Tokology

The reproductive apparatus of woman consists essentially of ovaries, oviducts, uterus, vagina and mammary glands.

The ovaries (Plates II and VI) are two almond-shaped bodies, situated about two and one-half inches distant on either side of the uterus. They are inclosed in the broad ligaments and suspended by a thread-like cord from the womb, also attached to the outer extremities of the oviducts. They consist of a stroma in which vesicles are imbedded. It is within these vesicles that the ova, or eggs, are found. Every four weeks, during the child-bearing period an ovum matures, and bursting through the vesicle, as well as the surrounding membrane of the ovary, is conveyed to the womb by the oviduct.

While not the largest, the ovary is the most important of the generative organs of woman. Upon these apparently insignificant structures depends the creative power giving the grand office of motherhood, a power akin to the divine. Maternity! the holiest shrine of human life, to which poets do homage, and true men bow in reverence!

The ovaries contain the fructifying principle, and also bestow on woman the characteristics of sex. These mysterious bodies are the grand source of feminine attractions. Remove all other generative organs and you do not change her in this regard—remove the ovaries, and she becomes masculine not only in character but appearance. Her figure changes, her voice becomes coarse and of lower pitch, her throat enlarges, and, in some instances, whiskers appear. Any diseased condition, too, of the ovaries produces great constitutional as well as emotional disturbances.

The oviducts or fallopian tubes (Plates II and VI) are minute cylindrical openings from the superior and lateral portion of the uterus, about three inches in length and terminating in fimbriated or finger-like extremities. The latter are minute muscular bodies, which grasp the ovum as it bursts through the membranes of the ovary, and convey it into the oviduct on its way to the uterus. The ovum is less than ¹⁄₁₂₀ of an inch in diameter, and the cavity of the oviduct is so small that it would scarcely allow the entrance of a hog’s bristle.

The uterus (Plates II, III, IV, V and VII) is a pear-shaped muscular organ situated in the inferior portion of the pelvis, between the bladder and rectum. It is less than three inches length and two inches in width, and one in thickness. It is pear-shaped, the cervix naturally pointing to the coccyx.

The canal or opening into the uterus through the cervix is small, capable of admitting a probe ¹⁄₈ to ¹⁄₄ of an inch in diameter. The walls are muscular, and in the unimpregnated state about half an inch in thickness. The cavity of the uterus is small and conical, having three openings, two at its upper portion into the oviducts, and one into the vagina. The latter is called the Os uteri or mouth of the womb. The upper broad portion is called the fundus. It weighs from one to two ounces. It is difficult to realize how very diminutive this organ is in the virgin state, especially when we consider its power of distension during pregnancy.

The external portion of the uterus is covered by the peritoneum, a serous membrane which is continuous with the lining of the abdomen and covering of all the viscera. The uterus is held in place by ligaments formed of folds of the peritoneum. The broad ligament enveloping the oviduct and ovaries extends to either side, and is firmly attached to the sides of the pelvis. The round ligaments, formed from obliterated bloodvessels of fetal life and peritoneal covering, pass from the upper portion of the womb to the outside of the pelvic bone and terminate in muscular and cellular tissue beneath the integument. There are also folds of peritoneum between the womb and bladder in the front, and the womb and rectum in the back, that assist in holding it in position. It is besides largely supported by the elasticity of the vagina and muscles of the perineum. So well sustained is the uterus that only serious violations of physical laws can cause deviations of position.

The Vagina (Plates II and III) is simply the external outlet or passage from the uterus. It is longer in back than in front, being from three to four inches in front and from five to six inches in the posterior portion. It is a cylindrical tube of firm elastic tissue, capable of great distension. The neck of the uterus dips into the upper part of the vagina about three-fourths of an inch. The communication between these organs is the cervical canal, which in health is found closed, admitting a probe with difficulty. The uterus and vagina are not one and the same as many suppose, yet communicate with each other. The vagina serves as a passage for the menstrual fluid, for the fetus at birth, and for the reception of the male organ in copulation, and in a state of health assists the perineal muscles in sustaining the uterus.

The mammary glands or breasts (Plate XI) are accessory to the generative system. They secrete milk which supplies the child with nourishment after birth. They are rounded and prominent, keeping their form and position through life, if the surrounding muscles and tissues have not been weakened by pressure of clothing.

Conception or impregnation takes place by the union of the male sperm and female germ. Whether this is accomplished in the ovaries, the oviducts or the uterus, is still a question of discussion and investigation by physiologists.

The ovum, or egg, matures and is taken up by the fimbriated extremities of the oviducts at the time of menstruation. To reach the outer world it must pass the length of the oviducts, the cavity and canal of the uterus and vagina. The fructifying principle of the semen consists of zoosperms, which under strong magnifying powers are seen to be filaments endowed with power of propulsion.

Once entering the uterine cavity there is no reason why they should not be able to pass into the oviducts or even to reach the ovaries. The probabilities are impregnation can take place at any point in the generative tract, providing the ovum and sperms come in contact while they still live. It is pretty well proven that the ovum after maturing and being dislodged from the ovaries may retain its life from six to eight days, and also be that length of time in making its exit from the uterus. That the sperms are viable, also, for some days, if retained in their own element at a certain temperature, has been established quite definitely.

