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since they serve to convey the ova from these glands into the uterus. They differ,
however, from the ducts of all the other glands in the body in being detached from
the organs whose secretions they convey. They are enclosed in the free margin of
the broad ligaments in the whole of their extent, except at their inner ends, where
they pierce the uterine wall. Traced from the uterus, to the superior angles of
which they are attached, they are found to pass almost horizontally outwards, for a
distance of from half an inch to an inch, until they reach the side walls of the
pelvis, against which they ascend, frequently in a tortuous manner, in front of their
corresponding ovaries and then arch backwards above these glands and internal to
their suspensory ligaments (fig. 280). Finally they turn downwards so that the
fimbriae are opposite the inner surfaces and posterior borders of the ovaries. Some
convolutions of the small intestine are often situated above and internal to the
right Fallopian tube, while the sigmoid loop of the large intestine may have a
similar relation to the left one. The average length of the tubes is from four to five
inches (120 mm.), and, as a rule, the right one is a little longer than the left.

Each tube may be divided into an isthmus, an ampulla, a neck, and a fimlriated
extremity. The isthmus corresponds to about the inner third of the tube, it is
straight, round and cord-like, and has a diameter of 2 mm. to 3 mm. Its lumen
communicates with the uterine cavity by an orifice which will barely admit a hog's
bristle. From this opening its cavity enlarges as it passes outwards but only very



270



FEMALE REPRODUCTIVE ORGANS.



gradually. The ampulla extends from the isthmus to the neck, and forms rather
more than one half of the total length of the tube. It differs from the isthmus in
its larger size, in being less firm to the touch and by its tortuous course. This part
of the tube increases in size from the isthmus to the neck, arid its average diameter
is 6 mm. to 8 mm., while in many cases it will admit, in the greater part of its
length, a No. 6 to No. 8 catheter. Ballantyne and Williams found that the orifice
at the neck of the tube, or ostium aldominale, was physiologically closed in tubes
removed during life, while in specimens obtained from the post mortem room
it was somewhat gaping, When moderately distended it has a diameter of




Ureter.
Rectum.

Suspensory liga-
ment of ovary.

Utero-sacral
ligament.

Fallopian tube.
Ovary.

Ligament of ovary.
JSroad ligament.



Vrachus.

Obliterated hypo-
gastric artery.



Fig. 280. PELVIC ORGANS OF THE FEMALE, VIEWED FROM ABOVE, (v. Bardeleben & Haeckel.)

U, uterus ; , bladder.

3 or 4 mm. The ovarian end of the tube expands in a trumpet-shaped manner
from the neck to enclose a space called the infundibulum or pavilion, and is
then prolonged into a number of irregular processes called fimbrice, hence the term
fimbriated extremity. From its irregular torn appearance it was named by the
ancient anatomists morsus dialoli. The.fimbrige vary considerably in number, size,
and complexity. The larger ones have numerous smaller processes attached to their
edges, and their inner surfaces present folds continuous with those lining the
pavilion. One of the fimbrise, which is longer than the others, is attached to the
upper end of the ovary. This, the ovarian fimbria, has a longitudinal groove leading
from the pavilion to the ovary, and bounded at its sides by secondary fimbrias.
In some cases this fimbria does not reach the ovary, but is attached to it by a v
ligament.

Peculiarities according- to ag-e. In the new-born child the Fallopian tubes are not
situated entirely in the cav.'ty of the true pelvis, their outer ends lying in the iliac fossas.
The ampullary part of the tube shows one to three spiral twists, and the edges of the ovarian
fimbria are not fringed. In old age the tubes tend to become narrower and straighter, and
their muscular coat atrophies.



THE OVARIES.



271



Varieties. A pedunculated cyst, known as the hydatid of Morgagni, apparently peritoneal
in origin, is frequently found attached to one of the fimbrias or to the tube itself. A second
smaller fimbriated opening not unf requently occurs at a short distance f roin the main one.
Congenital absence of a part or the whole of a tube occasionally occurs.

