PEOLAPSE OF THE UTEKUS. 447 



and tube explains why in certain cases of appendicitis the pain 

 and other symptoms are mistaken for disease of the uterine 

 appendages. It is of course possible on the other hand for septic 

 inflammation of the right tube to extend to the appendix lying 

 near it, but the reverse that is to say, inflammation passing 

 from the vermiform appendix to the broad ligament is more 

 common. 



Tubal Pregnancy. The ovum arrested in the Fallopian 

 tube may become impregnated, and a tubal pregnancy result. 

 The increase in the size of the ovum and the growth of its 

 membrane may erode the blood vessels supplying the part. The 

 consequent hemorrhage ploughs up the tissue of the broad 

 ligament, producing a haematoma, or ruptures the tube or the 

 broad ligament, and allows of free haemorrhage into the peritoneal 

 cavity. 



THE UTERUS. 



Prolapse. Prolapse of the uterus is practically a hernia of 

 the organ together with a portion of the pelvic floor. 



Procidentia is normally prevented by the support which the 

 uterus receives both from above and below. 



From above, the round ligament, passing from the upper part 

 of the lateral aspect of the body of the uterus, extends across the 

 anterior part of the broad ligament into the inguinal canal, and 

 serves as a very adequate support. 



The broad ligaments, directed outwards and then backwards, 

 reach the pelvic wall, to which they become attached. Their 

 lower borders are separated from the muscles constituting the 

 pelvic floor by a layer of connective tissue supporting the ureter 

 and a number of large veins passing away from the uterus and 

 the vagina. 



Lastly, the utero-sacral ligaments extend backwards from the 

 level of the supravaginal portion of the cervix, along the side of 

 the pelvis, to the front of the rectum. These form the upper 

 limit of the pouch of Douglas. 



From below the uterus is supported by the perineal body and 



