398 The Uterus 



In procidentia, after rupture of the perineum, or as the result of a 

 yielding of attachments, the uterus sinks between the thighs, and in 

 due time its mucous covering, which is the everted vaginal lining, 

 becomes dry and tough like skin. 



Haematocele. The escape of the ovum from the ovary is associa- 

 ted with slight bleeding, but when this is unusually severe the blood 

 trickles down into the retro-uterine pouch (v. p. 389). A hasmatocele 

 may also result from a leakage from the veins of the Fallopian tube 

 or from the uterus. Eventually the blood may undergo coagulation. 

 By vaginal and rectal examination a doughy tumour is made out 

 which may compress the rectum and thrust the fundus uteri forwards ; 

 if the effusion be sufficient, a hypogastric tumour may be detected. 

 The collection may burst through the vagina or rectum, or it may be 

 absorbed or become inert. Frequently such collections have been 

 successfully tapped through the rectum. 



Rupture of the pregnant uterus may be caused by violence, or by 

 muscular energy during labour, especially if the passage of the foetus 

 be impeded. The rent is generally near the junction of the neck and 

 body, but it may be so extensive as to allow the escape of the foetus 

 into the peritoneal cavity. 



Flagging contractions of the uterus may be stimulated by the ad- 

 ministration of ergot, but this drug should not be given until the os is 

 so fully dilated as to offer no impediment to the passage of the foetus, 

 or rupture of the uterus might occur. 



Reflexes. The uterus has a strange and wide influence over the 

 person ; the word ' hysterical,' as applied to certain nervous phenomena, 

 is derived straight from vo-repa, the womb. Hilton went so far as to 

 ascribe the frequency of ' hysterical ' affections of the hip and knee- 

 joints to an association, through the sympathetic filaments, of the 

 ovarian and uterine nerves with the sciatic and obturator ! 



THE OVARY 



The ovary has the shape of an almond, and weighs about \ oz. It 

 is placed between the layers of the broad ligament, being attached to 

 the corner of the uterus by a short, slender ligament just behind the 

 Fallopian tube ; externally it is joined to a fringe of that tube (v. p. 390). 

 It floats freely in the pelvis, but is apt to wander in childhood clown 

 the inguinal canal ; I once had occasion to operate for a strangulation 

 of the ovary through the crural canal. It may also be prolapsed into 

 the antero- or retro-uterine pouch, where it can be felt through the 

 vagina, movable and, perhaps, very tender. 



It consists of a fibrous coat, tunica alhu^inea^ which sends delicate 

 processes into the interior to support the blood-vessels and the Graafian 

 follicles. The broad ligament invests it with a serous coat, tunica 

 vaginalis, which is covered with columnar epithelial cells. 



