of these nerves that the uterus performs the varied functions of menstruation, conception, and parturition, and it is solely by their means that the whole fabric of the nervous system sympathizes with the different morbid affections of the uterus. ”

“ In some favorable cases of shoulder and arm presentation, the uterus is widely dilated before the membranes are ruptured and the liquor amnii discharged; and no difficulty is experienced in passing the hand into the uterus, laying hold of the feet, and [313] extracting the child by the operation of turning. If the uterus is not contracting strongly and at short intervals, little resistance is offered to the introduction of the hand, and the delivery may be speedily accomplished with safety both to the mother and child. ”

“ The uterus lies just under the incision, and the operator ascertains that it lies centrally (often the uterus is somewhat rotated to the right or left) , and then makes a free incision through the uterine wall and extracts the fœtus and placenta; as the uterus contracts, he slips his left hand behind the fundus, and grasps the uterus near the cervix, and effectually controls the bleeding. The assistant passes a large warm flat dab into the belly to restrain the intestines and omentum. ”

“ If you will press your fingers down deep into your abdomen, near the navel, you will feel the uterus as a hard round mass, which is often likened to a baseball. If it continues to feel hard and round there cannot be any serious amount of bleeding, but if it becomes soft, the tiny muscle fibers are relaxing their grip on the vessels and bleeding may possibly occur. Quite naturally the thing to do, then, is to stimulate the muscles to contract and this is done by kneading the uterus through the abdominal wall. ”

“ The uterus being a large vascular organ, is obedient to the laws of vascular action, whilst the ovum is more influenced by those regulating new-formed parts; with this difference, however, that new-formed parts or tumors are united firmly to the part from which they grow by all kinds of vessels, and generally by fibrous or cellular substance, whilst the ovum is united to the uterus only by very tender and fragile arteries and veins. ”

“ To sum up a normal pregnancy, we find that in the course of ten lunar months following the fertilization of an ovum, the uterus grows from a small, flattened pelvic organ, 3 inches in length, to a large muscular sac, about 15 inches long occupying the abdominal cavity. It increases its weight sixteen times, that is, from 2 ounces to 2 pounds, while the capacity of the uterine cavity is multiplied five hundred times. Within the uterus is a baby weighing about 71⁄4 pounds; a placenta weighing perhaps 11⁄4 pounds and approximately a quart of fluid. ”

“ The uterus remains undeveloped and in an infantile state until near the approach of puberty, when it develops rapidly, and continues to increase in size until the normal size is attained—about twenty years of age. By the putting on of corsets the free mobility of the uterus and its appendages and their normal development are interfered with. ”

“ Numerous abnormalities and diseases of the uterus may on the one hand prevent the entrance of the ovum into the uterine cavity, and on the other may prevent the upward passage of the spermatozoa to their goal. ”

“ Where there is a foreign body, as a tumor, fixed posteriorly to the uterus, or where the uterus is fixed in a retroflexed position, the patient may be placed in the knee-chest position, Sims's speculum introduced, and the vagina packed with cotton while the patient is in that posture ”

“ But lest any one should think that these words, “for the uterus warmed, draws, and the passages are opened,” signify that the uterus can attract the semen masculinum into its cavity, let them be aware that the philosopher does not say that the uterus attracts the semen from without into its cavity, but that in females, from the veins and passages, opened by the heat of intercourse, the menstruous blood is attracted from its own body ”

“ Because the uterus receives its nerves from the sympathetic system, which governs nutrition, circulation, respiration with distribution of animal heat, gestation, etc., these functions being out of sight, it is difficult to get at the root of the matter as regards the uterus in a suffering woman. ”

“ Strictly, the uterus can have no absolutely normal position or location, because it has a certain normal range of movements which depend to some extent upon respiration, intra-abdominal forces, and locomotion, but more especially upon the varying quantity of material in the rectum and bladder. ”

“ If part of the ovum be detached, we have not only a discharge of blood, but also the uterus, at that part, suffers in its action, and may influence the whole organ, so as to stop the action universally. ”

“ These tubes are often found fused or adherent to the ovary or to the uterus; but Fabricius describes the symphysis of the Fallopian tube with the rectum.
Absence of the uterus is frequently reported. Lieutaud and Richerand are each said to have dissected female subjects in whom neither the uterus nor its annexed organs were found. Many authors are accredited with mentioning instances of defective or deficient uteri, among them Bosquet, Boyer, Walther, Le Fort, Calori, Pozzi, Munde, and Strauch. Balade has reported a curious absence of the uterus and vagina in a girl of eighteen. ”

“ The organs of generation have now made their appearance, but the testes are contained within the abdomen, in the situation of the female uterus, the scrotum still remaining empty. The female organs are yet imperfect, and the uterus with its tubes resembles the two-horned uterus of the lamb. ”

“ The general cavity of the uterus is to a large extent obliterated by the ovum, but still persists as a space filled with mucus, between the decidua reflexa and the decidua vera.
Fig. 151. Diagrammatic section of pregnant human uterus with contained fœtus. (From Huxley after Longet.)
al. allantoic stalk; nb. umbilical vesicle; am. amnion; ch. chorion; ds. decidua serotina; du. decidua vera; dr. decidua reflexa; l Fallopian tube; c. cervix uteri; u. uterus; z. fœtal villi of true placenta; z ́. villi of non-placental part of chorion. ”