Structure. Beneath the external or peritoneal coat the walls of the tube
contain, besides areolar tissue, plain muscular fibres, arranged in an external longi-
tudinal and an internal circular layer. The submucous tissue contains, like that of
the uterus, mulfcipolar ganglion cells. The mucous membrane lining the tubes is
thrown into longitudinal plicse, which are broad and numerous in the wider part of
the tube, and in the narrower part are broken up into very numerous arborescent
processes : it is continuous, on the one hand, with the lining membrane of the




>jis.
Fig. 281. SECTION OF THE ISTHMUS OF THE FALLOPIAN TUBE; HUMAN. (E.A.S.)

uterus, and at the other end of the tube with the peritoneum ; presenting an
example of the direct continuity of a mucous and serous membrane, and making the
peritoneal cavity in the female an exception to the ordinary rule of serous cavities,
i.e., of being perfectly closed to the exterior. The epithelium in the interior of the
Fallopian tube is, like that of the uterus, columnar and ciliated ; the inner surface
of the fimbrise is also provided with cilia. On their outer or serous surface it passes
into the pavement epithelium of the peritoneal membrane. It does not appear
that there are glands, as was at one time supposed, in the mucous membrane lining
the Fallopian tubes, although the appearances of the folds of mucous membrane may
simulate tubular glands (fig. 281).

THE OVARIES.

The ovaries are two somewhat flattened oval bodies, which are placed one on
each side of the pelvis, and connected with the posterior layer of the broad ligament
of the uterus. The weight of each is about 100 grains (7 grammes on the average
according to Puech, but varying from 5'2f> to 10 grammes), and they usually
measure about one inch and a half in length (36 mm.), three quarters of an inch in
breadth (18mm.), and nearly half an inch (12 mm.) in thickness, but their size is
variable. 1 The exact position of the ovary is by no means uniform, and opinions are

1 Krause gives rather larger dimensions for the virgin (viz. : length, 41-52 mm. ; breadth,
20-27 mm. ; thickness, ,10-11 mu). ; volume, 4-5 c.c.) than for women of 35 to 40 who have borne
children (length, 27-41 mm. ; breadth, 14-16 mm. ; thickness, 7-9 mm. ; volume, 2-5 c.c.).



272 FEMALE REPRODUCTIVE ORGANS.

divided as to the condition which is to be regarded as normal. According to His.
"Waldeyer, and the majority of recent observers, the ovary in the adult nullipara is
placed against the side wall of the pelvis with its long axis vertical, in the erect position
of the body. Kolliker, however, describes it as lying obliquely in the pelvis with its
long axis parallel with the external iliac vessels, and Hasse, while admitting that the
ovary may be considered as normally occupying the position described by His, believes
that it is frequently drawn towards the uterus by the plain muscular fibres contained in
the broad ligament, so that its long axis is then directed obliquely downwards and
inwards. Adopting the account given by His as representing the usual position of
the ovary, we may describe it as presenting two surfaces, a mesial and a lateral, two
borders, an anterior and a posterior, and two extremities, an upper and a lower.
The mesial surface is free and covered to a variable extent by the fimbriated end
of the Fallopian tube and the adjacent portion of the meso-salpinx. Some convolu-
tions of the jejuno-ileum are often found on the inner side of the right ovary, and
the sigmoid loop of the large intestine may have a similar relation to the left ovary.
The lateral surface is also free and lies against a more or less distinct peritoneal
depression on the side wall of the pelvis termed the fossa ovarii. This depression
is generally situated a little below the level of the external iliac vessels, and is often
bounded below and behind by the ureter. The posterior border is free, convex, and
turned somewhat inwards towards the rectum. Like the mesial surface it is
covered partially by the fimbriated end of the Fallopian tube. The anterior border
is straighter than the posterior, it gives attachment to the broad ligament between
the two layers of which is the hilum, where the bloodvessels and nerves enter the
ovary. The Fallopian tube ascends in front of this border. To its upper extremity
is attached the ovarian fimbria of the Fallopian tube, and also a peritoneal fold,
termed the ligamenlum suspensorium ovarii or ligamentum infundibulo-pelvicum,
which passes downwards from the brim of the pelvis and contains the ovarian
vessels and nerves. The Fallopian tube bends backwards at the upper end of the
ovary. The lower end of the ovary is generally narrower than the upper, and is
attached to the uterus by the ligament of the ovary. This extremity does not
normally reach the floor of the pelvis, so that the ovary is suspended against the
side wall of the pelvis.

Peculiarities according 1 to age. In the young foetus the ovary lies in front of the
psoas muscle near the kidney and having the Fallopian tube on its outer side. From this
position it gradually passes downwards and inwards, so that at birth it lies at the brim of the
pelvis with its lower and inner end projecting slightly into the pelvis, and its upper and outer
part in the iliac fossa. During fostal life the ovary is long and narrow, but soon after birth
it becomes more oval in form. Until puberty its surface is smooth, but after the process of
ovulation is fully established it tends to become uneven. This is due to the laceration of the
surface by the rupture of the Graafian follicles and the cicatrizations that occur in connection
with the closure of the openings. In old "age the ovary undergoes atrophy, becoming more
fibrous and less vascular.