With many women the ovum passes off within twenty-four or forty-eight hours after menstruation begins. Some, by careful observation, are able to know with certainty when this takes place. It is often accompanied with malaise, nervousness, headache, or actual uterine pain. A minute substance like the white of an egg, with a fleck of blood in it, can frequently be seen upon the clothing. Ladies who have noticed this phenomenon testify to its recurring very regularly upon the same day after menstruation. Some delicate women have observed it as late as the fourteenth day.

Nourishment and development of the embryo.—There are three distinct periods of nutrition in the uterine development of the human being:

First—Yolk nutrition.

Second—Tuft nutrition.

Third—Placental nutrition.

The period of yolk nutrition in the human is brief and probably variable. The minute size of the egg renders it impossible for it to furnish nutriment for any length of time, as is the case with the embryo of the fowl. From five to eight days after conception takes place, a membrane is formed around the ovum, called the chorion. Outside of this is still another membrane attaching itself to the womb. The internal surface of the chorion is supplied with villi or tufts resembling mulberry seed. Through these the embryo receives its nutrition, until at the close of the second month, from these tufts the placenta, or after-birth, begins to be developed. This is attached to some portion of the uterus, usually the upper lateral portion.

The Placenta is a spongy, vascular organ, at full term eight to ten inches in diameter, and two or three inches thick at center, thinning at the edges, weighing from three-fourths to one and one-fourth pounds. In appearance it is not unlike a piece of liver, only less solid.

It is the proper vascular apparatus serving the combined purpose of fetal nutrition, respiration and excretion. At least, through its absorption all these functions are accomplished.

This, with the membranes surrounding the fetus and umbilical cord, is called the after-birth.

The placenta (Plates VIII and IX) lies in complete juxtaposition with the uterus, with an almost imperceptible membrane interposed. The fibers and bloodvessels of the uterus and placenta do not interlace, as some suppose; each has a distinct set of bloodvessels and capillaries, and a separate circulation. Nutrition and excretion are carried on by exosmosis, or transudation through this very attenuated membrane.

The fetal circulation is an especially interesting phenomenon. Instead of the blood going to the lungs for oxygenation, the entire circuit is performed without this, the placenta serving the office of lungs as well as of the digestive organs.

From the placenta oxidized blood is brought through the umbilical vein, a large portion of it passing to the liver, but all eventually enters the heart by the ascending vena cava. By the Eustachian valve it is directed through the foramen ovale to the left auricle, from this to the left ventricle, which conveys it to the aorta.

Part of the blood, instead of taking this course, enters the right ventricle, and in place of going to the lungs through pulmonary arteries, passes at once to the aorta, through what is called the ductus arteriosus. After traveling the entire circuit, it is taken back to the placenta by two umbilical arteries, which are given off from the iliac arteries.

At birth the ductus arteriosus closes; the umbilical veins form the round ligament of the liver, and the umbilical arteries the round ligament of the uterus in the female, and the urachus, a ligament of the bladder, in the male.

The foramen ovale also closes, establishing a complete septum between the auricles of the heart.

A blue baby or cyanosis neonatorum is the result should this valve fail to close. The venous blood commingles with the arterial blood, and death is the result sooner or later.

The umbilical cord is made up of two arteries and one vein. It is from two to four feet in length, attached at one extremity to the placenta, and at the other to the navel of the child. This is the medium of the circulation between the placenta and the fetus.

The membranes all unite before birth to form one thick, tenacious covering for the child, and also for the cord and fetal surface of the placenta.

This incloses the fluid—the liquor amnii—which serves to protect the fetus from blows or sudden jars. The membranes and the contained fluid form what is known as the “bag of waters.” Not rupturing before birth, they make what is called a veil or caul over the child’s face, to which is attached various superstitions, such as the gift of “second sight,” clairvoyance, etc.

Healthy nutrition of the fetus depends entirely upon the mother. The placenta not only represents the digestive organs, but the lungs of the fetus. Consequently upon the condition of the mother depends the condition of the child. It has no other means of getting nutriment, or of disposing of waste material. After birth it has the same advantage as the adult in correcting errors in diet and nutrition by elimination. The skin, with its miles of perspiratory ducts, then conveys effete matter from the system, the lungs keep up by respiration a constant interchange of oxygen for carbon, while the liver, kidneys and bowels are active in their functions of depurition. In utero these functions are all dormant, consequently giving the fetus a disadvantage for healthy growth. Mothers often show a great solicitude about diet and conditions during lactation, while they are comparatively indifferent to these matters during pregnancy.

Especially should they breathe deeply, and that, too, of pure air. Trall says: “If the mother does not breathe sufficiently the child must suffer. Many a mother gives birth to a frail, scrofulous child, for no reason except that during the period of gestation she is too sedentary and plethoric. I have known women of vigorous constitutions, who had given birth to several healthy children, become the mothers of children so puny and scrofulous that it was impossible for them to be raised to adult age. The reason is that the mother is obstructed in her respiratory system, and although she may breathe enough to sustain her own organization in a fair condition, she does not inhale oxygen enough to supply the needs of an intra-uterine being. Many ‘still births’ are explainable on this principle.”

