662 



UTERUS AND ITS APPENDAGES. 



But these changes are not limited to the 

 body of the uterus. The external uterine 

 orifice being now no longer required to serve 

 as a conduit for fluids to or from the uterus, 

 or for the passage of more solid contents, 

 becomes reduced in diameter, and may some- 

 times be observed to possess an aperture 

 that would hardly admit the head of a mo- 

 derate sized probe. 



Fig. 4-58. 



Os uteri in old nge. (Ad Nat.) 



FUNCTIONS OF THE UTERUS. 



The uterus, in common with the rest of 

 the generative organs, being concerned only 

 in the reproduction of the species, its offices 

 are limited to that period in which the 

 animal functions are maintained in their 

 highest state of efficiency. The growth of 

 the body is nearly or quite completed before 

 the sexual offices commence, and the power 

 of reproduction continues as long as the 

 frame is maintained in full vigour ; but when 

 the age arrives at which the animal func- 

 tions generally begin to decline, their de- 

 cay is anticipated by the total cessation of the 

 power of procreation in the female. The 

 period, therefore, is limited, yet not brief, 

 during wbicb the functions of the uterus can 

 be exercised, and on either side of this epoch 

 the organ remains passive, except under ab- 

 normal states. 



The chief functions of the uterus are those 

 which relate to 1. Menstruation; 2. In- 

 semination ; 3. Gestation ; 4-. Parturition. 



The office of the uterus in menstruation. 

 Although the uterus is the efficient instrument 

 in the performance of menstruation, yet the 

 power of initiating and regulating this function 

 resides in the ovaries, which exert a powerful 

 reflex influence, not only upon the uterus, but 

 also upon the entire organism. Without the 

 ovaries, menstruation has never been known 

 to occur. Their artificial removal is followed 

 by a permanent cessation of the catamenial 

 flow, although the uterus may be left unin- 

 jured ; while the congenital absence of both 

 ovaries is always accompanied by an enduring 

 amenorrhcea. 



The external sign or evidence of menstrua- 

 tion consists in the occurrence of a sanguine- 

 ous discharge, which escapes from the vaginal 

 orifice of women in health, periodically, except 

 during pregnancy and lactation. This dis- 



charge first appears usually between the four- 

 teenth and sixteenth years, and continues to 

 be repeated at intervals of a lunar month for 

 an average period of thirty years. The time, 

 however, of the commencement, as well as of 

 the decline, of menstruation is very variable, 

 and may be either much accelerated or re- 

 tarded, according to individual peculiarities.* 



Periods of duration and recurrence. The 

 catamenial period and interval together occupy 

 a space of one lunar month. And in some 

 women this function is performed with such 

 regularity that the day, and very nearly the 

 hour, of its expected return may be predicted. 

 The natural duration of the flow varies from 

 three to five or even seven days. An interval 

 then occurs during which the flow entirely 

 ceases. This occupies from twenty-one to 

 twenty-five days ; and it is during the ^first 

 half of this interval that conception most com- 

 monly takes place. 



It cannot, however, be asserted that this 

 degree of regularity is observed even in the 

 majority of women. Frequently the period of 

 regular return is anticipated by one or more 

 clays ; or, on the other hand, it may be re- 

 tarded, without the occurrence of any con- 

 comitant disturbance of other functions, such 

 as would justify the regarding of these ex- 

 amples as abnormal. But whatever may be 

 the amount of variation dependent in most 

 cases upon idiosyncrasy, still a law of pe- 

 riodicity is observed which, in all ages and 

 countries, has been recognised, and more or 

 less distinctly expressed by such terms as 

 catamenia, menses, courses, periods, regies, 

 mois, monatlicher Fluss, and the like. 



No catamenial discharge takes place nor- 

 mally during pregnancy or lactation. Excep- 

 tions to both these rules, however, occur, and 

 instances of the latter are sufficiently common. 

 But with regard to the former, it is probable 

 that many at least of the recorded cases of 

 menstruation during pregnancy have been 

 cases in which the placenta was implanted 

 low down, or even over the os, under which 

 circumstances it is well known that slight 

 flooding will occasionally commence at an 

 early period of gestation, and observe a cer- 

 tain rough periodicity. Upon anatomical 

 grounds, a catamenial flux during pregnancy 

 can only be supposed possible where the con- 

 dition of the uterus is such as to admit of the 

 discharge taking place from the vaginal portion 

 of the cervix ; an occurrence which is shown 

 by Mr. Whitehead to have obtained in all the 

 instances of supposed menstruation during 

 pregnancy which he had investigated. For 

 " on examining these cases with the speculum 



* For much valuable statistical information re- 

 lating to the periods of invasion and decline of the 

 catamenia, and in refutation of the popular belief 

 that these periods are greatly influenced by climate, 

 &c., see Robertson's Essays and Notes on the Physi- 

 ology and Diseases of Women ; also, on the subject 

 of menstruation generally, Whitehead, the Causes 

 and Treatment of Abortion and Sterility; A. Brierre 

 de Boismont, De la Menstruation, 1842 ; Raciborski, 

 De la Puberte, 1844. 



