sacrum ; the ether, b b t from the same point
to the lower margin of the fourth sacral ver-
tebra. Upon the latter the cervix will rest at
a point near the centre of the line. The di-
rection of the uterine body will be more con-
veniently shown by a third line, c c, drawn
through its axis. This line, if produced, will
pass out of the pelvis upwards at a distance
of |" in front of the sacral promontory;
and downwards, after traversing the posterior
wall of the cervix, it will pass out about the
centre of that wall, and impinge upon the ex-
tremity of the coccyx. The lower portion or
cervix of the uterus being curved upon the
body in the manner hereafter described, the
direction of its canal will be downwards, and
will be represented by a line drawn nearly
perpendicular to the horizon.
Form. The uterus belongs to the class of
hollow muscles, with which it is associated on
account of its cavity and the muscular cha-
racter of its proper parietes. In many of the
mammalia, the elongated form and general
arrangement of the tissues gives to the uterus
a resemblance to an intestine ; while in man
and the quadrurnana, in whom it possesses a
considerable degree of firmness and solidity,
the shape more nearly resembles that of the
urinary bladder.
The uterus has been compared to various
objects, such as a flask, a little gourd or cala-
bash, a pear, or a truncated cone. There is
enough of similarity to these several objects,
to excuse the comparison, yet the resemblance
is not sufficiently close to render any of them
an exact representative of that body ; but
perhaps the flattened pear conveys the best
idea of the uterine figure, although the pyri-
form outline is somewhat broken by the at-
tachment to its lateral borders of the parts
usually termed appendages (fig. 368.). These
should be, therefore, removed in order to dis-
play the proper boundaries of the organ (Jig.
424. and 431.).
Dimensions. The uterus does not attain to
its full development until after the establish-
ment of puberty. Previous to this period it
remains but little altered from its infantine
condition ; but as the period of puberty ap-
proaches, and about the time when the mam-
mae, which have also until then retained their
infantine state, begin to enlarge, the uterus
rapidly increases in bulk and weight. It then
soon reaches the size which, if unemployed, it
maintains through the rest of life, only wast-
ing, and becoming somewhat altered in figure
by absorption of its tissues, as age advances ;
or, if employed in the process of reproduc-
tion, then undergoing a degree of temporary
enlargement unparalleled by any other growth
of structure in man, and subsequently return-
ing, in part, though never entirely, to its for-
mer state.
The following are the average dimensions
of the virgin or nulliparous uterus. The
entire length from the centre of the fundus
(fig. 424 a), to that of the anterior lip b,
which gives the longest diameter, is 2", 3"
?///
Of this one half usually belongs to the
body, and the remainder to the neck or cer-
vix ; but the proportional length of either of
these parts may exceed the other by \" f 2 fff ' .
The greatest breadth of the organ is found
opposite to the point of attachment of the
Fallopian tubes. Here the transverse dia-
meter is I", 3"' ; at the point of junction of
the cervix with the body 10'"; about the centre
of the cervix 12 //x ; at the extremity of the
cervix, opposite to the point of junction with
the vaginal walls, IT" 12'".
The antero-posterior diameter of the uterus
is greatest about the centre of the body,
where it measures in the nulliparous organ
11"' 12"'.
Weight. The weight of the adult virgin
uterus, deprived of the appendages, is 9 12
drachms.
Regional divisions. The uterus is divided
primarily into a body and neck or cervix.
Each of these is again subdivided, the upper
portion of the body being termed the fundus,
while the lower or terminal part of the neck
is distinguished as its vaginal portion. These
divisions, though to a certain extent artificial,
are necessary, not only to facilitate descrip-
tion, but also to distinguish parts which ex-
hibit great and important differences both of
structure and function. So great, indeed, is
the amount of structural and functional dif-
ference between the body and neck of the
womb, as almost to justify these being re-
garded as two distinct organs.
The fundus is that portion of the body of
the uterus which lies above an imaginary line,
(fig. 424. A A,) drawn transversely across the
organ from the point of attachment of one
Fallopian tube to that of the opposite side.
