670 



UTERUS AND ITS APPENDAGES. 



relation to the powers of the different nerve 

 centres, it is scarcely possible to arrive at any 

 satisfactory conclusion regarding the relative 

 degrees of influence which these may be sup- 

 posed to exercise over the movements of the 

 uterus. The marked differences of opinion 

 still existing upon this subject* afford sufficient 

 evidence of the uncertainty of the data upon 

 which definite conclusions can be based. In 

 this uncertainty, however, all points of the 

 nervous system are not equally involved. 



The amount of influence of the cerebrum 

 upon the act of parturition can be determined 

 with tolerable accuracy. That the uterus is 

 in communication with the brain is proved by 

 the fact that the woman is conscious of the 

 fetal movements, and that she suffers pain 

 when the uterus contracts. Emotion may 

 excite, and may also for a time delay, uterine 

 action. The will cannot operate directly upon 

 the uterus, either in the way of producing, or 

 of restraining its contractions, but a slight in- 

 direct influence may be occasionally perceived, 

 when by voluntary changes of posture, or by 

 the use of those muscles which assist labour, 

 the force of the uterus is slightly increased ; 

 or conversely, when, by carefully restraining all 

 such movements and actions, this result is 

 avoided. 



It is further shown by the occurrence of 

 labour in cases of complete paraplegia, and also 

 during states of unconsciousness, induced by 

 anaesthetics, that the uterus contracts while it 

 is withdrawn from all volitional ami like cere- 

 bral influences. 



These several examples serve to show to 

 what extent the contractions of the uterus 

 may be influenced by the cerebrum, and also 

 how that influence may be withdrawn. It is 

 obvious that psychical influences are neither 

 necessary nor accessory to the simple act of 

 labour. They may often be regarded as dis- 

 turbing, but not as regulating forces. Hence 

 the dominant power over the contractions of 

 the uterus, which is exercised during labour, 

 must have itsseat in some of those nervous cen- 

 tres that are placed lower than the cerebrum. 



We may therefore proceed next to inquire 

 what are the attributes which from direct ob- 

 servation and analogical reasoning the uterus 

 may be supposed to derive respectively from 

 the ganglionic and spinal systems, regarded as 

 separate sources of motor power. But here, 

 on account of the intimate manner in which 

 the nerves derived from each of these centres 

 are bound up together, great difficulty arises 

 in distinguishing between the operations of 

 each, and these difficulties can be only in part 

 surmounted. 



The circumstances which point more par- 

 ticularly to the influence of the ganglionic 

 system will be first considered. 



The uterus derives a greater proportionate 



* See Tyler Smith, Parturition and the Principles 

 and Practice of Obstetrics ; and Lancet, 1856. 

 Scanzoni, Lehrbuch der Geburtshilfe. Brown- 

 Sequard. Physiology and Pathology. Carpenter, 

 Principles of Human Physiology; and Todd, art. 

 NERVOUS SYSTEM, in this Cyclopedia. 



supply of nerves from the ganglionic than from 

 the spinal system. This appears from the re- 

 searches of both Snow Beck and Kilian. 

 The actions therefore of those parts or organs 

 having like endowments, which are in other 

 respects also comparable with the uterus, may 

 be here examined. 



Of all organs the heart is that which most 

 nearly resembles the uterus. It constitutes, 

 after the uterus, the largest hollow muscle. 

 Like the uterus, it acts with rhythm, and, in a 

 certain degree, peristaltically. It continues its 

 contractions, with little, if any, interruption, 

 for a long time after its principal cerebro-spinal 

 connections have been destroyed, as by tying 

 the pneumogastric nerves. It continues to 

 contract rhythmically in many animals for a 

 variable time after death, or when cut out of 

 the body Its contractions are regulated mainly 

 by sympathetic ganglia, while the cerebro-spinal 

 fibres which it receives serve to establish rela- 

 tions between it and other parts. 



The uterus exhibits many like peculiarities. 

 It acts with rhythm and peristaltically. It 

 continues these actions, in numerous species 

 of animals, for a variable time after death. 

 Even in the human subject, a post-mortem 

 power of contraction seems to be occasionally 

 retained, as in the case of women whose spon- 

 taneous delivery has taken place some time 

 after all evidences of somatic life have ceased.* 

 In these several offices we may conclude that 

 the uterus also, so far as its operations are 

 under the dominion of the nervous system, is, 

 like the heart, chiefly influenced by sympathetic 

 ganglia and nerves. 



That this is the case is also further shown 

 by the occurrence of delivery under circum- 

 stances in which all spinal influence appears 

 to be abrogated. The following is an ex- 

 ample.-|- 



A woman was attacked with paraplegia in 

 the eighth month of pregnancy. She had 

 neither sensation nor motion in any part below 

 the umbilicus. No reflex movements what- 

 ever could be produced by tickling the soles 

 of the feet. The faeces passed involuntarily, 

 and the urine was drawn off daily. About the 

 ninth month, her medical attendant, when 

 about to pass the catheter, found a full-grown 

 fetus in the bed (dead). The uterus was con- 

 tracted, and the placenta in the vagina. The 



* A large number of these cases has been col- 

 lected by Dr. W. H. Wittlinger, " Von der nach 

 deni Tode der Mutter von selbst erfolgenden 

 Geburt," in the Analekten fiir die Geburtshulfe, 

 Bd. I. 1849. All cases of post-partum delivery are 

 probably due to one of three causes, viz., to a con- 

 tractile power or irritability remaining in the uterus 

 after death, and comparable to that which in vo- 

 luntary muscles produces the now well-known 

 post-mortem cholera movements ; to rigor mortis ; 

 or to the development of gases within the abdo- 

 men or uterus, causing the expulsion of the child 

 by pressure. The first is probably the cause of 

 birth within a few hours, and the last several days, 

 after the death of the mother, and the second of 

 the expulsion of the foetus before decomposition has 

 set in, yet at a later period than can be accounted 

 for upon the first hypothesis. 



f For this case I am indebted to Mr. Paget, 



