Ligaments of Uterus 391 



upper borders of these folds with the included uterus form a vertical 

 septum in the pelvis, whilst the lateral margins of the pouches con- 

 stitute the two anterior ligaments vesico-uterine, and the two posterior 

 ligaments recto-uterine. The blood-vessels, lymphatics, and nerves 

 of the uterus are placed between the folds of the broad ligament in a 

 good deal of loose connective tissue ; so are the ovary and its ligament, 

 the P'allopian tube, and the round ligament. The last-named is a 

 fibrous cord, five inches long, which is attached to the corner of the 

 uterus just below the Fallopian tube, and which passes through the 

 inguinal canal to spread out on to the tissues of the labium. In its 

 descent it carries a follicular process of the peritoneum, the canal of 

 Nuck, into which a piece of bowel, or even the ovary itself, may stray 

 (inguinal hernia, p. 310), and down which serous fluid may gravitate 

 (congenital hydrocele, p. 429). I have also seen an enormous encysted 

 hydrocele in this funicular process. Operations have been designed 

 for shortening these ligaments in the case of a backward tilting of the 

 uterus. It has likewise been thought that a forward tilting might 

 be due to a preternatural shortness of the ligaments. 



The broad ligament, the vessels and nerves of the uterus and ovary 

 which are within the broad ligament, the Fallopian tube, and the round 

 ligament constitute the pedicle of an ovarian tumour. Unilocular 

 cystic tumours not ovarian are often found in the broad ligament. 



The delicate sub-peritoneal tissue which connects the serous and 

 muscular coats of the uterus is liable to inflammation peri-metritis 

 but it may be impossible to distinguish this disease from inflammation 

 of the peritoneal coat itself. 



Structure. Beneath the sub-peritoneal coat is the thick wall of 

 non-striated muscular tissue, the fibres of which pass longitudinally, 

 obliquely, and transversely the longitudinal fibres being chiefly 

 external. Numerous blood-vessels run through this coat to the 

 mucous membrane. Hypertrophic outgrowths from the muscular 

 tissue, with a mixture of fibrous tissue, constitute the uterine Jibromata 

 or myomata ; they may extend towards the cavity of the uterus, or 

 appear as upheavals beneath the serous coat ; the latter may grow 

 harmlessly into the peritoneal cavity. According to their size and 

 situation these tumours may prevent conception, arrest gestation, and 

 complicate parturition. The intra-uterine growths cause frequent 

 bleedings and constant distress, and should, if possible, be enucleated. 

 These tumours sometimes shrivel up, or detach themselves under a 

 long course of ergot ; and sometimes, after parturition, they undergo 

 involution with the rest of the uterine wall. Their presence may be 

 determined, and size estimated, by the bimanual method of examination, 

 and by the uterine sound. With one index-finger in the vagina and 

 the other in the rectum, further information as to the size and position 

 of a tumour may often be obtained. Sometimes a submucous tumour 

 growing into the cavity stretches its base into a slender pedicle and 