This portion of the uterus is of a very dense
and firm texture. It is very slightly convex
in the virgin state, but becomes considerably
arched and expanded during pregnancy, when
it forms, as it were, a vaulted roof to the
organ. After parturition the fundus does
not regain its former figure, but retains more
or less of the rounded form which constitutes
one of the points of difference between the
nulliparous and multiparous organ. The
fundus is that part of the uterus which, from
its concealed position within the pelvis in the
unimpregnated healthy state, is the least ca-
pable of being examined during life. It is of
all parts of the uterus that which is the least
subject to destructive disorganisation by
malignant growths, frequently remaining un-
UTERUS (NORMAL ANATOMY).
625
altered in texture after the whole of the cer-
vix has been destroyed by carcinomatous
ulceration.
inner surfaces are not in immediate contact
like those of the uterine body ; but diverge
On the other hand it is the part slightly to enclose a flattened spindle-shaped
cavity, termed the canal or cavity of the
Fig. 424. cervix.
The situation of the widest or central part
of this canal is indicated by an external late-
ral bulging of the walls of the uterine neck.
The posterior part of the cervix receives a
loose investment of peritoneum ; but the
whole or the greater portion of its anterior
wall, as well as the lower or vaginal portion,
is uninvested by that membrane.
The vaginal portion. The lower extremity
of the cervix (fig. 424. below, c c) projects
Fig. 425.
Section showing the regional divisions of the uterus
(Outlined ad Nat.")
from which polypi, that are not cervical in
their origin, most frequently arise; and it is
very commonly the seat of those large hyper-
trophic growths of the uterine tissue, which
are usually termed fibrous tumours. The
fundus is also the part to which the upper
portion of the placenta is most frequently
attached.
The body is included between the line
above indicated, and another, B B, drawn
through the narrowest part of the organ, or
that point at which the tapering lateral walls
of the uterus approximate in the greatest de-
gree before they again diverge to pass into
the cervix. The body of the uterus consti-
tutes its principal portion. It is that part
which, more than any other, expands to in-
vest the ovum. It is freely supplied with
blood-vessels, which, entering by the lateral
border, ramify abundantly through the ante-
rior and posterior walls. These walls are
usually half an inch in thickness. They are
separated from each other by a scarcely appre-
ciable cavity, to be hereafter described, lying
between the inner surfaces of the parietes.
The extreme narrowness of this cavity is
shown in Jigs. 427 430., which represent
transverse sections of the uterine body, at
various points between the fundus and in-
ternal OS.
The cervix, or neck, (fig. 424. B c), is a
cylindriform prolongation of the uterine bodv,
to which it serves as an excretory conduit. It
is composed in part of tissues similar to those
of the body, hut the arrangement of these is
materially different. The walls of the cervix
measure 4'" in average thickness. Their
Supp.
Os uteri, and vaginal portion of the cervix.
(Ad Nat.)
Virgin.
into the vagina in the form of a flattened cone.
The length of this conical projection is about
4"'. It is of unequal diameter. Transversely
it measures 11'" 12"' at the base, and 6"'
7"' at the apex ; but its antero-posterior dia-
meters are only 1'" 8'" at the base, and 5"' at
the apex ; so that a section of this part will
represent an ellipse. Around the base of this
conical portion the walls of the upper end of the
vagina are attached. The vaginal attachment
constitutes the line of demarcation between
the lower or vaginal and the upper or supra-
vaginal division of the cervix. It should be
observed that the end of the cervix does not
lie, as is commonly supposed, exactly at the
extremity of the vaginal canal, but that it
projects into its upper wall, so that the upper
vaginal wall is shorter than the lower by the
whole antero-posterior diameter of the cervix
(fig. 426. and 433.). This explains the diffi-
culty which is sometimes experienced in
bringing the cervix into view when a tubular
speculum is employed, the sides of which are
all of equal length. There can be no doubt
that this peculiar position of the extremity of
the cervix prevents the part from suffering
injury in coitu, because the impulse of the
intromittent organ is received upon the end
of the vagina, and is distributed upon the
adjacent parts, through the intervention es-
pecially of the utero-sacral ligaments. See
further, p. 689.
At the apex of this conical mamelon is
observed a transverse fissure 3"' 4'" in
length. This is the lower or terminal orifice
of the cervical canal, the os externum uteri,
fig. 425., as distinguished from the os inter-
s s
626
UTERUS AND ITS APPENDAGES.
num fi /?g. 431, i, which marks the commence-
ment of that canal. The os externum is bor-
dered in front and behind by two smooth lips,
whose commissure on either side forms the
lateral boundaries of the orifice. The lips
constitute the terminations of the anterior
and posterior cervical walls respectively.
