(Pertaining to the bladder and womb.) pouch is usually an empty line. The womb is a hollow, thick-walled small organ, shaped like a pear ‘ it is triangular from side to side and flattened from before backwards. The adult virgin womb weighs about 1 plus ounces; it is about three inches long, two inches wide and one inch thick. It consists of two portions, of a body or corpus and of a neck or cervix. The walls of the womb are so thick (about half an inch) that its cavity consists only of a slit. This cavity is triangular in shape; its apex pointing downwards. The cavity of the womb communicates with the peritoneal cavity through the Fallopian tubes and with the vagina through the cervix. This direct communication between the exterior and the peritoneal cavity is responsible for the spreading upwards sometimes of fatally ending infections, due with to sepsis or to gonorrhoea. The interior disorders are explained in the next chapter.
THE special diseases to which women are subjected are almost entirely confined to their genital organs. Hence a through knowledge of their anatomy and physiology is indispensable for their full understanding.
A. ANATOMY.
For practical reasons we differentiate between the internal organs (womb, Fallopian tubes, ovaries and vagina) and the external organs, commonly termed vulva (labia majora, labia minora, clitoris, hymen, vulvovaginal glands and mons veneris).
The womb is the central organ, it lies below the level of the pelvic (* The bony basin of the trunk.*) brim, between the bladder and the rectum, (Plus The lower part of the large intestine.) its axis being directed forwards; as a rule it shows a slight rotation to the right, that means its left edge is nearer to the front of the pelvis than its right edge. Viewed from above, therefore, one can only see its fundus and posterior surface. The anterior surface touches the bladder, so that the vesicouterine ((++) Pertaining to the bladder and womb.) pouch is usually an empty line.
The womb is a hollow, thick-walled small organ, shaped like a pear ‘ it is triangular from side to side and flattened from before backwards.
The adult virgin womb weighs about 1 plus ounces; it is about three inches long, two inches wide and one inch thick. It consists of two portions, of a body or corpus and of a neck or cervix.
The walls of the womb are so thick (about half an inch) that its cavity consists only of a slit.
This cavity is triangular in shape; its apex pointing downwards. The cavity of the womb communicates with the peritoneal cavity through the Fallopian tubes and with the vagina through the cervix. This direct communication between the exterior and the peritoneal cavity is responsible for the spreading upwards sometimes of fatally ending infections, due with to sepsis or to gonorrhoea.
The interior surface of the womb is lines with a mucous membrane which is continuous with the Fallopian tubes and the vagina. The mucous membrane becomes ciliated near the orifices, it contains numerous tube-like glands, discharging a clear, viscid alkaline liquid. The walls of the womb consists mostly of involuntary muscle fibres, running in all directions, with numerous blood- vessels, lymphatics and nerves between them.
The lower part of the cervix projects, as above mentioned, into the vagina and is the called the vaginal cervix or portio vaginalis, while the upper part of the womb’s neck, which lies above the attachment of the cervix to the vagina, is called the supra-vaginal cervix or portio supravaginalis. The vaginal cervix in the virgin state is somewhat cone-shaped, its external opening being small and rounded on its apex which points downwards and backwards. After pregnancy this external opening becomes a transverse slit with definite anterior and posterior lips of the cervix.
The body of the womb is almost completely covered with peritoneum, (Serous membrane lining the abdomen) but its sides are partly uncovered; so is the cervix at the front, whilst its back is completely covered by the peritoneum, forming part of the pouch of Douglas (the cavity between womb and rectum).
The abdominal peritoneum which passes down the anterior abdominal wall on to the bladder, forms a fold between the bladder wall on to the bladder, forms a fold between the bladder and the womb, called the utero-vesical pouch. This pouch is bounded laterally by two distinct thickenings, called the utero- vesical ligaments.
On each side of the womb are the broad ligaments, passing outwards to the side of the pelvis, the utero-sacral ligament, passing to the sacral bone and the round ligaments, uniting the womb to the front of the abdomen and holding the womb up in its place.