The duration of pregnancy is nine calendar months or ten lunar months, about 280 days. If the date of impregnation is not known, the count should be made from the beginning of the last menstruation, and add eight days on account of the possibility of its occurring within that period. It is possible in some diseased conditions for the period to extend much beyond this time. I knew one case of amniotic dropsy where pregnancy extended forty-four weeks.

Helen Idleson, M. D., in the Med. Wochenschrift, sums up the results of her investigations as follows: “1. The duration of pregnancy amounts to 278 days, or nearly 40 weeks. 2. The sex of the infant influences the duration, this being longer in female infants. (?) 3. The heavier the child, the longer is the duration. (?) 4. The duration is longer in multipara than in primipara. 5. The younger the woman the longer is the duration. 6. The duration is longer in married than in unmarried women. 7. The first movements of the child are felt, on an average, on the one hundred and thirty-fifth day, but later in primipara than in multipara.

“The growth of the embryo after fecundation is very rapid. On the tenth day it has the appearance of a semi-transparent, grayish flake. On the twelfth day it is nearly the size of a pea, filled with fluid, in the middle of which is an opaque spot, presenting the first appearance of an embryo, which may be clearly seen as an oblong or curved body, and is plainly visible to the naked eye on the fourteenth day. The twenty-first day the embryo resembles an ant or a lettuce-seed; its length is from four to five lines and its weight from three to four grains. Many of its parts now begin to show themselves, especially the cartilaginous beginnings of the spinal column, the heart, etc.

“The thirtieth day the embryo is as large as a horse-fly, and resembles a worm, bent together. There are as yet no limbs, and the head is larger than the rest of the body. When stretched out it is nearly half an inch long. Toward the fifth week the heart increases greatly in proportion to the remainder of the body, and the rudimentary eyes are indicated by two black spots turned toward the sides, and the heart exhibits its external form, bearing a close resemblance to that in the adult.

“In the seventh week bone begins to form in the lower jaw and clavicle. Narrow streaks on each side of the vertebral column show the beginning of the ribs. The heart is perfecting its form, the brain enlarging and the eyes and ears growing more perfect, and the limbs sprouting from the body. The lungs are mere sacs, about one line in length, and the trachea is a delicate thread, but the liver is very large. In the seventh week are formed the renal capsules and kidneys.

“At two months the forearm and hand can be distinguished, but not the arm; the hand is larger than the forearm, but it is not supplied with fingers. The distinction of sex is yet difficult. The eyes are prominent. The nose forms an obtuse eminence. The nostrils are rounded and separated. The mouth is gaping and the epidermis can be distinguished from the true skin. The embryo is from one and a half to two inches long and weighs from three to five drachms, the head forming more than one-third of the whole.

“At the end of three months the eyelids are distinct but shut; the lips are drawn together; the forehead and nose are clearly traceable, and the organs of generation prominent. The heart beats with force, the larger vessels carry red blood; the fingers and toes are well-defined, and muscles begin to be developed.

“At the fourth month the embryo takes the name of fetus. The body is six to eight inches in length and weighs from seven to eight ounces. The skin has a rosy color, and the muscles produce a sensible motion. A fetus born at this time might live several hours.

“At five months the length of the body is from eight to ten inches, and its weight from eight to eleven ounces.

“At six months the length is twelve and a half inches; weight, one pound. The hair appears upon the head, the eyes closed, the eyelids somewhat thicker, and their margins, as well as the eyebrows, are studded with very delicate hairs.

“At seven months, every part has increased in volume and perfection; the bony system is nearly complete; length, twelve to fourteen inches; weight, two and a half to three pounds. If born at this period the fetus is able to breathe, cry and nurse, and may live if properly cared for.

“At eight months, the fetus seems to grow rather in length than in thickness; it is only sixteen to eighteen inches long and yet weighs from four to five pounds. The skin is very red, and covered with down and a considerable quantity of sebaceous matter. The lower jaw, which at first was very short, is now as long as the upper one.

“Finally, at term the fetus is about nineteen to twenty-three inches long, and weighs from six to nine pounds. The red blood circulates in the capillaries, and the skin performs the functions of perspiration; the nails are fully developed.”

There is a superstition that a child born at eight months is not as liable to live as if born at seven months; indeed, many suppose that an eight months’ child never survives. Facts do not prove this idea correct.

Personally I have known several eight months’ babies to live and do well, and I believe that their chance of life is much greater than if born at seven months.

Position of the fetus.—The fetus usually lies with the head downward, the chin resting upon the breast. The feet are bent in front of the legs, the latter flexed upon the thighs. The knees are separated from each other, but the heels lie close together on the back of the thighs; the arms are crossed upon the breast, so placed that the chin can rest upon the hands.

In this way it forms an oval, whose longest diameter is about eleven inches. This is the usual position, yet it often varies from it.