They are accordingly distinguished as the
anterior and posterior lips of the os uteri.
Their position and form are most conveniently
shown in a vertical section of the part {fig.
426. and 433.). The anterior lip is the
smaller; it projects but slightly into the
vagina, but it lies at a lower level than the
posterior one, on account both of the greater
length of the anterior wall of the uterus, and
also from the inclination of the upper part of
the organ forwards. In an antero-posterior
view, the anterior serves to conceal the pos-
terior lip, which lies higher in the pelvis, both
from the comparative shortness of the pos-
terior uterine wall, and also from the tilting
forward of the entire organ ; nevertheless the
posterior lip makes a greater projection into
the vagina, because the walls of that canal
are reflected off at a higher point upon the
cervix posteriorly than anteriorly. This un-
equal form of the two lips doubtless gave
origin to the term os tincae, by which the
older anatomists designated the part.
In no portion of the uterus is the difference
between the nulliparous and multiparous or-
gan so marked as in the vaginal portion of the
cervix. After the birth of many children, this
part becomes much enlarged, soft, flaccid, and
of irregular form, with notched margins ; but
in the virgin it has uniformly the smooth,
even, conical figure just described, while its
consistence is nearly that of soft cartilage.
External surface. The uterus, being a hol-
low or cavitary organ, possesses both an ex-
ternal and an internal surface. The external
surface exhibits two faces, anterior and poste-
rior ; three borders, one superior and two
lateral ; and three angles, two superior and
one inferior.
The anterior face is smooth, and gently
convex in the transverse direction (figs. 427
430.), but often slightly curved from above
downwards (fig. 426.). It is covered by peri-
toneum in all but its lower part, where this
membrane is reflected off to give a covering to
the bladder at a distance of not less than one
fourth of the entire length of the uterus from
its lower extremity. The posterior face is more
decidedly convex ; and in some subjects, espe-
cially in multiparae, it exhibits a marked pro-
minence along the median line, from which the
walls proceed outwardly in two nearly level
planes. These, meeting the less convex an-
terior walls at the lateral border, give to a
transverse section of such an organ an outline
more or less triangular (fig. 428.). The pos-
terior face also receives an investment of peri-
toneum. The membrane here, after covering
the entire posterior surface of the uterus,
usually dips down to cap the upper extremity
of the vagina. (Fig. 426. c r.)
The superior uterine border is moderately
convex ; it extends from the point of entrance
of one Fallopian tube to that of the other
(fig. 43 1.//). This border is entirely co-
vered by peritoneum. The two lateral bor-
ders extend from the point of entrance of
either Fallopian tube downwards to the
lower extremity of the uterine neck, as far
as the margins of the os uteri. These
borders are flexuous, being convex above,
concave towards and below the centre of
the organ, again slightly convex about the
middle of the cervix, and finally terminating
at the os uteri, after having their continuity
interrupted by the circular attachment of the
vagina near the termination of the uterine
neck. The lateral borders are uninvested by
peritoneum; for it is here that the two laminaa
of that membrane, which form the broad liga-
ment, meet to inclose the uterus; and by these
two lateral borders, the blood-vessels and
nerves supplying the organ enter it without
penetrating its outer or serous coat (fig. 428.).
The two superior angles are formed at the
points of entrance of the Fallopian tubes.
The inferior angle is occupied by the vaginal
portion of the cervix and the os uteri.
Internal surface and cavities of the bodij and
cervix. It has been stated that the walls of
the uterine body are in nearly close apposi-
tion internally, leaving only a small interme-
diate space, termed the cavity of the uterus,
which is easily displayed by cutting through
Fig. 426.
Vertical section of the uterus parallel with its lateral
borders.
a, anterior, and p, posterior, lip of cervix ; t, in-
ternal os uteri ; v a, vagina ; f, fornix ; c, loose con-
nective tissue immediately above the fornix; r,
point of posterior reflection of the peritoneum on to
the rectum, forming the retro-uterine pouch or space
of Douglas; bb, line of attachment of the cervix to
the bladder. The peritoneum ceases at the upper
b, in front. (Ad Nat.)
UTERUS (NORMAL ANATOMY).
