finger with the patient lying on her back, and in nullipare with a tight vaginal entrance. The same applies to the rectum.

THE HYMEN.

It

The hymen begins, as we have seen in the history of the development, as a protuberance from the posterior wall of the vagina. It is a fold of the mucous membrane containing elastic fibres, blood-vessels, lymph-vessels, nerves, and sometimes smooth muscular fibres. closes the vagina more or less completely, and varies much in shape, but in most cases it is more developed behind than in front. The most common shape, especially in childhood, is that of a strip of tissue bent so as to form two lateral halves touching one another in a straight middle line (Fig. 40). In other cases it forms a ring with a

round opening (Fig. 41). In others, again, it has the shape of a crescent (Fig. 42). Often the border is indented (Fig. 43), a form that is easily distinguished from a lacerated hymen by the softness of the tissues, the absence of cicatrices, the round contour of the tongues, and, above all, by the decided resistance that is felt in trying to enter the finger. Sometimes the hymen is only represented by a low circular or crescentic ridge. The upper surface shows a continuation of the rug of the vagina, of which it only forms the lowest, thinned part, somewhat in the manner of the relation between the fourchette and the posterior end of the labia majora.

The hymen is, as a rule, torn by the first successful coition, into two or three, rarely a greater number of flaps, but there is no loss of substance. By putting the flaps in contact we can reproduce its original shape. In childbirth, on the contrary, it suffers so much

that only three or four roundish prominences are left of it, the so-called caruncula myrtiformes.

In a strictly intact vulva considerable resistance is felt, and pain is caused by the examining finger, be it at the opening of the hymen or at its base, where it joins the rest of the vagina. An easy accessi

bility of the vagina without laceration of the hymen is due to a gradual dilatation by a comparatively small body. It must be borne in mind that this not always means masturbation. It may as well be the result of careful gynecological treatment, while a careless examination may rupture the membrane, producing a result similar to that of coition.

THE UTERUS.

The uterus (Fig. 44) is a hollow body with thick muscular walls situated between the vagina below and the small intestines above, the bladder in front, and the rectum behind. It has somewhat the shape of a flattened pear, and may be divided into two parts, called the neck, or cervix and the body, or corpus. A subdivision of the neck is the vaginal portion (Fig. 44, 4, a), which dips down into the vagina; and a subdivision of the body is the fundus (Fig. 44, C, f), which lies above the entrance of the Fallopian tubes. The neck is cylindrical or rather barrel-shaped, being thicker in the middle than at the ends, and the line of demarkation between it and the body is marked outside, on its anterior surface, by the fold formed by the peritoneum when from the uterus it passes over on the bladder.

The vaginal portion or infravaginal part of the cervix forms a rounded cone nearly one-half inch high, on the top of which is found a transverse slit measuring about one-quarter of an inch from side to side, and called the os externum, os tinca (i. e. the mouth of a tench), or simply the os uteri. If we imagine this opening prolonged so as to divide the cervical portion into two halves, the anterior is called the anterior lip, and the posterior the posterior lip-a condition that often is produced by childbirth, but then is pathological.

Virgin Uterus, natural size (Sappey): A, front view: the appendages and the vagina are cut away; a, vaginal portion of cervix; b, isthmus; c, body. B, the same in vertical mesial section: a, anterior surface; the letter is placed a little above the bottom of the vesico-uterine pouch.

C, the same with cavity exposed by coronal section: e, os externum; d, os internum; f, fundus, the letter placed just above uterine opening of Fallopian tube.

The anterior lip dips lower down than the posterior, but the pouch formed by the vagina being much deeper behind than in front (Fig. 44) the posterior lip goes much higher up, so that it is longer than the anterior. The vaginal portion is covered with a smooth mucous membrane with flat epithelium, like that of the vagina.

The supravaginal part of the neck is about inch long, and is bound with rather loose connective tissue to the bladder in front, and on the sides to the mass forming the base of the broad ligaments of the uterus, and called the parametrium. Behind, it is free, being separated from the rectum by a part of the peritoneal cavity called Douglas's pouch.

