UTERUS (NORMAL ANATOMY.) 



observed by a hand lens or a low power of 

 the microscope. Many of the arteries down to 

 T V" or T y in diameter are still seen to take 

 a remarkable corkscrew course, with numer- 

 ous very close spirals, especially in the outer 

 half of the sections. Beyond these the ves- 

 sels take a straighter course, and at length, in 

 their finer divisions, run in parallel lines, 

 sending off minute twigs at right angles, which 

 cross the ultimate fibres of the tissue, in the 

 manner peculiar to muscular structure. 



When the finer vessels of the body of the 

 uterus have reached the mucous membrane, 

 they dip down between the walls of the 

 canals, termed uterine glands, and spread out 

 in a network of capillaries; the meshes of 

 which surround the orifices of those canals in 

 the manner delineated in Jig. 439. a and b. ; and 

 from these the blood is again collected by the 

 small superficial veins, the course of which is 

 described at p. 637. 



The arteries which supply the cervix pene- 

 trate that part in a direction downwards and 

 inwards, pursuing the same corkscrew course 

 until they have nearly reached the mucous 

 surface, where they break up into finer ves- 

 sels and capillaries, which ramify over the 

 rugae in lines more parallel than those of the 

 uterine body. Both the arteries and capillaries 

 of the cervix are far less numerous than those 

 of the body of the uterus ; and, indeed, the 

 cervix generally in respect of its composition 

 exhibits a lower degree of organisation than 

 that of the principal portion of the organ, 

 although it appears to receive the largest sup- 

 ply of nerves. 



The veins of the uterus take a course cor- 

 responding with that of the arteries, and are 

 distinguished by the same names. They are 

 considerably longer and more numerous than 

 the latter. They form along the sides of the 

 uterus and within the folds of the broad liga- 

 ment a very considerable plexus (the uterine 

 plexus), which, together with the venous chan- 

 nels or sinuses ramifying in the uterine sub- 

 stance, are more conveniently examined in the 

 gravid organ, where they undergo great en- 

 largement. See Jigs. 444. 449. and 453., and 

 the descriptions of these. 



Lymphatics. These vessels are far more 

 easily examined in the gravid than in the un- 

 impregnat.ed uterus. They are very numerous, 

 and are divided by Cruveilhier into two 

 orders; the superficial, which lie immediately 

 beneath the peritoneum ; and the deep-seated, 

 which ramify in several places in the sub- 

 stance of the uterine walls. The lymphatics 

 of the cervix terminate in the pelvic and sacral 

 glands. Those of the body of the uterus, 

 after traversing the broad ligaments and 

 uniting with the lymphatics proceeding from 

 the Fallopian tubes, ovaries, and round liga- 

 ments, empty themselves in the glands situated 

 in front of the aorta and vena cava. 



Xerves. The nerves which supply the 

 uterus are derived partly from the spinal, but 

 principally from the sympathetic system. Ac- 

 cording to the dissections of Dr. Snow Beck *, 



* Phil. Trans., 1846, part ii. p. 219. 

 Supp. 



041 



the nerves which compose the hypogastric 

 plexus, consisting of gelatinous and tubular 

 fibres derived from the lower part of the 

 superior aortic plexus*, on approaching the 

 neck of the uterus begin to separate, and on a 

 level with the os uteri are joined by branches 

 which accompany the superior haemorrhoidal 

 artery. The anterior portion of the hypo- 

 gastric plexus, alter receiving branches which 

 accompany the iliac arteries, passes inwards 

 by the broad ligament, and supplies the lower 

 half of the uterus. These nerves, which are 

 continuations of the hypogastric plexus, as 

 they approach the body of the uterus se- 

 parate, and each pursues a different distribu- 

 tion. They lose the plexiform character and 

 form a number of distinct fine cords. 



These nerves, like all the nerves supplied to 

 the uterus, are chiefly composed of gelatinous 

 fibres, although some tubular fibres accom- 

 pany them ; but they are few in number, and 

 appear to be far from forming the essential 

 element of the uterine nerves. 



The middle portion of the uterus is sup- 

 plied by a distinct branch from the inferior 

 aortic plexus ; which, without communicating 

 with the hypogastric branches, passes to the 

 upper part of the uterine body and then divides, 

 to supply the part between the previously 

 described branches and the Fallopian tube, 

 sending also a branch to the ovary. 



The fundus is supplied sometimes by a 



* According to Dr. S^ow Beck, the white tubular 

 fibres which enter, pass, through, and emerge from 

 the semilunar ganglia, are all derived from cerebro- 

 spinal nerves through the medium of the splanchnic 

 nerve, while none of the tubular fibres actually arise 

 from the ganglia (as Bidder and Volkmann sup- 

 pose). The same was found to obtain in every 

 instance of sympathetic ganglia examined; the 

 tubular fibres could always be traced to the white 

 connecting cord between the spinal and sympathetic 

 nerves, and thence to the branch of the s'pinal nerve 

 from which it is derived. The gelatinous fibres, on 

 the other hand, all take their origin in the corpuscles 

 of the ganglia. In the white cords connecting the 

 spinal and sympathetic nerves, commonly regarded 

 as roots of the sympathetic, the tubular fibres com- 

 posing these, on being traced back to the spinal 

 cord, were found to be derived from the motor and 

 sensitive roots in apparently equal proportions. 

 The elements of the lower part of the superior aortic 

 plexus resemble those which form the semilunar 

 ganglia, viz. tubular fibres derived from the lumbar 

 nerves, and gelatinous fibres from the sympathetic 

 ganglia. 



The inferior aortic plexus is a continuation of the 

 branches from the plexus last described. These 

 divide to form the two lateral hypogastric plexuses, 

 and here a crossing of fibres of the opposite side 

 takes place. 



The lateral hypogastric plexus is composed of gela- 

 tinous and tubular fibres derived from the superior 

 aortic plexus. The distribution of nerves to the 

 uterus from this, their main source, is described in 

 the text. 



The sacral nerres, although they supply the 

 vagina, clitoris, labia, sphincter and levator ani, 

 bladder, and rectum, send no direct branches to the 

 uterus ; nor is there, according to this author, any 

 anatomical evidence to support the supposition 

 which some have entertained, that filaments derived 

 from these nerves might by a circuitous route reach 

 the uterus after their union with the pelvic plexus 

 Phil. Trans., 1846, part ii. 



T T 



