644 



UTERUS AND ITS APPENDAGES. 



nerally softer and less tenacious in proportion 

 as they are younger. 



c. The uterus during menstrual life. The 

 average duration of menstrual life is thirty 

 years. It occupies usually the interval be- 

 tween the ages of fifteen and forty-five. The 

 uterus in healthy women, throughout this en- 

 tire epoch, is maintained in a state of perfect 

 aptitude for the reproductive office, being, so 

 to speak, under the control of the ovaries, 

 with which it manifests so direct a sympathy, 

 that every periodic change in the condition of 

 the latter is, so far as the present state of our 

 knowledge justifies the assertion, represented 

 by a corresponding preparatory change in the 

 former. But the menstrual phenomena being 

 reserved for subsequent notice, it is only ne- 

 cessary to remark here that the uterus under- 

 goes usually a slight alteration in size about 

 the time of each eatamenial flow, when its 

 tissues are opened up, and become more spongy 

 from the larger afflux of blood to them. 



The lining membrane appears to suffer a va- 

 riable amount of disintegration. In the uterus 

 of women who have died during menstruation, 

 the interior may present a slightly roughened 

 appearance in certain places, or this may ex- 

 tend over the greater portion of the cavity. 

 In women who menstruate painfully, it not 

 infrequently happens that the entire uterine 

 lining, to a greater or less depth, is exfoliated 

 and discharged ; the process of expulsion 

 being accompanied by much suffering and a 

 greater escape of blood than occurs in ordi- 

 nary menstruation. These dysmenorrhceal 

 membranes (fig. 443.) present all the charac- 



Fig. 443. 



Portion of the lining membrane of the uterus cast off 

 during painful menstruation. (Ad Nat.}* 



teristics of a true decidual structure, having 

 upon their inner side, or that which had cor- 

 responded with the uterine cavity, the fine 

 cribriform surface occasioned by the orifices of 

 numerous utricular glands, and upon the re- 

 verse side the usual rough flocculent appear- 



* For this illustration 

 Oldham. 



I am indebted to Dr. 



ance characteristic of the outer surface of 

 membranes ordinarily discharged, along with 

 the ovum, in abortion. 



In other respects, the uterus, throughout 

 menstrual life, exhibits little or no alteration 

 in form or bulk, but continues to present those 

 characteristics of constant aptitude for its 

 greatest and most important office, which have 

 been explained in the description already given 

 of the adult organ ; and these characteristics, 

 if no pregnancy intervenes, it preserves until 

 the period arrives at which menstruation, to- 

 gether with the capacity for procreation, finally 

 ceases. 



d. The uterus during gestation. The fully 

 developed uterus. The gravid uterus is only 

 another term for the fully developed uterus ; 

 for, although the latter designation is com- 

 monly applied to the unimpregnated organ, 

 when it has reached its ordinary size in the 

 adult, the uterus does not attain the greatest 

 amount of development of which it is nor- 

 mally susceptible until the term of gestation 

 is complete. 



The case of the uterus is perhaps in certain 

 respects sui generis ; for it is the case of an 

 organ which, having reached a certain period 

 of growth, remains in a nearly passive con- 

 dition, so far as mere growth is concerned, 

 until a further amount of development is 

 evoked by a new stimulus. There are, in- 

 deed, two notable periods in the history of the 

 development of the uterus, at which the in- 

 fluence of such an additional stimulus is per- 

 ceptible. 



For, first, as already shown, the uterus, 

 like the mamma, remains without any material 

 change from birth to puberty. The establish- 

 ment of the latter condition is characterised 

 by a correspondingly rapid evolution of both 

 these organs. But the pubertal age may not 

 arrive ; the individual may retain, in respect 

 of reproductive capacity, the pre- pubertal con- 

 dition ; and the uterus, in these cases, does 

 not proceed beyond its first stage of develop- 

 ment.* 



Again, the second stage, having been reached 

 at puberty, may be continued through men- 

 strual life, until, with the cessation of pro- 

 creative power, the period of natural decline 

 in the organ commences, and this is the con- 

 dition which the part retains during the pe- 

 riods or intervals when it is not employed in 

 the process of reproduction, as well as through- 

 out life in those cases in which it is never so 

 employed. This degree of growth of the ute- 

 rus is evoked by the full development of the 

 ovary and the commencing discharge of ova, 

 and is coexistent with the establishment of 

 menstruation and the other conditions of pu- 

 berty. 



But a third stage of development of the 

 uterus is produced normally by the stimulus 

 of impregnation, and partly by the growth of 

 the ovum, and abnormally by the formation of 



* Compare >"# 405., representing the pre- pubertal 

 uterus in a -woman agerl nineteen, with fig. 442., of 

 the uterus of a child at three years. 



