The Pelvis. 



279 



glands. Those for the lower part of the cervix and the 

 upper part of the vagina enter glands on the pelvic floor 

 and accompany the uterine and iliac vessels to the glands 

 along the common iliac arteries, while those for the lowest 

 part of the vagina and external genitals communicate with 

 the superficial and the deep inguinal glands. Nerves. 

 The nerves of the uterus are derived from the third and 

 fourth sacral, the hypogastric plexus of the sympathetic 

 and the renal plexus, which, latter, supplies the ovaries 

 and the Fallopian tubes as well. The vagina is supplied 

 by the fourth sacral, the hypogastric plexus and the pudic 

 nerve. 



Operations. To locate the ovaries in salpingo- 

 oorphorectomy, or removal of the tubes and ovaries, after 

 the abdomen has been opened, the index and middle fin- 

 gers are conducted along the under surface of the abdom- 

 inal wall to the symphysis, thence over the bladder to the 

 uterus, then outwards, over the cornu uteri to the broad 

 ligament, behind which the tube and the ovary are, as a 

 rule, readily found. The best way to pick up these struc- 

 tures is to carry the fingers to the outer extremity of the 

 broad ligament, and then, turning the palmar surfaces 

 astride the broad ligament towards the uterus, to hook up 

 both tube and ovary together. Ligation of the pedicle. 

 The uterine and ovarian vessels must be tied separately 

 while the non-vascular portion of the broad ligament be- 

 tween them is left free. The clear space in the broad lig- 

 ament is a triangular surface near its upper and outer ex- 

 tremity and is free from vessels, being bounded above by 

 the ovarian vessels, below and on the inner side, by the 

 round ligament, while on the outer side is the pelvic wall. 

 The first ligature includes the ovarian artery and veins, 

 and is passed through the clear space of the broad liga- 

 ment and tied near the pelvic brim over the top of the in- 



