A theoretical and practical treatise on midwifery, including the diseases of pregnancy and parturition / by P. Cazeaux ; rev. and annotated by S. Tarnier.

  • Cazeux, Pierre, 1808-1862.
Date:
1871
Catalogue details

Licence: Public Domain Mark

Credit: A theoretical and practical treatise on midwifery, including the diseases of pregnancy and parturition / by P. Cazeaux ; rev. and annotated by S. Tarnier. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    pains in coition, and is a fruitful source of the acute or chronic inflam- matory engorgements of the uterus. I have met with a case of considerable shortening of the vagina, in which the os tincse had been sufficiently dilated by the membrum virile, to admit the index finger. In some instances the repeated coition produces a sort of artificial vagina, behind the os uteri, at the expense of the posterior vaginal wall, and if the finger be then carried under the neck of the womb, it will dip into a pocket, the anterior wall of which is placed against the posterior one of the uterus. This artificial vagina, produced by forcing up the posterior cul-de-sac, is sometimes longer than the natural canal. The vagina is in relation by its external face: in front, with the bas-fond of the bladder, to which it is united by some condensed areolar tissue, and also with the canal of the urethra, which indeed appears to be channelled out in its substance; behind, it is connected with the rectum, superiorly by a double fold of peritoneum, and inferiorly by areolar tissue, which is less condensed than that existing in front. Hence, the rectum is seldom drawn upon in the displacements of the uterus, whilst the bladder always partici- pates more or less in these accidents. The lateral borders afford attach- ment, above to the broad ligaments, and below to the pelvic areolar tissue and to some venous plexuses. The internal face of the vagina is covered by a mucous membrane, con- tinuous with that of the uterine cavity, excepting that its epithelium is not prolonged into the orifice of the latter, but terminates by a sort of denti- culated border, similar to the relation of the oesophageal epidermis with the stomach ; the internal surface also exhibits some wrinkles or rather some transverse elevations near the vulvar orifice. A raphe, or prominent ridge found on the median line, extends the whole length of the anterior wall of the vagina, affording origin to all those rugse; but the raphe is not so well marked on the posterior parietes as on the anterior; the term columns of the vagina has been applied to these two ridges. The transverse rugae are much better developed in young virgins and aged females; but, on the contrary, during pregnancy, and for a short time after delivery, they are nearly effaced. These transverse rugae have by some physiologists been regarded as organs of special sensation, and as designed to increase friction by the irregularities which they present. [The upper extremity of the vagina embraces the neck of the uterus, to which it is attached, at the junction of the lower with the middle third. The neck is thus divided into two portions, an intra-vaginal and a supra-vaginal portion. At the point of insertion there is a true continuity of tissue between the vagina and uterus, inasmuch as on the one hand the vaginal mucous membrane is simply reflected so as to form the mucous membrane of the os tineas, whilst on the other, the muscular fibres of the vagina are directly continuous with those of the uterus.] In thus folding upon itself in order to embrace the neck, the mucous membrane of the vagina forms a circular groove or cul-de-sac, described as the anterior and posterior cul-de-sac. The posterior one is, generally, deeper than the anterior, owing probably to the insertion of the vagina behind, upon a more elevated point of the neck.