lining of the uterus. Here they are in intimate contact with the utricular glands and the ultimate ramifications of the uterine bloodvessels. As they pass into the muscular tissue they become gradually narrowed into lymph-vessels and spaces, which have a very complicated arrangement, and which eventually unite together in the external muscular layer, especially on the sides of the uterus, to form large canals which probably have valves. Immediately under the peritoneum these lymph-vessels form a large and characteristic network covering the anterior and posterior surfaces of the uterus, and present, in various parts of their course, large ampullæ. They then spread over the Fallopian tubes. The lymphatics of the body of the uterus unite with the lumbar glands, those of the cervix with the pelvic glands.

The distribution and arrangement of the nerves of the uterus have been the subject of much controversy. They are derived mainly from the ovarian and hypogastric plexuses, inosculating freely with each other between the folds of the broad ligament, from which they enter the muscular tissue of the uterus, generally, but not invariably, following the course of the arteries. They are chiefly derived from the sympathetic; but, as the hypogastric plexus is connected with the sacral nerves, it is probable that some fibres from the cerebro-spinal system are distributed to the cervix. It is now generally admitted that nervous filaments are distributed to the cervix, even as far as the external os, although their existence in this situation has been denied by Jobert and other writers. The ultimate distribution of the nerves is not yet made out. Polle describes a nerve filament as entering the papilla of the cervical mucous membrane along with the capillary loop, and Frankenhauser says the nerve fibres surround the muscles of the uterus in the form of plexuses, and terminate in the nuclei of the

muscle cells.

Anomalies of the Uterus.-Various abnormal conditions of the uterus and vagina are occasionally met with, which it is necessary to

mention, as they may have an important practical bearing on parturition. The most frequent of these is the existence of a double, or partially

double uterus (Fig. 29), similar to that found normally in many of the lower animals. This abnormality is explained by the development of the organ during foetal life. The uterus is formed out of structures existing only in early foetal life, known as the Wolffian bodies. These consist of a number of tubes, situated on either side of the vertebral column, and opening externally into an excretory duct. Along their external border a hollow canal is formed, termed the canal of Müller, which, like the excretory ducts, proceeds to the common cloaca of the digestive and urinary organs which then exists. The canal of Müller unites with its fellow of the opposite side to form the uterus and Fallopian tubes in the female, and subsequently the central partition at their point of junction disappears. If, however, the progress of development be in any way checked, the central partition may remain. Then we have produced either a complete double uterus or the uterus bicornis, which is bifid at its upper extremity only; or a double vagina, each leading to a separate uterus.

If pregnancy occur in any of these anomalous uteri, and many such cases are recorded, serious troubles may follow. It may happen that one horn of the double uterus is not sufficiently large to admit of pregnancy going on to term, and rupture may occur. It is supposed that some cases, presumed to be tubal gestation, are really thus explicable. Impregnation may also occur in the two cornua at different times, leading to superfotation. It is, however, quite possible that impregnation may occur in one horn of a bifid uterus, and labor be completed without anything unusual being observed. A remarkable case of this sort has been recorded by Dr. Ross, of Brighton,' in which a patient miscarried of twins on July 16, 1870, and on October 31st, fifteen weeks later, she was delivered of a healthy child. Careful examination showed the existence of a complete double uterus, each side of which had been impregnated. Curiously enough, this patient had formerly given birth to six living children at term, nothing remarkable having been observed in her labors. It can only rarely happen that, under such circumstances, so favorable a result will follow, and more or less difficulty and danger may generally be expected. Occasionally the vagina only is double, the uterus being single. Dr. Matthews Duncan has recorded some cases of this kind, in which the vaginal septum formed an obstacle to the birth of the child, and required division.

[Double uteri are of several distinct types, the extremes of which are the "partitioned uterus," where the organ is single without, and double within, and the "completely bifid uterus," where there is a double vagina and cervix with a Y-shaped or double-barrelled body. The former can only be diagnosticated from within and is rarely discovered until after the second stage of a labor has been completed. In a case reported by Dr. B. F. Baer, of Philadelphia, the patient bore twins, one fœtus from each compartment, the birth of which was followed by two single placenta at intervals of a quarter of an hour. Where there is only one foetus the uterus develops mainly on one side, and the unoccupied one lies much lower than the fundus of the other. Dr.

1 Lancet, 1871, vol. ii. p. 188.

2 Researches in Obstetrics, p. 443.

Drysdale, of this city, discovered one such case by the touch after labor, and no doubt a careful scrutiny would find that they are less rare than might be presumed.

