Gravid Uterus.] 
bypogafttic and umbilical regions of the abdomen by its 
increafing bulk, it is no wonder that it fliould inftantly 
mount up before the fmall iuteftines. Their attachment 
to the loins by the mefentery, would feem to render this 
neceffary; but there is another caufe which co-operates 
towards this effect, and which almoft as certainly prevents 
tire epiploon from falling down before the uterus, though 
that membrane is naturally fo loofe, that we might con¬ 
ceive it to be fprcad out indifferently either before or be¬ 
hind the body of the uterus. Yet in fadt this fatty mem¬ 
brane is commonly found pulhed up by the uterus, and 
crowded all round the fundus uteri, with the fmall intef- 
tines in the epigaltric and adjacent parts of the hypochon¬ 
driac regions. The caufe of all this would appear to be 
the fpecific lightnefs of thofe parts in companion of that 
of the uterus. The inteftines contain fonie air, and the 
epiploon a good deal of oil, which gives them lightnefs, 
and buoys them up above the uterus. 
Whoever has any tolerable notion of the fliape of the 
abdomen, and fituation of the cavity of the pelvis, muff 
underftand that the axis of the uterus is very far from the 
perpendicular line, its lower end being turned backwards, 
and its upper end in proportion turned forwards. This 
obliquity changes with the attitude of body, and from 
many other caui'es. When eredt, the weight of the ute¬ 
rus preffes the lore-part of the abdomen into a greater ro¬ 
tundity, and then the axis of the uterus approaches near- 
eft to the tranfverie or horizontal line; and, in a recum¬ 
bent pofture, the contrary happens from a fimilar caufe. 
In the cafe of a firft pregnancy, the uterus ftretches itfelf 
higher up in the epigaftric region, and its axis comes 
nearer to the longitudinal or vertical direction, becaufe 
the parietes of the abdomen do not eafily give way, and 
do not fwell forwards in any great degree; but in a woman 
who has had many children there is a more loofe and pen¬ 
dulous abdomen, and thence the uterus does not lhoot up¬ 
wards, but rather forwards, and takes more of the tranf- 
verfe fituation. This oblique diredtion of the uterus, ap¬ 
proaching to the tranfverfe, is more remarkable in very 
fhort women; becauie in them the chef: is fo near the 
pelvis that the uterus is flopped in its afcent,. and forced 
»o lhoot forw ards. The fame thing happens, and for a like 
reafon, when the pelvis is very narrow. For in this cafe 
the uterus mu ft be higher, as no part of it can be lodged 
in the cavity of the pelvis. In a very fhort and crooked 
woman, with a very narrow pelvis, upon whom Dr. Hun¬ 
ter faw the Caelarian fedtion performed, the fundus uteri 
was turned not only forwards, but even a little downwards. 
As (he lay upon the table, the navel and hypogaftrium 
could not be feen; the navel being (ituated on what might 
have been called the pofterior and inferior part of the ab¬ 
dominal tumour. And to expofe that part of the abdo¬ 
men to the furgeon, it was neceffary with two afiifting 
hands to lift up the fundus uteri, or the rnoft prominent 
part of the abdomen ; without which the hypogaftric re¬ 
gion would have been inacceflible. Indeed, it was an ap¬ 
pearance which, without having feen, it was almoft im- 
poftible to have conceived. 
The obliquity of the uterus towards the right or left fide 
is not commonly, indeed cannot be, very coniiderable. 
A fmall degree of lateral obliquity is very common; and 
it is natural to fuppofe that in a reclined pofture, the mid¬ 
dle projection of the lumbar vertebrae will throw a little 
more than one half of the uterus into the lateral cavity 
between the fpine and one hip-bone. In fadt, we know 
that in all the laft months of the utero-geftation the abdo¬ 
men is often more full on one fide than on the other. Wo¬ 
men fay in fuch a cafe, that the child lies one fide; and 
they judge rightly. Where the child lies, the bulk mull 
both be more coniiderable and more permanent; but 
where there is only uterus, placenta, and water, the fwel- 
ling will be fofter, and projedt lefs. When the child lies 
more in one fide than in the other, the limb of that fide is 
weaker, more benumbed, and more liable to cramps and 
o.dom,atous fuellings. That an aukward pofition of the 
647 
child will occafion fpafms in the limb, experience feftifies 
with the cleared evidence. Many women feel that the 
one depends upon the other; and, from particular motions 
of the child, can certainly prognofticate eafe or pain till it 
fliall alter its fituation again. 