The free upper part of these ligaments enclose within their layers the Fallopian tubes, one on either side. The Fallopian tubes are about four and a half inches long; their inner end leads into the cavity of the womb, whilst the other end opens by a trumpet-like aperture into the peritoneal cavity.
The two ovaries are of the shape and size of an unshelled almond and lie projecting from the posterior lamina of the broad ligament near the side walls of the pelvis. The diameter of each ovary is about one and one-third inch by three-quarters by three- eighth of an inch. Their posterior surface looks backwards, the anterior is attached to the broad ligament, their long axis is almost perpendicular or somewhat transverse.
The ovary consists of a framework of connective tissue, containing the Graafian follicles. These are round masses of cells, one of which is an ovum or egg cell, so small that a hundred of them lying side by side would only cover in inch. From the period of puberty onwards these Graafian follicles ripen, rupture on the surface of the ovary and discharge the ova, which pass through the Fallopian tube into the cavity of the womb. This process is called ovulation. Before dealing with this important phenomenon I must review with a few words the external genital organs, called the vulva.
The vulva comprises :
(1) The mons veneris. This is an eminence in front of the symphysis pubis, composed of fat and connective tissue and, after puberty, is covered with hair.
(2) The labia majora. They are two longitudinal liplike folds of skin joined together above the mons veneris and separated below towards the perineum.
(3) The labia minora. Two small folds of epithelial covered tissue lying between the labia majora. Above they come together in the prepuce of the clitoris, below they furs with the hymen.
(4) The clitoris is richly supplied with blood vessels and nerves and is covered with a fold of skin, the prepuce.
(5) The hymen. A fold of mucous membrane, surrounding the vaginal orifice. It may extend entirely across and close the aperture; this condition is called imperforate hymen.
(6) The glands of Bartholin. Two round glands, opening near the vulval orifice between the hymen and the labia minora.
B. PHYSIOLOGY OF THE GENITAL ORGANS
At the age of puberty the female genital organs have reached their full development and their physiological function manifests itself in the menstruation or monthly period. It is one of the most remarkable and prodigious proceedings in the women’s life, characterized by discharge of blood, mucus and cells from the cavity of the womb, occurring at regular intervals during health, except during pregnancy and lactation. Its onset is preceded by a striking change of the whole body of the girl, familiar to every mother.
This menstrual flow continues for several days (4-5), the average amount of blood lost is about 4-6 ounces. The menstrual blood of a healthy girl is dark and free from clots, unless the flow is very profuse. It usually comes every 28 days, but there are many variations regarding the regularity as well as the duration. Climate, race, occupation, the way of living have a decisive influence on the physiological function.
As a rule the menstruation starts between the twelfth to fifteenth year of age. The process depends on the normal function of the ovaries. The ruptured Graafian follicle developing into the corpus luteum produces by internal secretion the progestin, which acts on the mucous membrane of the womb, resulting in the uterine haemorrhage. Hence menstruation never appears when the ovaries have been removed surgically or have been destroyed by diseases or x-rays.
The first menstruation of young girl is very often accompanied with more or less marked troubles, as there are pain in the back and abdomen and disorders of the whole constitution.
It may be difficult in many cases to differentiate between a normal and a pathological menstruation. Generally speaking in a normal condition all symptoms start before the onset of the menstrual flow and, as a rule, cease, or least diminish greatly after the second day of the menstruation.
Each mother should carefully watch her growing up girl and have an easy, understandable, and good explanation ready when the occasion arises. Mothers should know and realize how much their little girls need them in those days and how much can be done to overcome quite easily their difficulties and little troubles. A mother who loves her child should never leave this task to servants or outside friends. It is the mother’s job not only to explain what is happening, but also to give her instruction, how to behave during menstruation. A warning should be given to avoid excessive physical exercise in these days (swimming, riding, play-games, etc.).
