the tube is thicker and firmer in front and behind than on the right and the left sides. This greater thickness is in part due to the corrugated state of the mucous membrane in those precise localities, yet not wholly so, since the columns are observable even in multiparas who have long ago lost all their ruga or corrugations. The anterior column is thicker than the posterior one. They both grow slender as they ascend, and at the points where the vagina unites with the neck of the womb, the appearance of a column is lost.

I like these words, anterior columna, and posterior columna, because I like to suppose that when the anterior columna becomes shorter than it ought to be, the womb to which it is fastened by one end, while the other end is anchored to the arch of the pubis, must be drawn down toward the pubis, and kept there by the contracted or condensed columna, which holds or ties it there. In some instances this anterior columna becomes so short, or so condensed, that it can only with difficulty be extended again by pushing the womb away from the pubis with the finger; and even when one succeeds in so pushing it away, it is brought back again immediately by the elastic contraction of the condensed vaginal column, so that it renders a permanent cure of the displacement or derivation of the womb a very difficult thing to effect. I have seen it not half an inch long.

Kolrausch's plate, Fig. 18, which is, in my opinion, perfectly dependable, shows the anterior columna to be only one inch and three-quarters long, and the posterior columna only two inches and six-tenths in length instead of five or six inches. I have certainly examined many thousands of women of all ages and in various conditions, and my sense of the case is, that a vagina whose anterior column is two inches and a half long, is long enough, for it lets the os tincæ take its true place in the pelvis.

It is quite necessary for the Student to know not only the anterior column, but also the two ligaments that are called utero-sacral ligaments, which are nothing more than duplicatures of the peritoneum in every respect similar to the ligamenta lata. They go in a direction backwards and upwards from the uterine extremity of the vagina to the sacrum, into the anterior aspect of which they are inserted, and their office is to hold the end of the vagina up in its proper place. Look at Kolrausch's picture, and conceive of a band or cord proceed. ing from the posterior lateral surface of the vagina to the second segment of the sacrum. If such a string should be strong and taught, the vagina must keep its place, but if the string were cut, the vagina would drop down, and carry the womb along with it. The same effect would follow upon a relaxation of the band-the vagina must slide

down, carrying its womb along in its fall. Is not falling of the womb, then, the same thing as relaxation of the vagina? What else could it be? It could not be, and it is not anything else.

I have written so fully upon this subject in my Letters on Woman, her Diseases and Remedies, and in my Essay on the Acute and Chronic Diseases of the Neck of the Womb, that I must refer the student to those works for my further views of the disorders of the vagina.

It is proper, however, for me, in this place, to say that as the vagina is the excretory duct of the womb, it is so constituted as to undergo very great changes of its capacity in parturition. The tube may be considered as a cylinder in the non-gravid state, but when the womb is enlarged by the growing ovum, and particularly near the close of a pregnancy, the cervix uteri becomes a cone, and, of course, the upper end of the vagina, which invaginates that cone, must also assume a conoidal form. But when labor is advanced, and the os dilated, the upper end of the vagina must dilate pari passû. It is not every specimen of the vagina that is so distensible as I have represented it generally to be; and when it is really a resisting body, it yields reluctantly to the force of the throes and ofttimes causes the process to be slow and very painful, so that among the numerous causes of slow and protracted labors, we must occasionally find this tube at the bottom of the mischief. It becomes rigid in this way in certain women who have suffered from chronic vaginitis, the effect of which is to give a tendency to a sort of general stricture or narrowing of the whole canal. I have often met with instances in which the organ, even in married women, presented obstruction to the passage of a Recamier speculum up to the os uteri. It is manifest, then, that such a state of the tissues might interfere with the normal developments in a labor. I have published some cases of this stenosis of the vagina in my work on female diseases, and in my treatise on diseases of the cervix. A very good account of such affections is to be found in the work of Spaeth, Chiari, and Braun, already cited, as well as in my Translation of Colombat de l'Isere's Treatise on the Diseases and Special Hygiene of Females. M. Colombat's article is at p. 96, and at 97 is a lengthy account of cases observed and reported by myself.

The Womb.-The uterus is attached to the upper end of the vagina. It is a pear-shaped body, compressed from front to rear, and of various length, which may be from two and a quarter to two and a half inches, rarely three inches-being larger in women who have borne children than in those who have never been impregnated. It is divided into fundus, body, and neck; the fundus being the upper

most, and the neck the lowermost part of the organ. The vagina is united to the womb in such a way as to permit its neck to project like a nipple a short distance into that tube: in this regard also there is great variety, some women having almost half an inch of the cervix uteri hanging down in the vagina, while in others the connection seems to exist almost at the lower end of the cervix. (See the engraving.)

Fig. 37.

H

The cut (Fig. 37) represents the womb B, with the vagina H, laid open, in order to show the neck and mouth of the womb B projecting into the upper end of the vagina. In it are also seen the round liga

ments GG; the ovaries E E; the ligament of the right ovary F, and the Fallopian tubes cc, with their fimbriated extremities D.

