Branches to the isthmus (b'),

Numerous branches to the ovary (c' c' c'),

Branch to the round ligament (b).

The Uterine Artery (plate III. e) springs from the anterior division of the internal iliac and passes downwards and inwards towards the cervix uteri. It then passes upwards between the layers of the broad ligament by the side of the uterus, in an exceedingly tortuous manner well shown in plate III, to anastomose with the lower branch of the ovarian. Branches pass from it into the substance of the uterus; these are the curling arteries of the uterus. The Vaginal arteries (g g g) usually spring immediately from the anterior division of the internal iliac artery, but sometimes arise from the uterine or middle hæmorrhoidal. A special branch of the uterine artery to the cervix joins with its fellow at the isthmus to form the circular artery, and with those of the vagina to form the azygos artery of the vagina (h h). The vaginal arteries anastomose freely with those of the opposite side. Plate III., from

Hyrtl, illustrates beautifully the free anastomosis of branches of the aorta with the ovarian, uterine, and vaginal arteries. It should be noted that, in an operation for removal of the uterus, ligature of the broad ligament controls all hæmorrhage.

From the same anterior division of the internal iliac, proceeds the blood supply to the bladder and rectum.

(2.) Arterial supply to the perineal region.-This comes from the internal pudic. The superficial perineal branch supplies the labia; the artery to the bulb supplies the bulbus vaginæ; the terminal branches go to the clitoris.

(3.) Venous supply.-The venous supply of the pelvis is very abundant, and exists in the form of numerous plexuses freely communicating with one another. The veins are unprovided with valves. Hæmorrhage from a wound is therefore often exceedingly profuse, especially during pregnancy when the whole pelvic vascular system is hypertrophied.

The following is a summary of the main facts as to the venous supply of the female pelvis.

The vesical plexus lies external to the muscular coat of the bladder. The hæmorrhoidal plexus lies below the mucous membrane of the lower part of the rectum.

The veins of the labia correspond in distribution to the arteries, and those from the outermost parts drain into the pudic which opens into the common iliac vein. Large veins from the labia minora open into the pars intermedia of the bulb.

E

The veins from the glans and corpora clitoridis pass into the dorsal vein of the clitoris, which communicates with the vesical plexus.

The veins of the bulb pass into the vaginal plexus.

The vaginal plexuses- one outside the muscular coat and one in the submucous tissue-are most abundant at the lower part of the vagina,

Uterus and vagina with their venous
pampiniform plexus.

Fig. 62.

supply, seen from behind-(Luschka). Fallopian tube; pp

communicate with the hæmorrhoidal and vesical plexuses, and open into the internal iliac vein.

The uterine plexus is very abundant, as is well shown in one of

Hyrtl's plates; it ultimately opens into the ovarian veins (fig. 62), which pass, on the right side to the inferior vena cava, on the left to the left renal vein. The veins are small, lie in the outer muscular coat, and run longitudinally; they open into large sinuses in the middle layer of that coat, with which the capillary vessels communicate.

The ovarian plexus, otherwise known as the pampiniform plexus, lies between the folds of the broad ligament and communicates with the uterine plexus (fig. 62). Some apply this term to all the veins in the broad ligament. The ovarian plexus opens into the inferior vena

cava.

Beneath the peritoneum and between the layers of the broad ligaments are vast venous plexuses. Knowledge on this point is of the highest importance in relation to pelvic hæmatocele.

The vesical, hæmorrhoidal and vaginal plexuses, with the pudic veins, open into the internal iliac vein which opens into the inferior vena

cava.

From the hæmorrhoidal plexus, the superior hæmorrhoidal vein passes into the portal system; and thus we get a communication between the pelvic and portal venous systems.

LYMPHATICS.

Under this we take up

a. The Lymphatic Glands;

b. The Lymphatic Vessels.

a. The Lymphatic Glands.-These are (1.) the inguinal glands, which lie parallel to and just below Poupart's ligament; and (2.) the pelvic glands. These latter consist of (a) a gland at the isthmus uteri (Championniére); (6) hypogastric glands, which lie subperitoneally in the space between the external and internal iliac vessels; (c) sacral, on the lateral aspect of the anterior surface of the sacrum and in the mesorectum; and (d) a gland or collection of small glands at the obturator foramen -the obturator gland of Guérin. These all pour into the lumbar glands, which lie in front of the lumbar vertebrae and discharge into the thoracic duct.

b. The Lymphatic Vessels. (1.) Of External Genitals.-Numerous vessels form a network on the internal aspect of the labia majora, over the labia minora and round the vaginal and urethral orifices, vestibule and litoris; all of these open into the inguinal glands. From this arrangement, the enlargement of the inguinal glands in syphilis and vulvar cancer is intelligible. The lymphatics of the lower fourth of the vagina also open into these glands.

