GIG 



UTERUS AND ITS APPENDAGES. 



Below this large pavilion is another, the 

 fringes of which are large and floating. This 

 abnormal pavilion exhibits two orifices se- 

 parated from each other by a valve, which, 

 being prolonged into the canal of the tube, 

 interrupts all communication between that 

 part of the canal placed above and that below 

 it. The valve is formed of a fold of mucous 

 membrane. A probe introduced by the ab- 

 dominal orifice of the tube escapes by one of 

 the two orifices of the supernumerary pa- 

 vilion, whilst one passed from the uterus 

 appears at the other orifice of the same 

 accessory pavilion. 



M. Richard points out a very important 

 influence which these abnormal openings may 

 have upon the functions of the oviduct. An 

 ovum having entered the terminal pavilion, 

 if while endeavouring to gain the uterus it is 

 directed along the wall of the canal which is 

 opposite to the accidental opening, it will 

 reach the uterine cavity; but if, instead of 

 coursing along the wall opposite to the so- 

 lution of continuity, it descends along this 

 wall itself, then it will almost inevitably escape 

 by this abnormal orifice, and will fall into the 

 peritoneal cavity. Now, if this ovum has 

 not been fertilised, nothing remarkable will 

 ensue upon its escape into the peritoneum ; 

 but if the contrary, then it is possible that 

 the fertilised ovum having escaped from the 

 canal which should conduct it to the uterus 

 will give rise to an abdominal pregnancy. 



Displacement of the Fallopian Tube. This 

 is, perhaps, one of those conditions of parts 

 which would be the least likely to be detected 

 during life, and it may on that account have 

 been often overlooked. It is of necessity 

 associated with displacements of certain other 

 organs, whenever such displacements occur ; 

 as, for example, with prolapsus inversion and 

 retroversion of the uterus. In extreme pro- 

 lapsus or procidentia uteri the tubes, along 

 with the ovaries, are carried down and occupy 

 a position on either side of the prolapsed 

 organ, and between it and the walls of the 

 inverted vagina, while in inversion the tubes 

 are contained in the pouch formed by the 

 reversed uterus.* In this latter case the rela- 

 tive situation of all the parts is so altered 

 that the uterine orifices of the Fallopian tubes 

 may be sometimes discovered as forming 

 oblique openings in the upper part of the va- 

 gina.-f- But displacement of the Fallopian tube 

 may occur alone, and constitute a true her- 

 nia. Such an occurrence is recorded by M. 

 A. Berard.J I" this case the displacement 

 took the form of a crural hernia, which was at 

 first reducible, but after gradually increasing 

 in size it could be no longer reduced. As 

 fluid was distinguishable within the hernial 

 sac a puncture was made, but peritonitis 

 ensued, followed by death ; and upon exami- 

 nation it was found that the sac contained 

 nothing but the hypertrophied Fallopian tube. 



* See /0s. 470 and 471. 



t Patholog. Museum, Roy. Coll. of Surg. Lond 

 No. 2654. 

 | Kevue Me'dicale, Mai 1839. 



Meissner* has collected three other cases, 

 of hernia of the tube, one of which was con- 

 genital. These are all instances of inguinal 

 hernia of the tube. In the "Journal fur, 

 Geburtshelfer-{- " an instance of displacement 

 of another kind is recorded. The left Fal- 

 lopian tube had escaped through a rent in the 

 walls of the vagina near the os uteri, and 

 descended as far as the labia, so that the fim- 

 briae could be easily distinguished during life. 



The most common displacements of the 

 Fallopian tubes are those which result from 

 adhesions consequent upon inflammation of 

 their peritoneal coat. Such adhesions con- 

 stituted by bands or extensive surfaces of false 

 membrane, tie down the tubes to surrounding 

 parts, and in most instances effectually pre- 

 vent the performance of their proper func- 

 tions ; as where the tubes are adherent to the 

 uterus, the sides of the pelvis, or the bladder 

 or intestines. But the union is most com- 

 monly found to have taken place between 

 the extremity of the tube and some part of 

 the surface of the ovary, so that these are 

 inseparably united together (fig. 409.), and very 

 frequently in some abnormal position (Jig. 

 420.) 



Obliteration of the Fallopian Tube. In 

 advanced life a natural contraction of the 

 tube takes place, and the fimbriae also di- 

 minish and lose their luxuriance of form ; but 

 it frequently happens that, independently of 

 these natural changes, and even at an early 

 period of life, the tubes are found nearly or 

 entirely obliterated. Such obliteration may 

 be occasioned by tumefaction of the lining 

 membrane of the tube, or by a collection of 

 inspissated mucus in some part of the canal ; 

 or the entire calibre of the tube may be ob- 

 literated by cellular formation (atresia tubae). 



Occasionally calcareous concretions have 

 been found obstructing the tube ; and the 

 same result has been produced by growths of 

 a malignant kind. 



The occlusion, however, is generally con- 

 fined to the abdominal end of the tube. In 

 these cases, usually, the firnbriee are destroyed, 

 the opening into the abdomen is completely 

 closed, and the tube ends in a blunt cul-de- 

 sac. Such a condition of parts is generally 

 associated with an enlarged and tortuous state 

 of the tube, the walls of which are usually 

 thickened, and its canal filled with fluid. In 

 such cases the obliterated end of the tube 

 may remain free and unattached, but it is far 

 more often found united inseparably to the 

 ovary. This junction of the tube with the 

 ovary by artificial adhesion is the most com- 

 mon of all the morbid conditions of the ovi- 

 duct. It has been supposed by some to be 

 the result of certain libidinous habits and 

 practices ; but this conjecture is not supported 

 by any statistical evidence. The explanation 

 given by Rokitansky, that this form of adhe- 

 sion results usually from an extension of ca- 



* Die Frauenzimmer Krankheiten, Leipzig, 1845, 

 Bd. IT. p. 203. 

 f Frankfurt u. Leipzig, 1787. 



