1034 



THE FEMALE ORGANS OF GENERATION. 



the cervix, through the vagina and attaching the cut surfaces of the stump to the anterior and 

 posterior vaginal walls, so as to prevent retraction. In the treatment of uterine fibroids which 

 require operative interference, removal of the whole of the uterus together with the tumors 

 through an abdominal incision gives the most satisfactory results ; for, if the tumor is large, its 

 size acts as a barrier to its safe delivery through the pelvis and genital passages. After the 

 abdomen has been opened the uterine vessels are secured and the broad ligaments divided in a 

 similar manner to that employed in vaginal hysterectomy, except that the proceeding is com- 

 menced from above. When the two first ligatures have been tied, and the broad ligament 

 divided, it will be found that the uterus can be raised out of the pelvis. A transverse incision 

 is now made through the peritoneum, where it is reflected from the anterior surface of the 

 uterus on to the back of the bladder and the serous membrane peeled from the surface of 

 the uterus until the vagina is reached. The anterior wall of this canal is cut across. The 

 uterus is now turned forward and the peritoneum at the bottom of Douglas's pouch incised 

 transversely, and the posterior wall of the vagina cut across until it meets the incision on the 

 anterior wall. The uterus is now almost free, and is held only by the lower part of the broad 

 ligament on either side, containing the uterine artery. A third ligature is made to encircle this, 

 and, after having been tied, the structures are divided between the ligature and the uterus. 

 The organ can now be removed. The vagina is plugged with gauze, and the external wound 

 closed in the usual way. The vagina acts as a drain, and therefore the opening into it is not 

 sutured. 



APPENDAGES OF THE UTERUS. 



The appendages of the uterus are the Fallopian tubes, the ovaries and their 

 ligaments, and the round ligaments. They are placed in the following order : in 

 front is the round ligament ; the Fallopian tube occupies the upper margin of the 

 broad ligament ; the ovary and its ligament are behind and below both. 



THE FALLOPIAN TUBES. 



The Fallopian Tubes, or Oviducts, convey the ova from the ovaries to the cavity 

 of the uterus. They are two in number, one on each side, situated in the upper 

 margin of the broad ligament, extending from each superior angle of the uterus to 

 the sides of the pelvis. Each tube is about four inches in length ; and is described 

 as consisting of three portions: (1) the isthmus, or inner constricted third; (2) the 

 ampulla, or outer dilated portion, which curves over the ovary ; and (3) the 



Plmbrla ovarica. 



FIG. 574. Uterine appendages, seen from behind. (Henle.) 



infundibulum with its ostium abdominale, surrounded by fimbriae, one of which is 

 attached to the ovary, ihefimbria ovarica. The general direction of the Fallopian 

 tube is outward, backward and downward. The uterine opening is minute, and 

 will admit only a fine bristle ; the abdominal opening is somewhat larger. In 

 connection with the fimbrige of the Fallopian tube or with the broad ligament close 