Varieties. The above description of the position and relations of the ovaries is based upon
the examination of adult nullipara3, with the bladder empty and the uterus anteflexed and ante-
verted. The ovaries, however, are not firmly fixed in any one place, and even in the same
individual their position is liable to vary according to the condition of the other pelvic organs.
Thus, if the uterus be moved upwards and backwards, by distention of the bladder or other
causes, the ovaries will be displaced backwards towards the sacrum. His found that in cases
of lateral deviation of the uterus the ovary on the side towards which the uterus lies is
vertical, while the lower end of the opposite ovary is drawn towards the median plane by the
ligament of the ovary, so that its long axis becomes oblique. Waldeyer, however, has recorded
a case in which the ovary on the side opposite to the uterine deviation maintained its vertical
position against the side wall of the pelvis, apparently on account of the ligament of the
ovary being longer than usual on that side. Asa rule the ovary on the side towards which
the uterus is displaced is distinctly higher than the one on the opposite side. Thus in a
specimen of Waldeyer's, the one ovary had its upper end 1 c.m. below the level of the external
iliac vein, and the other ovary reached as high as the upper border of the corresponding vein.



THE OVARY.



273



Waldeyer states that he has not seen any cases, such as Hasse describes, where a normal ovary
lies in contact with the uterus.

Absence of one or both ovaries is extremely rare. Occasionally the ovary" retains its
infantile form until adult life. It is very uncommon to find it remaining in its primitive
position near the kidney, but sometimes in place of descending into the pelvis it takes a

Fig. 282. SECTION OF THE OVARY OP THE
CAT. (Schrbn. ) f

1, outer covering and free border of the
ovary ; 1', attached border ; 2, the central
ovarian stroma, presenting a fibrous and
vascular structure ; 3, peripheral stroma ;
4, blood-vessels ; 5. Graafian follicles in their
earliest stages lying near the surface ; 6, 7, 8,
more advanced follicles which are imbedded
more deeply in the stroma ; 9, an almost
mature follicle containing the ovum in its
deepest part; 9', a follicle from which the
ovum has accidentally escaped ; 10, corpus
Juteum.

similar course to that of the testicle.

passing into the inguinal canal and even

through the external abdominal ring to

the labium majus. When enlarged it frequently becomes prolapsed, passing downwards and

inwards behind the uterus, so that when both ovaries are enlarged they may meet near the

median plane.

STRUCTURE OF THE OVARY.

The ovary consists of a stroma, in which are embedded Graafian follicles con-
taining ova. The stroma is composed of a peculiar connective tissue with blood-
vessels, nerves, and plain muscular fibres, and it has an outer epithelial covering.





Fig. 283. PORTION OF THE SECTION OF THE PREPARED CAT'S OVARY, REPRESENTED IN THE PRECEDING

FIGURE, MORE HIGHLY MAGNIFIED. (Schrbn.)

1, epithelium and outer covering of the ovary ; 2, fibrous stroma ; 3, 3', less fibrous, more super-
ficial stroma ; 4, blood-vessels ; 5, small Graatian follicles near the surface ; 6, one or two more deeply
placed ; 7, one farther developed, enclosed by a prolongation of the fibrous stroma ; 8, a follicle farther
advanced ; 8', another which is irregularly compressed ; 9, part of the largest follicle ; a. tunica
granulosa ; 6, discus proligerus ; c, ovum ; d, germinal vesicle ; e, germinal spot.

Epithelium and stroma. The external surface of the ovary is of a whitish
colour, and in early life is comparatively smooth and even ; but in later life it
becomes more uneven and is marked by pits and scars. It is covered by an epi-

VOL. III. PART 4. T



274



FEMALE .REPRODUCTIVE ORGANS.



thelium which differs from that of the peritoneum in being composed of pyriform or
columnar cells ; and the surface has a dull appearance as compared with the shining
smoothness of the serous membrane. A distinct line of demarcation exists around
the attachment of the ovary, where the two kinds of epithelium pass into each other
( Waldeyer). This ovarian epithelium is the remains of the germinal epithelium from
which both the ova and the other cells within the Graafian follicles have been
developed in the embryo. Here and there are occasionally to be seen amongst the
ordinary epithelium-cells, others which are much enlarged and of a spherical form.
These are primitive ova, similar to those from Avhich the permanent ova are formed




Germinal Epithelium.
Tunica albuginea.
Small Graafian follicle.
Ovum.



