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- The Four Epochs of Woman's Life - 6/28 -


and is also highly distensible. When the bladder is allowed to become overdistended, it is carried backward and tends to cause a backward displacement of the uterus. The urethra, or excretory duct of the bladder, is about an inch and a half long, and lies firmly imbedded in the anterior vaginal wall.

The Vagina.-- The intermediate organ is the vagina. This is a musculo-membranous canal which connects the external with the internal organs of generation. The vagina lies in relation with the bladder and the urethra in front, and with the rectum behind. The vagina is sufficiently distensible to allow of the passage of so large a body as the child.

The Uterus.-- The internal organs of generation are the uterus, the ovaries, and the Fallopian tubes. Of these, the ovaries and the uterus are the essential female organs of generation. The virgin uterus is a small, hollow, muscular organ, somewhat pear-shaped, whose cavity is about one and a half inches deep. The uterus is divided by a natural constriction into a body and a neck. The neck, or cervix, is somewhat spindle-shaped, and has a canal running through its center which opens by a small aperture-- the so-called external orifice,-- into the vagina. In the virgin uterus the apposition of the anterior and posterior walls reduces the cavity to little more than a longitudinal cleft. With the advent of old age the whole organ suffers marked atrophy.

The uterus is situated in the middle of the pelvic cavity, between the bladder and the lower bowel. It is held in place by broad elastic bands which go to different sides of the pelvis; it is also in part supported by the structures below and above it. But so loosely is the uterus held that it is easily pushed about-- as, for instance, by a full bladder or a packed bowel. And persistently allowing the bladder to become overfull, and failure to have a daily evacuation of the bowels, are prolific sources of displacements of the womb.

Respiratory Movements of the Uterus.-- When no constrictions are placed about the waist, the uterus moves freely up and down with every respiration. So distinctly and with such regularity do these movements take place that an operator by watching the movements of the uterus can tell the effect that the anesthetic is having on the patient's breathing. These so-called respiratory movements play a very important role in the circulation of the uterus, and in the return of the venous blood to the heart.

Anything which interferes with these movements, as the use of corsets, or of tight bands around the waist, prevents the free return of the venous blood. The uterus becomes congested, and through the constant abnormal weight of the organ itself, as well as the pressing down upon it from above of the superincumbent organs, the uterus is pushed down below its normal position, the ligaments whose duty it is to hold it up become relaxed, and the unhappy woman suffers all the agonies that are attendant on the "falling of the womb." For this reason the disorder is frequently met with in women who have never borne children as well as in those who have.

The Fallopian Tubes.-- The Fallopian tubes extend from the upper, rounded angles of the uterus, within and along the free margin of the broad ligaments, for a distance of about two inches, to the vicinity of the ovaries, where each one terminates in a funnel-shaped orifice surrounded by a series of fringed processes. The lumen of the tube is narrowest at its inner end, where it opens into the cavity of the uterus by a minute orifice which scarcely admits a bristle; the diameter of the canal gradually increases until it reaches its ovarian extremity. The mucous lining of the tube is clothed by a single layer of hair-like epithelium, whose current sweeps from the ovarian toward the uterine end of the tube; and it is these movements which propel the ovum from the ovary to the uterus.

The Ovaries.-- The ovaries are two small bodies of an almond shape, and lie on either side of the uterus. The bulk of the entire organ consists of connective tissue, in which lie imbedded the Graafian follicles or ovisacs, in which the ova are contained. These follicles or ovisacs are minute cells which are packed immediately beneath the surface, where they occur in all stages of development. With the increase in size which accompanies their development the follicles pass toward the surface, where they form a distinct projection, and at this point will occur the final rupture of the sac and the escape of the ovum. It is supposed that the ovum is grasped by the fringe-like extremity of the Fallopian tube and is carried through it by the movements of the ciliary epithelium to the uterus.

The formation of new follicles continues only for a short time after birth, when the Graafian follicles are the most numerous; the entire number contained within the ovaries of the child being estimated at over 70,000. In view of the unquestionably large number of follicles in very young ovaries, and the relatively small number of ova which reach maturity, the degeneration of many follicles after reaching a certain degree of development seems certain.

CHAPTER IV.

PHYSIOLOGY OF THE FEMALE GENERATIVE ORGANS.

