The Uterus

superior, portion, inferior, cervix, inch and little

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Surfaces and Borders of the Uterus.

The uterus has two surfaces, two lateral borders, a superior or fundal border, an inferior or vaginal border, and two angles.

1st. Anterior Suiface.—This is triangular, slightly convex, and touches the lower end and posterior surface of the bladder.

2d. Posterior Surface. — Is markedly convex, and presents on the median line a sort of crest, which passes over the superior edge to the in sertion of the vagina.

3d. Lateral Borders. —The broad ligaments are inserted on these edges. 4th. Superior Border.—Smooth, rounded, thick, it is included between the insertions of the tubes.

5th. The Inferior Portion is formed by the vaginal portion of the cervix.

The angles formed by the union of the superior edge with th3 lateral edges, are remarkable in that it is at this point that the tubes are at tached. The round ligaments are in front of, and the ligament of the ovary is behind, these Fallopian tubes. (Fig. 33.) I. Body of the Uterus.

The body is the part placed above the circular notch that separates the inferior part of the organ from the middle part. This notch is very prominent in the foetus and nulliparw, largely disappearing, exteriorly at least, in multipara.

II. Neck or Cervix of the Uterus.

The neck must be described separately in nulliparte and multiparte.

In nulliparse it is slightly flattened from before backward, is almost cylindrical, and bulges a little at its centre; its length is from 1.1 inch to 1.17 inches, its width from .6 to .9 of an inch at its centre, and about .7 of an inch at its superior and inferior parts. Its thickness is almost equal to its width. The vagina, inserting at the union of the inferior with the middle part of the neck, divides it into two parts: 1st Supra-vaginal Portion.—This is about .7 of an inch in length, its anterior portion reaching the bladder. The peritoneum, after extending over the superior half of this anterior part of the neck, passes on to the bladder, forming the vesico-uterine cul-de-sac. Its inferior portion is closely united to the bladder, and it reaches the rectum at its superior part. The peritoneum holds it throughout its length, and passes from it

to the rectum, forming the recto-uterine cul-de-sac.

Its edges reach the inferior part of the broad ligaments.

2d. Infra-vaginal Portion, os tincm—At the base of the vagina it pro jects about .29 of an inch, a little further behind than in front, and this is due to the greater height of the insertion of the vagina .behind. This projection, shaped like a cone, has a transverse slit, of from .23 to .31 of an inch, at its apex, which divides it into two lips, one in front the other behind. The anterior lip of the os tin= is a little thicker than the poste rior. This slit is the orifice of the os tincie (carp's mouth), and external orifice of the cervix.

In the multipara the supra-vaginal portion is little changed. The infra-vaginal portion, on the contrary, is essentially different from that .of a nullipara. Instead of a conical shape, it is larger, in the form of a cylinder. The lips are uneven, wrinkled and furrowed by depressions which correspond to the lacerations caused by the passage of the fcetal head at delivery. They are principally seen on the left, in consequence of the great frequency of the left occipito-anterior positions. The orifice is distorted, enlarged and open.

The os tincre may, in some women, be so shrivelled, that one can scarcely find it per vaginam, and then it feels hard and irregular, with a little opening that tells where the cervix is. These deformities are in proportion to the number of pregnancies. Tarnier is said to have seen three women in whom the cervix kept the nulliparous shape. The women had had but one child. These cases therefore are entirely ex ceptional.

II. Internal Surface of the Uterus.

The cavity of the uterus is shaped like a canal, flattened from before backwards, larger in the body than in the cervix, which is narrow, with a kind of contraction at the isthmus.

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