Mcmbrana granulosa
of a large follicle.



Fig. 284. SECTION OF PART OF THE OVARY OF A YOUNG GIRL. (v. Bbhm and Davidoff.) ^

in the fostus and young subject, but it is doubtful whether the formation of ova from
cells of the germ-epithelium proceeds further in the adult.

Within the epithelium a firm layer of fibrous tissue encloses all the deeper parts.
This has been compared to the dense fibrous covering of the testicle, and thence
named tunica albuginea orarii, but without sufficient reason, for it is not a distinct
tunic, and is in fact no more than a condensed part of the ovarian stroma.

The stroma is chiefly composed of a fine connective tissue, in which the cells,
many of which are spindle-shaped, are remarkably abundant and distinct. Besides
the spindle-shaped cells, others^ are met with which closely resemble the interstitial



THE OVARY.



275



cells of the intertubular substance of the testis. Like these, they have a polyhedral
or irregular shape and often a yellowish colour, and they are chiefly found ac-
companying the blood-vessels, although in older ovaries they may be very" extensively
diffused throughout the stroma. The stroma also contains elastic tissue, and is
permeated by blood-vessels, which are large towards the hilum and in the centre of
the ovary where the tissue is more fibrous, and become gradually smaller towards the
surface. Along these blood-vessels in the deeper part of the ovary bands of muscular
fibres run, having entered from the broad ligament ; but it is uncertain whether
they extend into the more superficial parts of the ovarian stroma. According

Fig. 285. SECTION OF THE OVARY OF A

NEWLY-BORN CHILD. HIGHLY MAGNI-
FIED. (Waldeyer.)

a, Ovarian or germinal epithelium ; b,
formation of an ovarian tube ; c, c, pri-
mordial ova lying in the germ epithelium ;
d, d, longer tube becoming constricted so
as to form nests of cells ; e, e, larger
nests ; f, distinctly formed follicle with
ovum and epithelium ; y, g, blood-
vessels.




to some authorities the spindle-
shaped cells which characterize
the ovarian stroma are also of
a muscular nature. There is a
general radial disposition of the
bunds of stroma from the hilum
towards the surface.

Graafian follicles. Im-
mediately under the superficial

covering of the ovary there is a layer of stroma somewhat different from the deeper
parts, and which is so uniformly spread over the organ as to have received the
name of cortical layer. This is particularly obvious in the ovaries of some animals
(figs. 282, 283, 5) and of young children, in whom this layer is comparatively thick,
and to the naked eye its appearance is granular from the accumulation in it of an
immense number of closely set small vesicles, constituting the early condition of the
ovarian or Graafian follicles with their contained ova. Embedded more deeply in
the substance of the ovary are seen other larger and less numerous follicles of varying
size, the largest being also the most deeply seated. The very largest, however, which
are approaching maturity, eventually reach the surface again, owing to their being
gradually more and more distended with fluid, and may there be seen projecting
somewhat, in the form of clear vesicles, from one-twentieth to one-sixth of an inch
in diameter. When these are punctured or ruptured a drop of clear fluid (liquor
folliculi) escapes, carrying with it the minute ovum surrounded by an accumulation of
the epithelium-cells of the follicle, known as the discus proligerus. Rupture of a
Graafian vesicle, or it may be of more than one, occurs in healthy females at or before
every successive menstrual period. After the discharge of its contents, the empty
and collapsed Graafian follicle becomes filled with a peculiar reddish -yellow tissue
and constitutes a body termed corpus luteum. Should pregnancy occur, this body
undergoes a considerable development, which is maintained during the greater part
of the time of utero-gestation. But in the unimpregnated female the corpus luteum
begins to retrograde within ten or twelve days after its commencement, and
soon shrinks and ultimately disappears. Other follicles, especially before and
after the child-bearing period, may after advancing to a certain stage of development
undergo a retrograde metamorphosis, their contents becoming broken up and

T 2



276



FEMALE REPRODUCTIVE ORGANS.



liquefied and their walls collapsed and converted into a non-vascular homogeneous
membrane. Follicles iu this condition are not at all infrequent in the deeper parts
of the ovary (fig. "28G, Ic).

