DISEASES OF THE LIGAMENTS, PELVIC PERITONEUM AND PELVIC CELLULAR TISSUE.
Dr. L. Ran, of Heidelberg, has collected facts in relation to them from literature, and we borrow our remarks on this subject largely from his work. Tumors in and around the round ligaments, in the neighborhood of the inguinal canal, are of practical importance on account of their being easily con founded with hernia and fibrous tumors of the round ligaments, owing to their intimate connection with the abdominal wall.
Malformations, Hypertrophy, and Atrophy, Hypercemia and Inflamma tion, Lacerations, shortening of one of the ligaments is frequently observed, and it may cause obliquity of the uterus to the corre sponding side. Also a downward displacement of the round ligament on one side of the uterus may cause a slight displacement of the organ. Absence of the round ligaments is observed only with absence of the uterus. Ruysch describes a case where there was a second round ligament attached to the neck of a uterus that was deflected to the right. Blob thinks that in this case a membranous band was mistaken for a round ligament.
Hypertrophy and the round ligaments are really contin uations of the muscular structure of the uterus, hypertrophy is a constant accompaniment of pregnancy, and during their thickened state they can be felt on the side of the uterus. In case of pregnancy in one horn of a double uterus, the ligament on the corresponding side is found thickened.
Thickening of the round ligament always accompanies pathological en largement of the uterus. Likewise with atrophy of the uterus we find the round ligament diminished in size.
Hyperaemia and repeatedly found the liga ments in a state of hyperaemia in women who died during menstruation, and also where the return circulation had been impeded for a long time.
The distension of the veins in the inguinal canal, that is frequently met with in pregnant women, has been described by Aetius as hernia varicosa mulierum. Boivin and Dues illustrate the same condition after Cloquet as " Varicoale des cordons suspubiens," with the remark that the distended veins might simulate double inguinal hernia. Similar cases are reported by Cruveilhier and Teale. Rau quotes several cases where the round ligaments were the sole seat of an inflammatory process. Scanzoni observed the extension of inflammation from the uterus to the round ligaments in the bodies of women who died during the puerperal state, and is also inclined to ascribe the pain that is frequently felt in the inguinal region in cases of chronic metritis to the extension of the in flammation from the uterus to the round ligaments.
Petsche reports a case of laceration of the round ligament and its pro lapse by the anus. Korb mentions a case where, during delivery, rupture of a vessel caused hemorrhage into the parenchyma of the round liga ments, and through the inguinal canal externally, forming a hematocele on the right side.
Spasm of the round Ligaments. —This is an affection observed in 1805 by Delmanzo at the Tubingen clinic, and quoted by Scanzoni. An epi leptic girl of nineteen years at times felt violent pains in the right in guinal region, and thought that something protruded there. At each attack the cervix was found to be displaced to the left, and when the pains subsided, it returned to its normal place. F. A. Walter and Voigtl mention a calcification of, and Boivin and Dugs an osseous concretion in, the round ligaments.
Hydrocele of the round most frequent cause of the disease described under this name, seems to be the persistence of the processus vaginalis. Dr. Saechi pointed out in his treatise on " Hydrocele in Women " that Warthon, Camper, Weisberg and others found that this peritoneal appendix existed both in young girls and adults. Dr. kandl in his treatise on the " Vaginal Process of the Peritoneum," states that he found in the cadavers of nineteen girls aged from one to twelve • weeks four times the diverticulum of Nuck, three of which were on both sides. In his investigations he came to the conclusion, that with the for mation of the anterior abdominal wall, the vaginal process also grows if it is not obliterated soon after the descent of the testicles. The diverticu lum of Nuck may remain open, or become obliterated at a higher point, in such a way that a hollow space is left behind, as illustrated by Blob. In both cases this hollow space may become filled by a serous or purulent exudation, forming tumors which have been frequently opened by surgeons, who by the symptoms diagnosticated strangulated hernia, were induced to perform herniotomy, and found neither intestine nor omentum.