ANATOMY OF THE FEMALE ORGANS.
THE bony part of the skeleton which is of particular interest to women,
is the pelvis, so called, because it forms a basin or cavity which
contains the most important female organs of generation.
All the organs that are liable to the diseases of women, bear certain
anatomical relations to the pelvis, so that the phrase, _pelvic
diseases of women_, is often employed instead of the phrase, _diseases
of women_, and pelvic surgery means also, surgical procedures, that may
be employed for the relief or cure of these diseases.
In confinement, the pelvis again comes into more or less prominence,
for when the diameters of the pelvic canal have not their normal
measurements, there is likely to be an obstruction to the passage of
the child into the world, so that mechanical means must be employed to
overcome the obstacle. A broad pelvis in a woman is always a guarantee
that there will be no insurmountable difficulty in the parturient act.
PLATE I shows the shape and locality of the bone in the human body, and
gives also an approximate idea of the relation of the pelvis to the
rest of the body.
While the pelvis was referred to above as a basin or cavity, this is
only partly true, for it is also a canal or passageway, through which
the child is born. The pelvis is divided by a prominent line into the
false and true pelvis.
The False Pelvis is all that expanded portion of the pelvic cavity
which is above the rim or line that forms a circular ridge, which
marks the beginning of the bony canal to which the term true pelvis is
applied.
The True Pelvis constitutes the lower subdivision of the pelvic cavity.
The circular ridge, which marks the division, constitutes also the
_inlet_ of the true pelvis, which is much smaller than the upper or
false pelvis. Its walls are more perfect and their lower circumference
is very irregular and forms what is called the _outlet_. Between the
_inlet_ and the _outlet_ we have what is called the true pelvic cavity,
in which the internal female generative organs are contained.
These organs are located in the following order from before backwards:
first, behind the pubis there is the bladder, and behind this is the
uterus, and thirdly and a little to the left is the rectum.
On each side of the womb, but also in the small or true pelvis, are the
Fallopian tubes and ovaries.
In this order the anatomical relations are easily remembered, and I
believe that every woman should make it an object to learn at least
as much of her own anatomy as I have laid down; because there is just
little enough, so as not to make it tiresome, and quite enough to
insure intelligent reading in the subsequent chapters.
The points of differences between the male and female pelvis are
entirely on the principle of adaptation to natural functions. The
female pelvis has a broadness or greater prominence of the hips and
a correspondingly greater pelvic cavity, while that of the male is
altogether more massive.
Its cavity is deeper and narrower, and the muscular eminences and
impressions on the surfaces of the bones are much stronger marked.
PLATE II. This illustrates a cut or section, through the middle of
the pelvis, from before backwards, so as to give a side view of the
capacity of the true pelvis and of the organs that it contains. A
careful study of this plate will permanently fix the anatomy in the
reader’s mind.
[Illustration: PLATE II
A Median Section of the female Pelvis and of the Organs that are
centrally located.
This plate is anatomically correct; the uterus resting normally on and
being elevated by the distended bladder.]
The lines _a_ and _b_ show the planes of the inlet and outlet of the
true pelvis, and it will be seen that within these lines the most
important organs of the female are located.
THE BLADDER.
The bladder is situated at the anterior part of the pelvis. It is in
relation, _in front_ with the _symphysis pubis_, behind with the womb,
some convolutions of the small intestines being interposed; its base
lies in contact with the neck of the uterus and with the anterior wall
of the vagina. The bladder is said to be larger in the female than in
the male, and is very broad in its transverse diameter.
THE URETHRA.
The urethra is a narrow membranous canal, about an inch and a half in
length, extending from the neck of the bladder to the external orifice.
It is placed beneath the symphysis pubis, embedded in the anterior wall
of the vagina, and its direction is obliquely downwards and forwards.
Its diameter, when undilated, is about a quarter of an inch; behind the
bladder and urethra, there is in regular order the uterus and vagina,
and behind both of these, the rectum.
THE PERINEUM.
The Perineum is the muscular triangular body between the vagina and
rectum; it constitutes a segment of the female pelvic floor; it is
the _prop_ for all the pelvic organs, and for that reason every woman
should know precisely what it is, and study the plate carefully until
she understands it. The skin covering it is of a dark color, thin and
freely movable over the underlying parts. There is no part of the
pelvic anatomy so vulnerable, because in confinement during the passage
of the child’s head into the world, the perineum is put on a great
stretch, and if the delivery progresses too quickly or is hurried, then
the tissues have no time to stretch themselves so as to accommodate the
child’s head, and they must naturally tear.
The awkward and officious use of instruments will do the same thing. I
have seen the perineum torn asunder from this cause, from the vagina
and back into the rectum.
PLATE III is one of the most instructive drawings that I could devise.
It gives the reader a practical illustration of the internal generative
organs and their anatomical relations to each other. This was a drawing
from my own dissection, and the clearness and artistic reproduction is
due to the skill of the engraver, Mr. H. X. Van de Casteele, of this
city.
THE VAGINA.
The vagina is a membranous canal, extending from the vulva or
_introitus_ to the uterus. It is situated in the cavity of the pelvis,
between the bladder in front and the rectum behind; its direction is
not in a straight line, but curved from below backwards and upwards.