In addition to Graafian follicles in various stages of development and retrogression, there
may also occasionally be seen in sections of the adult ovary and constantly in that of the
young subject, cords or tubes composed of rounded or polyhedral cells, sometimes with
developing ova imbedded amongst the other cells (fig. 280, /;). These cords may be in con-




Fig. 286. SECTION OF THE OVARY OF AN ADULT BITCH. (Waldeyer. ) i- 5 -

a, germ-epithelium ; b, egg-tubes ; c, c, small follicles ; d, more advanced follicle ; e, discus
proligerus and ovum ; /, second ovum in the same follicle (this occurs but rarely) ; ff, outer tunic of the
follicle ; h, inner tunic ; i, membrana granulosa ; k, collapsed retrograded follicle ; /, blood-vessels ;
7??, m, longitudinal and transverse sections of tubes of the parovarium ; y, involuted portion of the
germ-epithelium of the surface ; s, place of the transition from peritoneal to germinal or ovarian
epithelium.

tinuity with the germinal epithelium or they may be altogether cut off from it. Others occur
which are partially constricted into rounded nests of cells by growth of the stroma across the
cords, and similar nests or groups are found entirely separated, and with or without a developing
ovum in the centre. It is from such nests of cells that the Graafian follicles have become
developed.

Structure of the Graafian follicles. The smallest Graafian follicles have no
proper wall. They consist merely of a single layer of cells, immediately investing
the contained ovum (fig. 284). In section, the cells are flattened and look spindle-
shaped in the- human subject, and not very unlike the cells of the ovarian stroma, so



THE OVARY.



277



that they have been thought to be derived from those cells ; but the observations
of Balfour and others upon the lower animals tend to confirm the_vie_w which
was first taken by Waldeyer that, like the ova themselves, the epithelium-cells of
the follicles are originally derived from the germinal epithelium. These smallest







Fig. 287. FIGURES SHOWING VARIOUS STAGES IN THK DEVELOPMENT OP THE GKAAFIAN FOLLICLES IN

THE RABBIT. HIGHLY MAGNIFIED. (E. A. S. )

A, From a section of the ovary of a young rabbit, showing the " egg- tubes' of Pfliiger continuous
with the germinal epithelium of the surface, from which they are developed somewhat after the manner
of tubular glands. Some of the egg-tubes contain primitive ova. B, primitive Graafian follicles derived
from the breaking up of an egg-tube. C, a Graafian follicle within which the permanent ovum has
now become distinct. The follicle has only a single layer of epithelium. D, a larger follicle in which
there are two distinct layers of epithelium, but the inner layer is formed of flattened cells. E, a
larger but still quite young follicle in which the inner layer of cells as well as the outer is composed
of columnar epithelium. Figs. B, C, D, and E are taken from sections of ovaries more advanced in
development than A.

follicles are very numerous, especially in the young subject ; indeed, it has been
computed that in the ovaries of a female child at birth there cannot be fewer than
70,000 of them. If this is the case, a large proportion must degenerate and dis-
appear without coming to maturity. Their size is about T ^oth of an inch
("25 mm.).



278 FEMALE REPRODUCTIVE ORGANS.

In follicles which are a little larger, and situated somewhat more deeply in the
stroma, the epithelium-cells, although still in a single layer, are no longer flattened
but cubical (fig. 287, c) ; a, membrana proprietor basement membrane can be detected,
and the layer of stroma next to the follicle is beginning to be somewhat differentiated
from the rest so as to form a special fibrous wall to the follicle. In others again a
second layer of cells is beginning to be formed or may be found entirely formed
within the first, and of the two layers thus produced, one immediately invests the
ovum, and the other lines the wall of the follicle (fig. 287, D). The former is the
beginning of the discus proligerus, and the latter of the membrana granulosa. The
cells of both layers soon become columnar (fig. 287, E).

In follicles which are still larger, fluid is seen to be accumulated between the two
layers of cells, and thus to distend the follicle. This collection of fluid is absent at
one part, generally that which is directed away from the surface of the ovary, so
that here the cells which surround the ovum are in continuity with those which line
the follicle, and the ovum is thus in a manner attached at this place to the wall of
the follicle (see fig. 283). In the largest follicles the chief difference in the contents
of the follicle consists in the far greater accumulation of the liquor folliculi, and in
the multiplication of the epithelium-cells both those which line the follicle (mem-
brana granulosa) and those which invest the ovum (discus proligerus) so that each
of these parts consists, in large follicles, of several layers of cells, mostly rounded or
irregular, but columnar next to the wall of the follicle and the exterior of the ovum
respectively.

The larger follicles have a very distinct wall, which is continuous with and



Online LibraryJones QuainQuain's Elements of anatomy (Volume 3:4) → online text (page 34 of 44)