cular fibres from the uterus, and striated fibres coming from the transversalis muscle and the pubic spine. An artery from the deep epigastric runs through its centre and anastomoses with one from the uterus. The artery is accompanied by a vein. The genital branch of the genito-crural nerve lies in front of the ligament at the external ring. Other veins and nerves join it from below. At first it lies under the anterior layer of the broad ligament. When it leaves the broad ligament it has a peritoneal covering of its own, which, as a rule, stops at the internal ring in the adult. During fetal life the peritoneum forms a pouch which accompanies it through the inguinal canal, and is called the canal of Nuck, and corresponds to the processus vaginalis in the male. This pouch normally grows together, forming a fibrous string, but abnormally it may persist and give rise to female hydrocele, or be found as a sheath of the ligament in Alexander's operation. (See Retroflexion of Uterus.)

During pregnancy the round ligament becomes finger-thick. It is only found in women and the higher apes, who occasionally take the erect position. It contracts when stimulated by electricity like other muscles. Both ligaments being contracted at the same time they tilt the fundus uteri forward, and as they contract simultaneously with the abdominal muscles, they prevent retroversion from being produced by coughing, lifting, straining at stool, etc.1

During copulation they produce probably a kind of suction, and by their intimate connection with the muscular platysma of the broad ligament, and working together with the superior round ligament, they cause erection of the inner genital organs. During labor they pull the fundus forward and downward, and thus give it the most favorable direction in relation to the superior strait.

The arteries of the uterus come from three sources: the uterine artery from the internal iliac; the ovarian from the aorta; and the insignificant artery of the round ligament from the epigastric. The uterine goes behind the peritoneum on the posterior wall of the pelvis, down into the parametrium, and forms a loop in front of the ureter, a short distance from the anterior lateral fornix of the vagina (Fig. 56). (Compare Fig. 54.) Hence it goes up between the two layers of the broad ligament, following the edge of the uterus to the corner of the same, where it anastomoses with the ovarian artery. It sends numerous branches off at right angles to the uterus, where they anastomose with those from the other side (Fig. 38). At the level of the internal os such anastomosing branches in front and behind form the circular artery. The trunk has a very tortuous course, and the branches are wound like corkscrews, helicine arteries (Fig. 55, H. P.). These branches have so small a lumen and so thick a mus'J. H. Kellogg of Battle Creek, Mich., Trans. Am. Ass. Obstet. and Gyn., 1889, vol. ii. p. 266.

cular coat that in many cases the whole uterus can be cut loose from the broad ligament without using ligatures or clamps for arresting hemorrhage.

During pregnancy the uterine artery stays comparatively small, its calibre equalling that of the ureter, while the ovarian is much thicker. The uterine veins form a network in the muscular coat, and open into a conglomeration of veins lying at the edges of the uterus. From the middle of this plexus the two uterine veins follow the uterine artery, and carry the blood to the internal iliac vein. At its upper end this plexus anastomoses with the branches of the ovarian

The Uterine Artery in its Relation to the Ureter: a photographic reproduction of a section of the pelvis, extending from the pectineal eminence above to the lesser sacro-sciatic foramen below (Polk). On the right side the broad ligament has been removed: U, uterus, right side freed of peritoneum; 0, ovary; C, base of bladder showing urethral orifice, the organ having been cut away on a level with the utero-vesical peritoneal fold; the dotted line running across its upper edge corresponds to the utero-vaginal_junction; above this, at F, we have the circular artery of the cervix; A, uterine artery; BB, ureter, with a probe passing through it; D, ovarian artery; E, round ligament, held up to show the ovary and vessels behind it: R, rectum.

vein, and below with the vaginal and vesical plexuses. The ureter passes right through it (Fig. 57). During pregnancy the uterine veins are enormously enlarged and form the so-called sinuses, large spaces the walls of which only consist of the internal coat of the veins, and are intimately bound to the surrounding muscular tissue. The Lymphatics.-The uterus is exceedingly rich in lymphatic spaces and vessels. They begin in the mucous membrane as open spaces lined with endothelium, and separating the bundles of connective tissue. In the muscular layer are found similar spaces and vessels, and they all communicate with a superficial network of vessels in the serous membrane. From the uterus the lymphatics go

through the broad ligament. Those from the cervix go to the obturator glands, situated at the inner entrance of the obturator canal and communicating with the inguinal glands. Those from the body go to the internal iliac glands, situated between the external and internal iliac artery, and which, again, send vessels to the sacral glands on the anterior surface of the sacrum and to the lumbar glands in front of the lumbar vertebræ. The gland of the isthmus is situated in the lower inner angle of the broad ligament.