It is a common obfervation, tliat the ligaments and tubes 
of the pregnant uterus are attached low er upon the fide 
of the uterus than they were before pregnancy. If the 
reafon of this has not been fo generally known, it is never- 
thelefs evident. The peritonaeal coat of the uterus makea 
the broad ligament on eacli fide, much in the fame manner 
as the analogous membrane of the intefiinal tube makes 
the mefentery. When a woman is not pregnant, this liga¬ 
ment is of confiderable breadth, the fpermatic veffels pafs 
between its two laminae, the round ligament runs down¬ 
wards, and outwards, on its anterior furface, and the tube 
runs in loofe ferpentine turns upon its upper edge. But, 
in proportion as the circumference of the uterus grows 
larger, the broad ligaments grow narrower, their pofterior 
lamella covering the pofterior furface, and their anterior 
lamella covering the anterior furface of the uterus itfelf. 
As a proof of what has been laid, we obferve that the 
round ligaments do not now run down on the fore-part of 
the broad ligaments, but upon the fore-part of rhe body 
of the uterus itfelf; a proof that the peritonaeum, which 
covers the uterus at this part, is the very membrane which 
before pregnancy made the anterior lamella of rhe broad 
ligament. Farther, in proportion as the fundus uteri rifes 
upwards, and increafes in lize, the upper part of the broad 
ligament is fo ftretched, that it clings clofe to the fide of 
the uterus, fo that in reality the broad ligament difappearsy 
no more of it remaining than its very root ; viz. its upper 
and 'outer corner, where the group of fpermatic veffels pafs 
over the iliacs immediately to the fide of the uterus. In 
this ftate, though the fmall end of the tube opens into the 
fame part of the uterus as before impregnation, yet the 
tube has a very different diredtion; inftead of running out¬ 
wards in the horizontal direction, it runs downwards, cling¬ 
ing to the fide of the uterus. And behind the fimbriae lies 
the ovarium, for the fame reafon, clinging elofe to the 
fide of the uterus. The fimbriae and ovarium are com¬ 
monly placed upon the iliac veffels, or flefhy brim of the 
pelvis, behind the group of fpermatic veflels. 
The round ligaments run almoft perpendicularly down¬ 
wards from the fundus uteri to their parage through the 
mulcles ; they are confiderably enlarged in thicknefs, and 
are fo vafcular, that when injedted, they feem to be little 
more than a bundle of arteries and veins. Their arteries 
are all convoluted. Both their arteries and veins are 
brandies principally of the fpermatics, and both evidently 
anaftomofe with their refpedtive external veflels in the 
groin, or upper part of the labia. Even in this enlarged 
ftate of the round ligaments, it is very difficult to fay 
how they terminate in the groin; they appear to be infen- 
fibly loft. 
The ovaria feem to have undergone no remarkable 
change, except that one which contains the corpus lu- 
teuin ; which for the 1110ft part can be diftingui(lied by a 
rounded fullnefs, and frequently a coniiderable promi¬ 
nence, fenfible both to the fight and touch, upon the mid¬ 
dle cf which there is a (mail pointed cavity or indentation 
like a cicatrix. Upon flitting the ovarium at this part, 
the corpus luteum appears a round body, of a very di Hindi 
nature from the reft of the ovarium. Sometimes it is ob¬ 
long or oval, but more generally round. Its centre is 
white, with Some degree of transparency;: the reft of its 
ftibftance has a yellowifti caft, is very vafcular, tender, and 
friable, like glandular fiefli. Its larger veflels cling round 
its circumference, and thence fend their fmaller branches 
inwards through their fubftance. A few of thefe larger 
veflels are fituated at the cicatrix or indentation on the 
outer furface of the ovarium ; and are there fo little co¬ 
vered, as to give that part tiie appearance of being bloody 
when feen at a little diftance. When there is only one 
child, there is only one corpus luteum ; and two ia cafe 
06' 
ANATOMY, 
