According to my opinion, the making of the proper inclination of the uterus dependent upon the filling of the bladder or rectum, is alto gether inexcusable; a physiological act can certainly not be dependent upon such contingencies. Equally improbable and impossible is that theory advanced by Hoist, that the semen is injected completely through the cervical canal into the uterine cavity itself. Even though the vagina and cervix lay in the same axis, the extreme narrowness of the cervical canal, its corrugated projections, and particularly the smallness of the in ternal os, would preclude the possibility of such an occurrence.
In support of this theory, a certain suctional power has been attri buted to the uterus, which has been particularly emphasized by C. F. Eichstedt, and by which the entrance of the semen into the cervix is promoted. The muscular fibres of the uterus can certainly not exert this power, since, as has already been observed by Kiwisch, their contraction only empty the uterus of its contents, but cannot in any way perform the contrary task. For this reason this suctional power was ascribed to an over-distension of the blood-vessels occasioned by the sexual excitement, which was supposed to convert the uterine parietes, but particularly the cervix, into a kind of erectile tissue resembling the corpora cavernosa, a supposition which is particularly supported by the anatomical structure of these parts. According to Henle, the blood-vessels of the vaginal por tion are so arranged and constructed that a condition simulating erection is easily possible. Hell], Litzmann and Orally Hewitt, in touching the vaginal portion for the purpose of a gynecological examination in nervous and excitable women, have been made aware of a change in the external cos, and a swelling of the whole vaginal portion, which probably were caused only by sexual excitement. Wernich has noticed similar condi• tions immediately after cohabitation. It should not be disputed, for a moment, that such changes-of the genitals do appear during coitus, but it may rightfully be questioned whether such anatomical changes really serve any purpose in the onward movement of the semen. This result is supposed to be brought about, first, by an expulsion of the mucus from the cervical cavity; secondly, the semen is drawn up by the enlargement of the cervical cavity occasioned by the cessation of the congestion. The first 'is probable; the parietes are made thicker and firmer by the marked distension, the pressure in the cervical cavity is increased, and the mucus is driven downward through the external os, thereby freeing the canal of that obstacle. But it is somewhat different with the upward suction of the semen, which is supposed to occur with the cessation of the con gestion. This, according to my view, would only be possible if the uterus
were enclosed in an inflexible capsule; then, by withdrawal of the hyper lemia, since the whole cervix could not in this way be reduced to the smallest possible volume, a negative pressure would be occasioned in the cervical cavity. A regular formation of a cavity, as described by Ducel lier, would indeed not occur, but probably whatever lay before the inter nal es, mucus and semen, would be drawn up into the canal. But these are not the physiological relations which exist. The parietes of the cer vix, which have suffered a marked distension by the inordinate fullness of the blood-vessels, are, by the gradual subsidence of the hyperiemia, gradually drawn in tovrards the centre of the organ, and thereby the de velopment of a negative pressure in the cervical cavity is prevented. The increased space oecupied by the enlarged cervix is again filled by those neighboring tissues which were pressed together by its swelling. The cervix, enlarged by cohabitation, would conduct itself similarly to the cor pus cavernosum urethra3 of the male; here as there, we have a canal sur ronnded by cavernous tissue. If the cervix really possessed the power of suction, and if it could aspirate the semen, air must certainly enter into the urethra after- the cessation of the erection of the penis, which certainly is not the ease. If the semen deposited in front of the external es were not under a certain pressure, it would never be driven into the cervical canal. The most that we can admit, then, is that in c,onsequence of these transient changes of the circulatory relations, the entrance of the semen is made easier by the removal of the cervical mucus; the advance et the semen must be accomplished by itself.
From the physician's standpoint, certain drawing movements are also mentioned, which the irritated vaginal portion causes the os uteri to perform. This appearance was noticed in a prolapsed uterus, where very frequentiv lacerations, caused by a previous birth, are to be seen, and in consequence of which the external os is badly torn, and the cervical mucous membrane seems to be everted. By gentle manipulations, as, for instance, in attempts at reposition, the lacerations are closed, the mucous membrane is drawn in and the external os again assumes its previous form. It is possible that these occurrences, from the rapidity and novelty of their appearance, have furnished the idea of drawing movements. I believe that too much value has been attached to this single observation. It is at least very remarkable tha,t among the great number of cases-of prolapsus uteri, this phenomenon has so seldom been observed.