FIG. 57.

The Uterine Veins and the Ureter (Luschka). The bladder being considerably distended, it was cut off sufficiently to show the inner surface of its posterior wall where it is in contact with the uterus and the vagina. On the right side also part of the posterior wall of the bladder was removed in order to show the course of the ureter on the anterior wall of the vagina. Where the uterus and the vagina are concealed by the bladder their contours are marked with heavy black lines: a, anterior surface of uterus, showing how far it is covered with peritoneum when the bladder is full; b. portion of supravaginal part of cervix covered by the bladder; c, vaginal portion of uterus; d, vault of vagina; e, anterior wall of vagina; f. cut surface of bladder-wall; g, trigone; h, vesical opening of urethra; i, i, i, venous plexus at the side of the uterus and the vagina; k, right ureter; 1, left ureter. (Two-thirds natural size.)

The Nerves.-Branches from the second, third, and fourth sacral (spinal) nerves meet with others from the hypogastric plexus (sympathetic) in a large ganglion on either side of the cervix, from which cervical ganglion branches go to the uterus, the vagina, and the blad

der. Those of the uterus end in the nucleus of the muscular cells, and in ganglia in the mucous membrane.

Function. The rôle the uterus plays as a copulative organ is not quite settled, but much evidence has been adduced in favor of the theory that it exerts a suction by which the semen is drawn into its cavity. But it is a well-demonstrated fact that conception may take place independently of such action.

The most important physiological destination of the womb is to furnish a place of attachment for the ovum, to shelter the fetus during its development, and to expel the child during parturition.2

The uterus is the seat of the chief portion of the menstrual flow. At the menstrual period its epithelium is thrown off, and a new one is formed in the interval between two menstruations.

THE FALLOPIAN TUBES.

The Fallopian tubes, or oviducts (Fig. 58), are two long, slender, round tubes connected with the upper angles of the uterus. Their

Posterior View of Left Uterine Appendages (Henle): 1, uterus; 2, Fallopian tube; 3, fimbriated extremity and opening of the Fallopian tube; 4, parovarium; 5, ovary; 6, broad ligament; 7, ovarian ligament; 8, infundibulo-pelvic ligament.

length varies between 3 and 5 inches. The tube starts from the highest point of the corner of the womb, above the round ligament in front and the ovarian ligament behind. From thence it goes first outward, and turns then backward, lying near the wall of the pelvis,

1 Joseph R. Beck, Am. Jour. Obst., 1874, vol. vii. pp. 353-391.

Several cases are on record of women with a fracture of the spine, causing complete paralysis of the abdominal muscles, in whom the child was expelled by the mere contractions of the womb.

above and in front of the ovary, and finally it curves round the free end of the ovary, the abdominal end being turned against the ovary and the bottom of the pelvis. Sometimes it has even been found surrounding the ovary entirely, with the abdominal end resting on the ovarian ligament.

It may be divided into three parts-the isthmus, the ampulla, and the fimbria. The isthmus comprises about the inner third. It begins

Fallopian Tube laid open (from Playfair, source unknown): ab, uterine portion of tube; cd, folds of mucous membrane; e, tubo-ovarian ligament, or fimbria ovarica; f, ovary; g, round ligament.

in the outermost and uppermost corner of the uterine cavity with an opening called the ostium uterinum, which is so fine that it barely admits a bristle. It goes through the wall of the uterus, and extends as a cord about inch thick outward. The ampulla is the middle part, which is twice as thick or more, curved, and follows a serpentine course. It has also been called the receptaculum seminis, because it seems to be particularly destined to hold and preserve the spermatozoids until they come in contact with the ovum. Its calibre admits a uterine sound. The fimbriae are the outermost part. They surround the outer end of the ampulla like a collar with long flaps. One of these, the fimbria ovarica, is attached to the free end of the ovary, and forms a gutter. In the middle of the fimbria is the ostium abdominale, which again is a very fine opening, leading into the peritoneal cavity. Often a pedunculated hydatid is found at the abdominal end. This was originally the end of the Müllerian duct, of which the tube is a development.

As we have seen in the chapter on Development, the tubes have a common origin with the uterus. The point that forms the limit between the two is the insertion of the round ligament. The tube, like the uterus, is composed of three layers-a serous, a muscular, and a mucous and each of these is continuous with the corresponding