As the vagina is a curved canal, which proceeds backwards from the vulva, and upwards towards the rectum, it follows that the womb lies nearer to the sacrum

than to the pubis. The womb is so situated that its long diameter is parallel to the axis of the superior strait, while the vagina is more nearly parallel to that of the inferior strait; hence, at their junction, they make an obtuse angle of nearly 95°, any deviation from which implies a displacement of the womb.

Let the Student say the breadth of a womb is about an inch and a half; its thickness about one inch; its length two inches and a quarter: this is the mean. I subjoin a drawing that represents the internal

organs divided transversely from top to bottom, and showing the front or anterior half. A is the fundus or bottom of the womb, which is the uppermost or highest portion of the organ. B is the triangular cavity

whose outlet is through the canal of the cervix (c), leading down to the orifice of the womb in the vagina, which orifice is called os tincæ, or os uteri. At D D are seen the left and right Fallopian tubes laid open, to expose the narrow passage by which the ova are conducted from the ovaria F F. E E are the fimbriated extremities of the tubes, which are also called morsus Diaboli, or Devil's bit: they are the infundibula or ingluvies which take up the ova as they spontaneously escape from the ovisacs of the ovaries when expelled once a month. The wing-like expansion on each side of the womb is the broad ligament, and the round ligament is seen through it and in front of it on either side of the uterus.

Suppose half an inch of the cervix uteri to project into the upper part of the vagina; then if the whole length be two inches and a quarter, we shall have one and three-quarter inches of the womb above the upper end of that canal. Such being the case, the womb would fall over to the right or left side of the pelvis, were it not restrained or stayed by what are called its broad ligaments, which, passing from its sides towards the sides of the pelvis, keep it steady, or prevent it from assuming an oblique attitude; it would also fall backwards towards the sacrum, and sometimes become lodged or wedged under the promontory of that bone, were it not restrained from moving in that direction both by its round ligaments, called by Fallopius its cremasters, and also by its connections with the bladder. The uterosaeral ligaments, which form the lateral walls of Douglas's cul-de-sac, also maintain the uterus in situ. It cannot fall forwards, for it is sustained by the bas-fond of the bladder, which, by filling with urine, must, and does always push it backwards again.

Structure and Powers of the Womb.-The substance of which the womb is composed has not been fully understood. In the unimpregnated state, it is dense and gristly to the feel, and cuts very hard; the cut surface being of a faint pinkish hue and a fibrous appearance; but those fibres are disposed without any apparent regularity or order. It is supplied with bloodvessels, absorbents, and nerves, which are very small during the unimpregnated state; but the same vessels in the gravid womb acquire an enormous size, and are exceedingly numerous and tortuous; so that, in fact, the ovum, at full term, appears to be contained within a vast network, or rete vasculosum, united together by a quantity of muscular fibres and other tissues. The womb, at the full term, is an exceedingly sanguine organ, being furnished with torrents of blood from the uterine and spermatic

arteries, the former reaching it from below, and the latter from above, with free inosculation of the several channels of circulation.

As to the interior membrane, or mucous coat of the womb, it is unnecessary to speak here: the cut, exhibiting Mr. Coste's view, will explain the matter with sufficient clearness.

Various attempts have been made to demonstrate the muscular fibres of the womb, and they have been divided into layers, and planes, and fasciculi for that purpose: but the very fact of such difference of opinion is proof enough that the arrangement of them is not yet clearly known. If it were known and demonstrable, there would no longer exist any dissidence concerning it, since whatever is clearly demonstrable, ceases to be a subject of dispute or doubt. This much, at least, is well known; namely, that the contractile fibres of the womb are capable of acting partially, or so as to change the form of one part of the organ, while another part of it acts with less intensity, or not at all. Thus, it occasionally happens that we find the uterus, after delivery, contracted in its middle, as if a string had been passed round it and drawn tightly, causing it to assume the shape of the hour-glass. This state is familiarly denominated an hour-glass contraction. Again, we not unfrequently find the whole organ elongated, and almost of a farciminal form; its fundus being raised high upwards, towards the epigastrium, while the body of it is narrow or slender like an intestine. I feel assured that I have sometimes found it, after delivery, full nine or ten inches in length, and not more than four inches in transverse diameter, estimated by feeling it through the relaxed integuments of the abdomen. These circumstances prove that the uterine fibres which affect

Fig. 39.

the conjugate diameter of the organ may act with force, while those which affect its longitudinal diameter are either in a state of repose, or of very slight action; which leads us, as I think, to the inference, that the longitudinal and horizontal fibres are separate and independent organs or parts of the uterine structure. The annexed cut (Fig. 39), from M. Chailly's Midwifery, gives a view of an arrangement of muscular fibres which seem to converge upon the tubes and round liga

ments. Let the Student conceive of a

separate, non-coördinate action in these fascicles of muscles, and he will perceive that such action might greatly embarrass a labor in