The body of the uterus, in the more restricted sense of the word, is triangular. It forms a flattened truncated cone, with the end turned down to the cervix and the base up to the fundus. The sides

are a little convex (Fig. 44, 4). The anterior surface is convex from side to side, and straight or slightly concave from above downward. The posterior surface is strongly convex in all directions. The fundus is moderately convex from side to side, and much more so from the anterior to the posterior surface (Fig. 44, B and C).

The interior of the womb contains a cavity (Fig. 44, B and C), the anterior and posterior walls of which are in contact. It is 2 inches long in the nulliparous woman, and is divided into three parts, the cervical canal, the isthmus, and the cavity of the body. The cervical canal is about 1 inch long, is spindle-shaped, and on the anterior and posterior wall there is found a longitudinal ridge from which branches go outward and upward, separated by deep pouches. The whole formation is called arbor vitæ, palma plicatæ, or plica palmata. The isthmus, or os internum, is the narrowest part of the cavity, nearly cylindrical, about inch long and inch in diameter. The median ridge of the arbor vitæ extends to its upper end. The cavity of the body is triangular, with curved sides bulging into the cavity and smooth surfaces. At the two upper angles are found the uterine apertures of the Fallopian tubes.

The wall is about of an inch thick in the thickest parts, which are the middle of the edges of the body, the middle of the fundus, and the middle of the cervix. It is thinnest at the entrances to the Fallopian tubes and at the external os.

The size of the womb increases somewhat by sexual intercourse, and still more by childbirth. The length measures in virgins 2 to 24 inches, in nulliparæ 2 to 23 inches, in multiparæ 2 to 3 inches. The width on the level of the Fallopian tubes, the broadest part, is in virgins 11 to 13, in nulliparæ the same, in multiparæ 13 to 2 inches. The thickness is about the same in all three classes, varying from of an inch to 14 inches.

The cervix is about 14 inches from side to side in the middle, and

a little less at the ends.

The body is only a little longer than the neck in nulliparæ; in those who have borne children it becomes three-fifths or two-thirds of the length of the whole organ.

The wall is composed of three layers-a serous, a muscular, and a mucous. The serous coat is formed by the peritoneum, and does not cover the anterior surface and the sides of the cervix.

The muscular part of the wall may be divided into three layers, which become distinct during pregnancy: an outer longitudinal layer, which sends prolongations into the round and the ovarian ligaments, the tubes, and the sacro-uterine ligaments; a middle layer of interlacing longitudinal and transverse fibres, which is in connection with the muscular coat of the vagina; and an internal transverse layer, which is especially developed in what was formerly the two hores, and near

the internal os, in which latter place it forms a sphincter. It enters also the folds of the plicæ palmatæ. The middle layer is the thickest and contains the vessels.

Vertical Section through the Mucous Membrane of the Human Uterus (Turner): e, columnar epithelium; the cilia are not represented: g,g, utricular glands; ct, interglandular connective tissue; v,v, blood-vessels; mm, muscular layer.

The mucous membrane (Fig. 45) lines the whole cavity. In the body it is thin and intimately connected with the muscular layer, bundles of the muscles and connective tissue extending from one to the other. When fresh it is pink. It consists of fine threads of connective tissue and round or oblong cells (Figs. 46 and 47), and is perforated by numerous tubes, composed of a basement membrane and a layer of ciliated columnar epithelium, and called the utricular glands. They have a general direction parallel to one another, but are tortuous, and have often two or three branches in the deeper parts of the mucous membrane.'

In the cervix the mucous membrane is thicker, is composed of

1 According to Dr. Arthur W. Johnstone of Danville, Ky., the mucous membrane is an adenoid tissue, like that of the tonsils, the thyroid body, the spleen, the thymus, the lymphatic glands, and the lymph-tissues in the wall of the alimentary canal. The cells originate as granules in the fibres. They are only found between the age of paberty and the climacteric (Traps. Brit. Med. Soc., June 23, 1886).