Practical treatise on the diseases of the uterus, ovaries and fallopian tubes / by A. Courty ; translated from the third edition ... by Agnes M'Laren ; with preface by J. Matthews Duncan.

Date:
1882
Catalogue details

Licence: Public Domain Mark

Credit: Practical treatise on the diseases of the uterus, ovaries and fallopian tubes / by A. Courty ; translated from the third edition ... by Agnes M'Laren ; with preface by J. Matthews Duncan. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    31/842 (page 19)
    The result of a great number of measurements taken at all ages, both in the state of vacuity and of gestation, is that the distance between the opening of the ureter at the posterior angle of the trigone and the insertion of the vagina at the cervix, while very variable, is on an average from 1 to 2 centimetres. The distance between this opening and the free portion of the cervix is still more variable as it depends on the size and length of the cervix. The distance between the ureter and the margin of the uterus is equally variable, since the ureter is sometimes at some distance from it, whilst in other circum- stances, as at the end of gestation, it is in immediate contact with the uterine border, as shown by the fact that the ureter and uterus may be torn or ulcerated at the same point, as occurred in a case of fistula after delivery which came under my own observation. When the bladder is empty the anterior surface of the uterus is bent over it, forming a slight curve with the concavity looking forwards and down- wards. When it fills, this surface rises and is directed in turn forwards and upwards. When it is distended the uterus may be com- pressed by it against the sacro-vertebral angle, or if the ligaments are relaxed may even be turned backwards, its base looking towards the concavity of the sacrum, and may become fixed in this position when such a displacement occurs at the commencement of pregnancy or after delivery.1 The posterior surface of the uterus is covered in all its extent by the peritoneum, which, as it passes over the utero-sacral ligaments, forms at the sides Douglas's folds, whilst in the middle line it extends to the upper part of the posterior vaginal wall to form, by its reflection on to the rectum, the recto-vaginal cul-de-sac (Dig. 18 r). The posterior surface assumes alternate positions exactly the reverse of the anterior surface, according as the bladder is full or empty. It looks towards the rectum, being generally separated from it by circumvolu- tions of the small intestine, though exceptionally it may rest upon it when raised and pushed towards it bv the distension of the bladder or by one of the pathological conditions which will occupy our atten- tion when studying displacements of the womb. The upper margin is in relation with the circumvolutions of the small intestine, of which it somewhat retains the impression. In the majority of women it does not reach the level of the brim (Sappey). However it extends beyond the horizontal plane, passing immediately above the symphysis of the pubis, which allows of its being examined by palpation in the greater number of patients. The lateral borders correspond with the interstices of the two peritoneal folds, anterior and posterior, which, as they leave the uterus, form the broad ligaments. They are continuous with those of the vagina. Both are in immediate relation with the numerous vessels which enter these two organs. The lower extremity projects into the cavity of the vagina, which encircles it. It is a little lower before than behind, and the posterior utero-vaginal cul-de-sac has in consequence a greater depth than the anterior one (Dig. 18). 1 Sappey, Anat. descript., t. iii, p. 661. Paris, 1864 ; Comte, Bulletin de la Societe anatomique, 1826, t. i, p. 49.