448 CLINICAL APPLIED ANATOMY. 



the visceral layer of the pelvic fascia, together with the muscles 

 forming the floor of the pelvis, particularly the levator ani, on 

 each side. 



Coincidently with the descent of the uterus in prolapse, the 

 bladder is drawn downwards, and the vaginal wall may protrude 

 at the vulva, constituting a cystocele. Similarly, but later, the 

 rectum may be displaced together with the posterior vaginal wall, 

 forming a rectocele. 



When the prolapse is great, the ureters may be so stretched as 

 to interfere with the passage of urine through them, and double 

 hydronephrosis result. 



Metritis. The serious consequences which result from septic 

 inflammation of the body of the uterus are readily explained 

 anatomically. 



The blood from the uterus is returned through a large plexus 

 of veins in the broad ligament, which eventually empties its 

 contents into the internal iliac vein. In septic metritis following 

 upon parturition, the venous spaces in the uterine wall become 

 filled with blood clot teeming with micro-organisms, and 

 gradually an infective thrombosis extends proximally to the 

 internal iliac, and even the common iliac veins on one or both 

 sides. Should the common iliac veins become blocked with a 

 septic clot, phlegmasia will occur. 



Inflammation of the wall of the uterus may extend laterally 

 into the tissue between the layers of the broad ligament, 

 constituting pelvic cellulitis or parametritis. Or it may progress 

 so as to involve the peritoneal covering, thereby inducing pelvic 

 peritonitis or perimetritis. 



Pus originating from inflammation of the uterus may, if left 

 to itself, find its way out through the vagina, or may track 

 upwa'rds between the layers of the broad ligament, so as to 

 reach the iliac fossa and point above the middle of Poupart's 

 ligament, or may evacuate itself through the rectum. 



Myomata. Myomata of the uterus may be said to exist in 

 three varieties, according to the position in which they are 

 found interstitial, subperitoneal, and submucous. 