Where one side of a bifid uterus is impregnated, the unoccupied one rotates into the hollow of the sacrum, and the other develops under the abdominal wall. The sound will readily enter the empty half of the organ in the median line, and may lead to an error in diagnosis, the pregnancy being regarded as extra-uterine. Very skilful obstetricians have been deceived in this way.

Uterus septus uniformis. a. Vagina. b. Single os uteri. c. Partition of uterus, thick above and thin below dd. Right and left uterine cavities. ee. Two ridges in the posterior wall of the cervix. (From KUSSMAUL, after GRAVEL.)

Pregnancy in a uterus unicornus is apt to terminate fatally by rupture, but exceptional cases may occur and the foetus be delivered at

In one case seen by the writer the development of the abnormal uterus gave rise to much pain and distress for several months, and an extra-uterine pregnancy was regarded as almost certain by the family physician. The child was a female of four pounds, and died in three days from an undeveloped duodenum and an imperforate rectum : the cornu was on the right side.-ED.]

Ligaments of the Uterus.-The various folds of peritoneum which invest the uterus serve to maintain it in position, and they are described as its ligamerts. They are the broad, the vesico-uterine, and sacrouterine ligaments; the round ligaments are not peritoneal folds like the others.

The broad ligaments extend from either side of the uterus, where their laminæ are separated from each other, transversely across to the

pelvic wall, and thus divide the cavity of the pelvis into two parts; the anterior containing the bladder, the posterior the rectum. Their upper borders are divided into three subsidiary folds, the anterior of which contains the round ligament, the middle the Fallopian tube, and the posterior the ovary. The arrangement has received the name of the ala vespertilionis, from its fancied resemblance to a bat's wing. Between the folds of the broad ligaments are found the uterine vessels and nerves, and a certain amount of loose cellular tissue continuous with the pelvic fascia. Here is situated that peculiar structure called the organ of Rosenmüller, or the parovarium (Fig. 31), which is the remains of the Wolffian body, and corresponds to the epididymis in the male. This may best be seen in young subjects, by holding up the broad ligaments and looking through them by transmitted light; but it exists at all ages. It consists of several tubes (eight or ten according

to Farre, eighteen or twenty according to Bankes'), which are tortuous in their course. They are arranged in a pyramidal form, the base of the pyramid being toward the Fallopian tube, its apex being lost on the surface of the ovary. They are formed of fibrous tissue, and lined with pavement epithelium. They have no excretory duct or communication with either the uterus or ovary, and their function, if they have any, is unknown

A number of muscular fibres are also found in this situation, lying between the meshes of the connective tissue. They have been particularly studied by Rouget, who describes them as interlacing with each other, and forming an open network, continuous with the muscular tissues of the uterus (Fig. 32). They are divisible into two layers, the anterior of which is continuous with the muscular fibres of the anterior surface of the uterus, and goes to form part of the round ligament; the posterior arises from the posterior wall of the uterus, and proceeds transversely outward, to become attached to the sacro-iliac synchondrosis. A continuous muscular envelope is thus formed, which sur

1 Bankes: On the Wolffian Bodies.

rounds the whole of the uterus, Fallopian tubes, and ovaries. Its function is not yet thoroughly established. It is supposed to have the effect of retracting the stretched folds of peritoneum after delivery, and more especially of bringing the entire generative organs into harmonious action during menstruation and the sexual orgasm; in this way explaining, as we shall subsequently see, the mechanism by which the fimbriated extremity of the Fallopian tube is said to grasp the ovary prior to the rupture of a Graafian follicle.

Posterior view of muscular and vascular arrangements. Vessels.-1, 2, 3. Vaginal, cervical, and uterine plexuses. 4. Arteries of body of uterus. 5. Arteries supplying ovary. Muscular fasciculi.-6, 7. Fibres attached to vagina, symphysis pubis, and sacro-iliac joint. 8. Muscular fasiculi from uterus and broad ligaments. 9, 10, 11, 12. Fasiculi attached to ovary and Fallopian tubes. (After ROUGET.)

The round ligaments are essentially muscular in structure. They extend from the upper border of the uterus, with the fibres of which their muscular fibres are continuous, transversely, and then obliquely downward, until they reach the inguinal rings, where they blend with the cellular tissue. In the first part of their course the muscular fibres are solely of the unstriped variety, but soon they receive striped fibres from the transversalis muscles, and the columns of the inguinal ring, which surround and cover the unstriped muscular tissue. In addition to these structures they contain elastic and connective tissue, and arterial, venous, and nervous branches; the former from the iliac or cremasteric arteries, the latter from the genito-crural nerve.