624 



UTERUS AND ITS APPENDAGES. 



At such a time the uterus, supported be- 

 tween the folds of the broad ligament, which 

 constitutes a moveable dissepiment, dividing 

 the pelvis transversely into two unequal parts, 

 and sustained by the parts attached to it 

 around and below, lies with its fundus directed 

 obliquely upwards and forwards, while the 

 cervix or neck looks downwards, and very 

 slightly backwards towards the orifice of the 

 rectum. The relative heights of these several 

 parts are determined by two lines : the one, 

 a fl} drawn from the lower border of the 

 symphysis pubis to the promontory of the 

 sacrum ; the ether, b b t from the same point 

 to the lower margin of the fourth sacral ver- 

 tebra. Upon the latter the cervix will rest at 

 a point near the centre of the line. The di- 

 rection of the uterine body will be more con- 

 veniently shown by a third line, c c, drawn 

 through its axis. This line, if produced, will 

 pass out of the pelvis upwards at a distance 

 of |" in front of the sacral promontory; 

 and downwards, after traversing the posterior 

 wall of the cervix, it will pass out about the 

 centre of that wall, and impinge upon the ex- 

 tremity of the coccyx. The lower portion or 

 cervix of the uterus being curved upon the 

 body in the manner hereafter described, the 

 direction of its canal will be downwards, and 

 will be represented by a line drawn nearly 

 perpendicular to the horizon. 



Form. The uterus belongs to the class of 

 hollow muscles, with which it is associated on 

 account of its cavity and the muscular cha- 

 racter of its proper parietes. In many of the 

 mammalia, the elongated form and general 

 arrangement of the tissues gives to the uterus 

 a resemblance to an intestine ; while in man 

 and the quadrurnana, in whom it possesses a 

 considerable degree of firmness and solidity, 

 the shape more nearly resembles that of the 

 urinary bladder. 



The uterus has been compared to various 

 objects, such as a flask, a little gourd or cala- 

 bash, a pear, or a truncated cone. There is 

 enough of similarity to these several objects, 

 to excuse the comparison, yet the resemblance 

 is not sufficiently close to render any of them 

 an exact representative of that body ; but 

 perhaps the flattened pear conveys the best 

 idea of the uterine figure, although the pyri- 

 form outline is somewhat broken by the at- 

 tachment to its lateral borders of the parts 

 usually termed appendages (fig. 368.). These 

 should be, therefore, removed in order to dis- 

 play the proper boundaries of the organ (Jig. 

 424. and 431.). 



Dimensions. The uterus does not attain to 

 its full development until after the establish- 

 ment of puberty. Previous to this period it 

 remains but little altered from its infantine 

 condition ; but as the period of puberty ap- 

 proaches, and about the time when the mam- 

 mae, which have also until then retained their 

 infantine state, begin to enlarge, the uterus 

 rapidly increases in bulk and weight. It then 

 soon reaches the size which, if unemployed, it 

 maintains through the rest of life, only wast- 

 ing, and becoming somewhat altered in figure 



by absorption of its tissues, as age advances ; 

 or, if employed in the process of reproduc- 

 tion, then undergoing a degree of temporary 

 enlargement unparalleled by any other growth 

 of structure in man, and subsequently return- 

 ing, in part, though never entirely, to its for- 

 mer state. 



The following are the average dimensions 

 of the virgin or nulliparous uterus. The 

 entire length from the centre of the fundus 

 (fig. 424 a), to that of the anterior lip b, 



which gives the longest diameter, is 2", 3" 



?/// 



Of this one half usually belongs to the 

 body, and the remainder to the neck or cer- 

 vix ; but the proportional length of either of 

 these parts may exceed the other by \" f 2 fff ' . 



The greatest breadth of the organ is found 

 opposite to the point of attachment of the 

 Fallopian tubes. Here the transverse dia- 

 meter is I", 3"' ; at the point of junction of 

 the cervix with the body 10'"; about the centre 

 of the cervix 12 //x ; at the extremity of the 

 cervix, opposite to the point of junction with 

 the vaginal walls, IT" 12'". 



The antero-posterior diameter of the uterus 

 is greatest about the centre of the body, 

 where it measures in the nulliparous organ 

 11"' 12"'. 



Weight. The weight of the adult virgin 

 uterus, deprived of the appendages, is 9 12 

 drachms. 



Regional divisions. The uterus is divided 

 primarily into a body and neck or cervix. 

 Each of these is again subdivided, the upper 

 portion of the body being termed the fundus, 

 while the lower or terminal part of the neck 

 is distinguished as its vaginal portion. These 

 divisions, though to a certain extent artificial, 

 are necessary, not only to facilitate descrip- 

 tion, but also to distinguish parts which ex- 

 hibit great and important differences both of 

 structure and function. So great, indeed, is 

 the amount of structural and functional dif- 

 ference between the body and neck of the 

 womb, as almost to justify these being re- 

 garded as two distinct organs. 



The fundus is that portion of the body of 

 the uterus which lies above an imaginary line, 

 (fig. 424. A A,) drawn transversely across the 

 organ from the point of attachment of one 

 Fallopian tube to that of the opposite side. 

 This portion of the uterus is of a very dense 

 and firm texture. It is very slightly convex 

 in the virgin state, but becomes considerably 

 arched and expanded during pregnancy, when 

 it forms, as it were, a vaulted roof to the 

 organ. After parturition the fundus does 

 not regain its former figure, but retains more 

 or less of the rounded form which constitutes 

 one of the points of difference between the 

 nulliparous and multiparous organ. The 

 fundus is that part of the uterus which, from 

 its concealed position within the pelvis in the 

 unimpregnated healthy state, is the least ca- 

 pable of being examined during life. It is of 

 all parts of the uterus that which is the least 

 subject to destructive disorganisation by 

 malignant growths, frequently remaining un- 



