280 Anatomy Applied to Medicine and Swgery. 



fundibulopelvic ligament well beyond the fimbriated ex- 

 tremity of the tube. A second ligature is applied to the 

 utero-ovarian ligament (the ovarian artery runs towards 

 the uterus in this ligament), while a third ligature is tied 

 over the top of the broad ligament at the cornu uteri, in- 

 cluding, therefore, the uterine vessels as well as the Fal- 

 lopian tube. After ligating as above, the ovary and the 

 tube are excised and removed. 



In abdominal hysterectomy, Kelly advises the 

 ligation of the uterine arteries, after splitting the 

 broad ligament and separating the cellular tissue of 

 the ligament by blunt dissection until the pelvic floor is 

 reached where the artery may be felt pulsating and where 

 it can be ligated. The reason for ligating the artery in 

 this situation is that, near the cervix, it lies almost im- 

 mediately above and at right angles to the ureter, and, be- 

 sides, in the neighborhood of the cervix, there are two 

 large uterine veins along with a large vaginal vein which 

 are in close association with it. 



Pelvic Suppuration is dependent on the presence 

 of pus-producing organisms. These may find their way 

 up through the vagina into the uterus, and thence through 

 the ostium abdominale into the pelvic cavity. An exam- 

 ple of suppuration, caused by organisms following this 

 route, is that due to the presence of gonococci. Another 

 route, whereby suppurative processes may invade the sys- 

 tem, is that seen where, after a confinement or an abortion, 

 etc., a metritis is developed, followed by a parametritis 

 and then by a pelvic cellulitis. If the case does not im- 

 prove and is not a suitable one for treatment by massage, 

 etc., and if pus develop, then it must be evacuated, and this 

 should be attempted by vaginal puncture, rather than by 

 abdominal incision. If the pus be not evacuated artificial- 

 ly, it may find an outlet naturally by breaking into the 

 rectum, the vagina, the bladder or the abdominal wall, 