627
the substance of the organ. No just concep-
tion, however, of the real form or capacity of
this interspace can be obtained by examining
it with the aid of sections made in one direc-
tion only.
In order to obtain a correct notion of the
form and extent of this cavity, it is desirable
first to make a longitudinal section through
the centre of the entire organ parallel with
its lateral borders. The cavity or interspace
is then indicated by a line running from below
upwards, and terminating within half an inch
of the funclus (fig. 426.).
The upper half of this line indicates the
cavity of the uterus ; the lower half, that of
the cervix. The latter alone exhibits a true
cavity; for here the parietes of the cervix are
Fig. 427.
Fig. 2$.
Fig. 429.
Fig. 430.
Series of horizontal sections of the uterus.
Fig. 427., just above the entrance of the Fallopian
tubes, fig. 428., in the centre of the cavity. Fig.
429., close to the internal os uteri. Fig. 430., the
centre of the cervical canal. The upper or more
convex border marks the posterior surface in each
section. (Ad Nat.)
observed to diverge slightly, so as to leave a
spindle-shaped canal traversing the whole
length of the uterine neck (J!g. 431. cc).
A second view is obtained by cutting com-
pletely through the uterus in the direction of
its transverse diameter, and parallel with its
extremities. If the entire organ be cut up into
many such segments (j%.427 430.), itis then
seen, from the length of the central line, that
the cavity varies in breadth, its widest part
being in the segment which includes the ex-
tremities of the Fallopian tubes ; whilst from
this point downwards the line diminishes in
length, until at the narrowest portion of the
uterus, or that representing the commence-
ment of the cervix, it measures only !'"
3'" in diameter.
But the most complete view of the interior
of the uterus is obtained by a section carried
through the centre of the organ, dividing it
midway between its anterior and posterior
walls. The entire cavity which is thus ex-
hibited at one view is seen to be of a trian-
gular form ; its boundaries being formed
superiorly by the fundus, and on either side
by the two lateral borders, whilst in each
angle is observed an aperture. The two su-
perior openings are the lower orifices of the
Fallopian tubes. The inferior opening lead-
ing to the cervical canal constitutes the os
uteri internum (fig. 431. i).
Fig. 431.
Vertical section of nulliparous uterus parallel with
its anterior and posterior walls.
c, uterine cavity; cc, cervical cavity or canal;
i, internal os uteri ; e, external os uteri ;f,f, Fallopian
tubes ; v a, vagina, (Ad Nat.)
Since the cavity in the interior of the
uterine body has a triangular form, whilst
externally the shape of the organ is more or
less pyriform, it is evident that the parietes of
this " hollow muscle " cannot have every-
where an equal thickness, for otherwise the
form of the cavity would correspond with
s s 2
628
UTERUS AND ITS APPENDAGES.
that of the external surface. But whilst the
anterior and posterior walls exhibit an average
and nearly uniform thickness of about 6' /x ,
that of the lateral boundaries and of the
fundus varies from 6'" to V" '. Hence the
section of this cavity represented in fig.
426., which exhibits the organ as divided
from before backwards, is described by a
right line; whilst the section (fig. 431.)
shows the cavity as bounded by three curves,
the decree of curvature varying in different
subjects, and being generally supposed to be
always greatest and most marked in women
who have never borne children.
This point has been much dwelt upon as
serving to distinguish the nulliparous from
the multiparous uterus. I have reason to
think, however, that this observation has
been again and again repeated without con-
firmation by an appeal to facts. For although
the sides of the virgin uterus are often strongly
incurved, yet in some uteri in my possession
from young subjects who had not borne
children, the walls of the cavity are nearly
straight, and this is the form which they have
in the foetus (fig. 44-2.), and in undeveloped
uteri (fig. 465.); whilst in other specimens,
taken from women who had borne many chil-
dren, the sides and fundus may be incurved in
various degrees. Much will depend upon the
mode in which the sections are made; for un-
less, in dividing the organ, the knife has passed
exactly through the median line, a portion of
either the anterior or posterior wall will be in-
cluded in the section, and the apparent form of
the cavity will be materially modified thereby.
