THE PELVIC CAVITY IN THE FEMALE. 



PLATE 22. 



A median sagittal section of the female pelvic region. From a Leipzig model from nature (His). 

 FIG. 72. The relation of the ureter to the uterine artery and to the cervix and vagina. The left half of a speci- 

 men in which a median section of the female pelvic viscera has been made. The broad and round ligaments have been 

 incised and the uterus displaced upward and backward. 



in, as it were, between the bladder and rectum, and almost entirely surrounded by a peritoneal 

 duplicature, the ligamentum latum (broad ligaments). 



The Bladder. The capacity of the female bladder is about one-fourth less than that of 

 the male. The position of the viscus behind the anterior pelvic wall and its. relation to the 

 peritoneum are about the same as in the male. The posterior wall of the bladder, however, 

 has quite a different topography on account of the presence of the uterus and the vagina. The 

 larger part of the bladder (that is, of the base or fundus) rests upon the upper portion of the 

 anterior vaginal wall (Plate 22); the top of the bladder borders upon the cervix uteri. The 

 uterus and the bladder are united by a loose connective tissue, but between the bladder and the 

 vagina the connective tissue forms a tense layer, the vesicovaginal septum. The connection 

 between the anterior cervical wall and the posterior surface of the bladder is so firm, however, 

 that the uterus promptly follows the movements of the posterior vesical wall produced by the 

 varying degree of distention of the viscus. The peritoneum covers the bladder above and behind, 

 as far as the middle of the posterior surface, from which situation it is reflected upon the uterus 

 at the junction of the body with the cervix, forming the vesico-uterine jold (excavatio vesico- 

 uterina). It will be observed that the bladder may be opened through the anterior vaginal wall, 

 without injuring the peritoneum, for the purpose of removing foreign bodies (calculi) and pal- 

 pating the interior of the viscus. The bladder may also be opened above the pubis (sectio alta), 

 as in the male, for the treatment of vesical tumors or tuberculosis. 



The Ureter. As the ureter of the female enters the true pelvis, it crosses the origin of the 

 external iliac vessels and runs downward to the outer side [in front of. ED.] of the internal iliac 

 artery. It then crosses over the origin of the uterine artery and passes to the inner side of this 

 vessel (Figs. 72 and 73). In the neighborhood of the cervix the uterine artery is usually very tor- 

 tuous (perhaps as a result of a past pregnancy ?) and passes inward over the ureter to ascend upon 

 the body of the uterus. Very close to this crossing the artery usually gives off a good-sized branch, 

 the ramus cervicovaginalis. The ureter is imbedded in loose connective tissue alongside of the 

 cervix. At the level of the anterior lip of the cervix the ureters approach the vaginal wall and 

 empty into the bladder somewhat below the external orifice of the uterus. This relation of the 

 ureter must be remembered by the operator (in vaginal hysterectomy, for example), since the 

 ureter is not infrequently divided in this situation. During its course in the true pelvis the ureter 

 is occasionally exposed to compression from uterine or ovarian tumors, so that retention of the 

 urine in the ureter and in the kidney with its manifold sequelae is possible. [According to Cun- 

 ningham, the ureter near its termination is about f of an inch external to the lateral aspect of 

 the cervix uteri. ED.] 



The Urethra. The female urethra is but three centimeters in length. It is wider than in 

 the male and so capable of dilatation that the interior of the bladder may be palpated through 

 the urethra by the average finger. In consequence of the greater width and of the shorter length, 



