APPLIED ANATOMY. 



point it is crossed by the uterine artery. It then inclines somewhat inward and forward 

 along the sides and anterior wall of the vagina to enter the bladder. Its opening in 

 the bladder is about 2. 5 cm. ( i in. ) below the level of the external os, which is almost 

 as far down as the middle of the anterior vaginal wall. The ureters run in the blad- 

 der wall obliquely for about 2 cm. (^ in.) and their openings are from 2.5 cm. to 5 

 cm. ( i to 2 in. ) apart according to the amount of vesical distention (Fig. 460) . 



Blood- Vessels. The main blood-vessels of the pelvic genital organs are the ute- 

 rine and ovarian arteries, described by some authors as the single utero-ovarian artery. 



The uterine artery comes from the internal iliac and passes almost horizontally 

 inward toward the lower portion of the cervix. As it approaches the cervix it gives off 

 a cervicovaginal branch passing to the upper part of the vagina. At this point it has 

 just crossed in front of the ureter and is about level with the external os. It then inclines 

 upward, reaching the side of the uterus at its junction with the vagina. It passes up the 

 side of the uterus, in nulliparae a short distance away from its side, but in multiparse close 

 to it, until it reaches the cornu above. It here is continuous with the ovarian artery. 



The ovarian artery comes down from the aorta as does the spermatic artery in 



FIG. 461. Lymphatics of uterus. (Cuneo and Marcille.) 



the male. It crosses the brim of the pelvis in front of the ureter, enters the infundibulo- 

 pelvic or suspensory ligament of the ovary and runs horizontally towards the uterus in 

 the broad ligament between the round ligament and the ovary. It gives branches to the 

 ovary and tube and as it reaches the cornu of the uterus it crosses in front of the round 

 ligament and joins the uterine artery. As the uterine and ovarian arteries are continu- 

 ous with each other either one may be the larger and they vary, considerably in size. 



A branch of the deep epigastric artery accompanies the round ligament inward 

 and anastomoses with the uterine and ovarian arteries. It may be enlarged in dis- 

 ease of the ovaries and tubes. 



Lymphatics (According to Poirier and Cuneo). The cervix has three sets of 

 lymphatics. The first passes outward and upward along the side of the pelvis ante- 

 rior to the ureter to empty into the nodes along the external iliac artery. The second 

 set passes backward behind the ureter to empty into a node on the anterior division 

 of the internal iliac artery. The third set passes from the posterior surface of the 

 cervix almost directly backward in the uterosacral ligaments to empty, some into the 

 lateral sacral nodes high up in the hollow of the sacrum and some into the nodes of 

 the promontory (Fig. 461). 