Thus the uterine cavity in the unimpreg-
nated state is nothing more than the narrow
interspace between the flattened walls which
are normally either in immediate contact, or
are separated from each other by only a small
quantity of mucus. The triangular form re-
sults from the confluence of three ducts or
channels ; viz., the two oviducts above, and
the cervical canal below. The tubal canals,
having passed through the substance of the
uterus, expand trumpet-like into the uterine
cavity, whilst in the same way the cervical
canal traced upwards is prolonged, though
more gradually, into the same cavity. But
the perpendicular diameter of the uterus
being always greater than the transverse,
the form of the cavity, in so far as it is trian-
gular, represents not an equilateral, but an
isosceles triangle with incurved sides (fig. 431 .).
By reference to these particulars regarding
the form of the interspace between the uterine
walls, we are enabled to explain many pheno-
mena relating to the first entrance of the
ovum into the uterus, and its mode of deten-
tion there, before it has become organically
united to the uterine walls.
The cavity of the uterus is lined by a mu-
cous membrane, the peculiarities of which
will be afterwards more fully described. This
membrane appears to the unaided eye nearly-
smooth, and is usually of a pale pink colour,
except in those cases where death has oc-
curred during menstruation, when it is of a
deep red hue, and more or less plainly
vascular. A moderate amplifying power,
however, suffices to show that the mucous
membrane is not smooth, but is perforated
everywhere by minute apertures, which are
the orifices of numerous ramified canals or
follicles occupying the substance of the mu-
cous membrane, and lying for the most part
in a direction perpendicular to the surface
upon which they terminate. A few folds are
occasionally perceptible in the mucous mem-
brane, these being seen chiefly in the neigb>
bourhood of the tubal orifices.
The apertures by which the Fallopian
tubes enter the upper angles of the uterus are
so small as only to admit of the passage of a fine
bristle (fig. 406.). That by which the cavity
of the body communicates at its inferior angle
with the canal of the cervix has an average
diameter of 1|'" 3"'. This orifice is the
os uteri internum (fig. 431. i).
The following are the dimensions of the ute-
rine cavity : length 11'" 12'"; breadth be-
tween the points of entrance of the Fallopian
tubes 11'" 12'"; at the centre of the ca-
vity 4"' ; at the os internum 1'" 3"'.
The cavity of the cervix consists of a flat-
tened fusiform canal running through the
centre of the uterine neck. The widest por-
tion occurs about the middle, where the
canal measures transversely 3'" 6'" (fig.
431.cc), whilst towards either extremity the
parietes gradually approximate so as to leave
a narrow aperture at each end ; the superior
aperture being the orifice already described
as the os uteri internum, the dimensions of
which have been given; the inferior being the
os externum, or os tincae, which measures
3'" 4"' in transverse diameter. The antero-
posterior diameter of the canal at its widest
part is not more than !'" 2'". The en-
tire length of the cervical cavity is 12"'
13'".
The mucous membrane lining this cavity
is probably not greatly inferior in extent to
that of the uterine body. But on account of
the smaller space in which it is contained,
instead of forming an even layer, the mem-
brane is here thrown into numerous folds or
plicae, having intermediate furrows, often
traversed by lesser plicas, which extend the
secreting surface, and furnish a more consi-
derable seat for those numerous mucous
crypts which abound upon almost every por-
tion of this structure.
The forms which the cervical folds or
plica? assume are sufficiently remarkable to
have attracted the attention of anatomists at
all periods. They are, however, so variable,
that if twenty specimens be compared to-
gether, scarcely two will be found to present
precisely the .same arrangement. On this
account it is difficult to furnish any descrip-
tion of them which shall be universally appli-
cable.
Nevertheless, two forms appear to me to be
more prevalent than others. In one a single
prominent raphe occupies the centre of each
wall of the cervix. (Fig. 431. c c.) Com-
UTERUS (NORMAL ANATOMY).
mencino; sometimes at a distance of 1'" 3'"
above the margin of the uterine lip and ex-
tending upwards either centrally or to one
side of the median line, and reaching as far as
the internal os, it terminates here in a bulbous
expansion, or branches out into numerous
small ramifications. From either side of this
median perpendicular fold are given off lateral
plica?, varying in number, but being usually
not less than 6 9. These soon bifurcate
once or twice, so that the number of folds will
vary considerably, according as they are
counted immediately at, or at some distance
from, their line of junction in the central
raphe. The uppermost pair of lateral plicae, or
those next to the raphe, often exhibit the
same bulbous extremity; and these together
fill the upper or narrowest portion of the cer-
vical canal. Lower down, where the canal be-