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.

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.

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.