(2.) Of Vagina (upper three-fourths) and Cervix Uteri.-The lymphatics from these open into the hypogastric glands. So far we have followed Sappey's description.

Le Bec asserts that the lymphatics of the vagina pour into a series of trunks at the level of the isthmus uteri and that those of the cervix join them; and that the conjoined lymphatics then pass below the base of the broad ligament to the obturator ganglion, from which vessels communicate with others from the thigh and even from the epigastrium. The relation between lymphatics and glands is as follows:(a) Those of the external genitals pass into the inguinal glands. (b) The lymphatics of the vagina and cervix pass to the hypogastric glands (Sappey). According to Le Bec, they pass to the obturator gland.

:

(3.) Of Uterus.-The lymphatics of the body of the uterus pass through the broad ligaments, and, along with those from the ovary and Fallopian tube, enter the lumbar glands. If Le Bec be right, the lymphatics from the cervix pass below the broad ligament, and those from the uterus along the upper part of the same.

Leopold, who has investigated the lymphatics in the unimpregnated uterus, considers "the mucous membrane of the uterus as a lymphatic surface which contains no special lymphatic vessels, but consists of lymph sinuses covered with endothelium." "The lymph passes from the lymphatic spaces of the mucous membrane, through the mucous membrane hollows, into the lymph spaces and vessels of the muscular coat, surrounds here all the bundles up to the serous covering, and flows into the larger vessels which enter the broad ligament in the neighbourhood of the vessels." (Loc. cit. S. 31.)

These are matters not of mere anatomical detail, but of the very highest pathological and practical importance. The richness of lymphatic supply to the vagina, cervix, and uterus explains the extraordinary rapidity with which septic matter spreads through the body, and the extreme danger which may attend even an insignificant lesion of the internal genital organs, when septic matter is present and is absorbed. We may remark here that septic matter will of course follow the lymphatic routes already laid down. It should not be forgotten, however, that the bacteria passing along the lymphatic vessels may penetrate them, pass into the peritoneal cavity, and thence spread through the diaphragm to set up the pleurisy and pericarditis so common in septicæmia (Lusk). Thorough comprehension of lymphatic distribution and knowledge of the evil effects of septic matter are of the first importance to the student.

The lymphatics of the Rectum lie in two layers (mucous and muscular), and open into the glands of the mesorectum or into the sacral glands.

The stomata of the peritoneum of the pelvis communicate with lymph capillaries lying in the subendothelial tissue.

NERVES.

These are (a) Spinal, (b) Sympathetic.

(a) Spinal.-The following is the nervous supply of the pelvic muscles:

Levator and Sphincter ani are supplied by inferior hæmorrhoidal branch of pudic, 4th and 5th sacral, and coccygeal nerves;

Coccygeus, by 4th and 5th sacral and coccygeal nerves ;

Muscles of Perineum and Clitoris, by the branches of pudic nerve. (b) Sympathetic.-The hypogastric plexus, which lies between the common iliac arteries, gives off branches which, reinforced by branches from the lumbar and sacral ganglia and sacral nerves, form the inferior hypogastric plexuses-one on each side of the vagina. From these, filaments proceed to the vagina, uterus, Fallopian tube, and ovary.

The terminations of the nerves in the muscular layers of the uterus have been studied by Frankenhauser, who figures them passing to the nuclei of the unstriped muscle. Those entering the mucous membrane are said to end in ganglia. Numerous end bulbs have been found in

the clitoris and vagina.

DEVELOPMENT OF PELVIC ORGANS.

The following is a very brief summary :—

The Wolffian bodies appear in the foetus about the third and fourth week. They fulfil the function of kidneys until the second month, and

then wither.

The Fallopian tubes, uterus and vagina are derived from the Ducts of Müller. These appear on the anterior aspect of the Wolffian bodies. Their lower portions coalesce to form the uterus and vagina; while, above, they remain separate, as the Fallopian tubes.

The ovary first appears as a thickening on the Wolffian bodies. It is made up of interstitial tissue projecting from them and covered by epithelium-the germ epithelium. According to Foulis, the ova are developed from the latter; the cells of the membrana granulosa are formed from the connective corpuscles of the interstitial tissue. Waldeyer believes that the ova and the cells of the membrana granulosa both originate from the germ epithelium; and in this Balfour agrees with him (vide chap. on Ovarian Tumours).