612 



UTERUS AND ITS APPENDAGES. 



particular spot from which the ripe ovum is 

 about to be expelled ; to convey the ovum 

 in a direction opposite to the course of the 

 fertilising fluid, so as to ensure the meeting 

 and commingling of the generative elements, 

 an event to which the limited calibre joined to 

 the peristaltic action of the oviduct probably 

 in a great degree contributes ; to afford pro- 

 tection to the ovum during that brief sojourn 

 in which the first effects of fertilisation are 

 manifested upon its constituent parts ; to 

 aid probably in certain changes which are 

 operated upon the surface of the ovum, con- 

 sisting first, in all cases apparently, in a strip- 

 ping off of the adventitious covering with 

 which the ovum is invested on entering the 

 tube, and secondly, in some instances, in 

 the addition of certain materials which in- 

 crease slightly the bulk of the ovum ; and 

 lastly, in transmitting onwards the ovum, so 

 altered and prepared for more complete de- 

 velopment, to the cavity of the uterus, or in 

 conveying away those which, for want of 

 impregnation, are destined to perish. 



In reference to these conclusions regarding 

 the offices of the Fallopian tube, which the 

 present state of physiology appears to war- 

 rant, the question here naturally arises, how 

 far they are applicable to the female of man, 

 or to what extent her case may be viewed 

 as exceptional on account of certain differ- 

 ences in her organisation and habitudes. 



One of the most observable of these dif- 

 ferences is the absence of that marked dis- 

 tinction of periods alternating with each other, 

 such as are shown in a greater or less degree 

 in the females of most mammalia in regard 

 to the activity of the sexual functions. 



That these alternating periods of desire 

 and aversion to the coitus are strictly sig- 

 nificant of corresponding temporary states of 

 physical capacity and incapacity for concep- 

 tion, is placed beyond doubt, by the results 

 of examination of the internal organs and 

 their contents at these respective periods. 



In those animals in which the oestrus re- 

 turns at short intervals, the male generally 

 remains potent at all times. The temporary 

 incapacity is on the side of the female, and 

 occurs in the intervals between the successive 

 acts of ripening and discharge of the ova from 

 the ovary, together with their passage down 

 the tube. It has been shown that during 

 these events only will she receive the male, 

 and therefore, on that account also, is con- 

 ception then only possible. 



This circumstance is rendered more striking 

 in animals in whom this interval is longest, 

 as in the roe-deer, where the oestrus returns 

 only once annually, and in whom the capacity 

 for procreation is limited to a few weeks, for 

 the reason stated by Bischoff, that then the 

 ovary contains ripe ova and the testes ripe 

 semen, anil at no other time. 



But in the human female, whatever views 

 may be entertained regarding the connexion 

 of a separate act of ovulation with each 

 menstrual period, it is certain that here a 

 marked astrus is wanting, and that although 



the capacity for impregnation is apparently 

 greatest about the times of menstruation, 

 yet, notwithstanding the assertions of those 

 who maintain that there is a perpetual recnr- 

 rence of temporary incapacity for procrea- 

 tion, there is no period at which the healthy 

 human female can be shown to be positively 

 incapable of conception during any part oi" 

 menstrual life. 



It may, however, be asked whether the oc- 

 casional occurrence of impregnation during 

 an intermenstrual period, at a date more 

 distant than usual from the last menstrual! 

 act can be explained consistently with a strict 

 interpretation of the law that menstruation 

 and ovulation are contemporaneous acts. 



This appears to be reconcilable with the 

 circumstance that although these acts, so far 

 as observation has yet gone, are very fre- 

 quently and perhaps usually coincident, yet 

 exceptionally an ovum may be emitted during 

 an intermenstrual period, the ripening and 

 not the time or the act of emission of the 

 ovum being probably the essential feature, or 

 that the ovum, supposing it to have been 

 emitted from the ovary at the time of men- 

 struation, may possibly remain in the tube 

 susceptible of impregnation longer in the 

 human female than in the mammalia gener- 

 ally, or may even be impregnated after reach- 

 ing the uterus. * 



That the Fallopian tube in the human 

 subject is, occasionally at least, the seat of 

 impregnation, is demonstrated by the occur- 

 rence of the tubal form of extra-uterine ges- 

 tation ; while the numerous examples already 

 quoted of other mammalia render it highly 

 probable, by analogical reasoning, that this is 

 the normal seat of that function in man. 



That the first encounter of the generative 

 elements may also take place either in the 

 uterus or upon or even within the ovary, is 

 plainly possible. That it occurs sometimes at 

 or near the ovary is evidenced by the varieties 

 of extra-uterine gestation termed ovarian and 

 ovario-tubal. It is even possible that, in 

 some of these, insemination may have been 

 so coincident with the spontaneous opening 

 of the Graafian follicle, that the spermatozoa, 

 penetrating further than usual, may have 

 reached the ovary at that precise moment 

 when a passage had been prepared for the 

 ovum, and some may have actually passed 

 into the follicle and have impregnated the 

 ovum there. No argument certainly can be 

 opposed to this on the ground of physical 

 impossibility f ; while, on the other hand, it 

 is also conceivable that impregnation may be 

 delayed until after the ovum has entered the 

 uterus, as in the case just suggested of a 

 fertilising coitus occurring later than usual 

 after the menstrual period ; but I am not 

 aware of any good anatomical or physiological 

 reason for regarding the uterus, as by pre- 



* These points are more fully considered under 

 the head " Menstruation," p. 608. 



t See the argument regarding the anatomical 

 evidence lor this form of gestation at p. 586. 