When distended it is cylindrical in shape, but naturally it is
flattened from before backwards, so that its walls are ordinarily in
contact with each other. In length it averages about four inches in
its anterior wall, while its posterior wall describes a segment of a
larger circle, that makes it between one and two inches longer. At its
commencement it is constricted, and at its upper extremity, where it
is attached to the womb, it is dilated, so as to surround the vaginal
portion of the neck of the womb (_see_ Plate III, _c_) this is a short
distance above the mouth of the womb. The attachment extends higher up
on the posterior than on the anterior wall of the womb, which makes the
posterior lip of the womb longer than the anterior.
The mucous membrane is continuous above with that covering the
vaginal portion of the uterus; below it begins at the vulva. Running
longitudinally along the anterior and posterior walls are distinct
ridges or raphe; these are the columns of the vagina.
The relations of the vagina to the neighboring organs can be studied to
better advantage by referring to Plate I.
[Illustration: PLATE III
The Vagina slit open to the neck or Cervix of the Uterus, showing the
insertion of the latter into the former.
From the author’s own design, beautifully illustrating:—
_a._ Fundus (or Base) of the Uterus.
_b._ Uterus’ Body.
_c._ Cervix, or Neck.
_de._ Vaginal part, forming the Anterior and Posterior Lips.
_f._ Mouth of the Womb.
_gg._ Interior of Vagina, illustrating the Vaginal Folds.
_h._ Perineum.
_ii._ Round Ligaments.
_kk._ Broad Ligaments.
_ll._ Uterine Vessels and Nerves.
_mm._ Fringed Extremity of the Fallopian Tubes.
_nn._ Fallopian Tubes.
_oo._ Ovaries.]
Its anterior surface is concave, and is in relation with the base of
the bladder and with the urethra. Its posterior surface is convex
and connected to the anterior wall of the rectum for the lower
three-fourths of its extent, the upper fourth being separated from the
tube by a fold of the peritoneum, the _recto-uterine fold_, which forms
a _cul-de-sac_ between the vagina and rectum. Its sides give attachment
superiorily to the broad ligaments, and inferiorily to the Levatores
Ani muscles and recto-vesical fascia.
THE UTERUS OR WOMB.
The uterus is the organ of gestation, receiving the fecundated ovum in
its cavity, retaining and supporting it during the development of the
fetus, and becoming the principal agent in its expulsion at the time of
parturition. In the virgin state it is _pear-shaped_, flattened from
before backwards, and situated in the cavity of the pelvis, between the
bladder and the rectum. It is retained in its position by the round
and broad ligaments (Plate III, _ii_ and _kk_) on each side, but _also
by virtue of its anteverted position, and by the vagina and perineum_.
Its upper end or base (_a_) is directed upwards and forwards; its
lower end, or apex, is directed downwards and backwards in the line of
the axes of the inlet of the pelvis. It therefore forms an angle with
the vagina. The uterus measures about three inches in length, two in
breadth at its upper part, and an inch in thickness, and it weighs from
an ounce to one and a half ounces in its healthy condition.
The fundus or base is the upper broad extremity of the organ (_a_); it
is convex, covered by peritoneum, and placed on a line below the level
of the brim of the pelvis.
The body (_b_) gradually narrows from the fundus to the neck. Its
anterior surface is flattened, covered by peritoneum in the upper
three-fourths of its extent, and separated from the bladder by some
coils of the small intestines; the lower fourth is connected with the
bladder.
The posterior surface of the body is convex, covered by peritoneum
throughout, and separated from the rectum by some convolutions of the
intestines.
Its lateral margins are concave and give attachment to the Fallopian
tubes (_n_), above.
The round ligaments (_i_) are attached below and in front of these,
while the ligaments of the ovaries (_o_) are attached behind and below
these structures.
The cervix or neck of the womb (_c_ _d_ _e_) is the lower rounded and
constricted portion of the uterus; around its circumference is attached
the upper end of the vagina, which extends upwards a greater distance
behind than in front.
At the vaginal extremity of the uterus is, in the virgin womb, a round,
but after childbirth a transverse aperture, the _os uteri_ or mouth
of the womb, bounded by two lips, the anterior of which is thick, the
posterior narrow and long.
THE FALLOPIAN TUBES.
The Fallopian tubes, or oviducts (_n_) convey the ova from the ovaries
to the cavity of the uterus. They are two in number, one on each side,
situated in the free margin of the broad ligament, extending from each
superior angle of the uterus to the ovaries. Each tube is about four
inches in length; its canal is exceedingly minute, and commences at the
superior angle of the womb by a minute orifice, the _ostium internum_,
or internal mouth, which will hardly admit a fine bristle; it
continues narrow along the inner half of the tube, and then gradually
widens into a trumpet-shaped extremity, which becomes contracted at
its termination. This opening is called the _ostium abdominale_, or
abdominal mouth, because it communicates freely with the abdominal
cavity. The margins of this extremity are surrounded by a series of
fringe-like processes, termed _fimbriæ_, and one of these processes is
connected with the outer end of the ovary. This part of the Fallopian
tube is called the fimbriated or fringed extremity (_m_).
THE OVARIES.
The ovaries are analogous to the testes in the male. They are two
oblong flattened and oval bodies, situated one on each side of the
uterus, in the posterior part of the broad ligament behind and below
the Fallopian tubes. Each ovary is connected, by its anterior margin,
to the broad ligament, by its inner extremity to the uterus by a proper
ligament of the ovary, and by its outer end to the fimbriated extremity
of the Fallopian tube by a short ligamentous cord. The ovaries
are of a whitish color, and present either a smooth or a puckered
uneven surface. They are each about an inch and a half in length,
three-quarters of an inch in width, and about a third of an inch thick,
and weigh from one to two drams.