Ovulation; Etiology of Menstruation; Uterine Nerve-supply; the Function of the Uterus; Stages of the Menstrual Cycle; Average Duration of the Menstrual Flow; Character of tahe Flow; Relation of Ovulation to Menstruation; the Menstrual Wave; Definition of Menstruation; Premomitory Symptoms of the Flow; Hygiene of Menstruution.

"Toil and grow strong; by toil the flaccid nerves Grow firm, and gain a more compacted tone."

-- ARMSTRONG.

Ovulation.-- At birth the formation of the ova is nearly completed; the production of' new cells probably ceases after the second year. The ovaries of the child of two years contain, therefore, the full quota of ova, although the vast majority of these cells always remain immature and undeveloped. While it is probable that a variable number of the immature ova undergo partial development before puberty, yet the advent of sexual maturity at that time marks the establishment of the regular development of the Graafian follicles and their contained ova, accompanied by the attendant phenomena of menstruation.

During the entire child-bearing period, or from about the age of fifteen to forty-five years, the development of the Graafian follicles and the discharge of the ova are continually taking place. The liberation of the ova usually takes place at definite times, which in general coincide with the menstrual epochs, one or more ova being set free at each period; but this is by no means invariable.

The ripe human ovum or germ cell is a spheric cell, about 0.2 mm. in diameter, consisting of granular protoplasm, in which lies a nucleus which contains the germinal spot. The proper cell-wall is a structure of great delicacy, outside of which is a secondary envelope.

Menstruation.-- The etiology of menstruation has been variously explained at different epochs. The chief theories have been that of plethora, and the ovulation, the tubal, and the nerve theories.

First, the Theory of Plethora.-- From the time of Hippocrates to 1835 the theory prevailed that in the female body the formation of blood is sufficiently rich to provide every four weeks for an overflow of the same, the evacuation of which becomes a necessity. It was believed that this excess of blood depended on an excess of formative power in the woman.

Second, the Ovulation Theory.-- This was distinctly formulated about 1845. It construed the menstrual hemorrhage as a subsidiary phenomenon, entirely dependent on the periodic dehiscence of ovules. The changes supposed to take place in the Graafian follicles at each menstrual period were believed to involve a peculiar expenditure of nerve force, which was so much dead loss to the individual life of the woman. The growth of the Graafian vesicle and its contained ovum was supposed to cause an irritation of the nerves of the ovary, which was reflected to the entire nervous system. The gradual accumulation of this irritation finally caused a reflex action which determined an afflux of blood to the uterus and ovaries, which constitutes the catamenial flow.

The ovulation theory was refuted by the following facts: Ovulation may and does occur without menstruation; women who have never menstruated may conceive; conception may occur during lactation, without the menses having returned since the last parturition; children at birth have many ovules contained within the ovaries; ovulation may persist for a time after the menopause, and even pregnancy has occurred, although very rarely after this time; the menses may continue regularly after the removal of the ovaries and Fallopian tubes; this is exceptional, and, as a rule, the periods only continue for two or three years at longest.

Third, the Tubal Theory.-- Lawson Tait thought that thorough removal of the tubes was far more essential in determining the menopause, and that cases of periodically recurring hemorrhage after the removal of the ovaries were to be explained by the fact that the tubes had not been sufficiently removed. As an anatomic and surgical fact, the tubes can never be wholly excised unless the upper part of the uterus is also amputated.

Fourth, the Nerve Theory of Menstruation.-- This is based upon the following views:

1. That menstruation is a process directly controlled by a nerve-center situated in the lumbar region of the spinal cord.

2. That the menstrual impulses reach the uterus through two sets of nerves.

3. That menstruation is the result of nerve irritation, vascular congestion, and the subsequent relief of these by hemorrhagic discharges.

4. That hemorrhage from the uterus is the result either of a local uterine condition, or of influences outside of the uterus acting directly on the center.

5. That the removal of the appendages arrests menstruation by preventing the propagation of uterine influences to the center.

Uterine Nerve Supply.-- One set of nerves causes contraction of the muscular fibers of the uterus, while the other set transmits impulses which bring about its vascular engorgement; and they are probably concerned in bringing about the determination of blood to the uterus and its appendages, which is so marked a feature of the menstrual process.

As the result of long-continued investigation, Johnstone has come to the conclusion that the lining membrane of the uterus belongs to that class of organs whose function it is to replace organic waste. "Menstruation is a periodic wasting away of those corpuscles that are


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