Residues between the Uterus, its Appendages, the Intestine and Om en are frequently found in this class, rarely in the former.
These are usually cases in which considerable residues of former in flammation are found in the uterus and its surroundings. In 130 cadavers of which 76 showed residues in the uterus, in the pars- and perimetrium, I found this condition 16 times. In a larger number of preparations I found the same percentage. These residues, in the form of plates or bands, are found either immediately between the uterus and a smaller or larger portion of the colon (5 times), small intestine (3 times), or omentum (once), and frequently they extend to the mesentery of the involved intestine, and to the connective tissue on it, or the uterus is bound by pseudo-membranes to the tubes and ovaries, and from these organs radiate pseudo-membranous bands to the ileum, descending colon, or sacrum; the vermiform appendix and the lower border of the mesentery are also sometimes found to be fixed by adhesions coming from the uterine appendages.
Most frequently it happens that the tubes, ovaries and broad ligaments are matted together by pseudo-membranes, which send smaller or larger prolongations, usually to the sigmoid flexure or to a higher point on the colon, or to the small intestines, which become more or less fixed, stretched or twisted. These residues between the uterus, the appendages and the intestines are often connected by smaller or larger pseudo-membranes with the pelvic peritoneum or with that portion of peritoneum lying over the pelvic inlet, under which, usually, subperitoneal tissue thickenings are found, and frequently these residues are also connected with the parametric residues in the immediate or more distant surroundings of the lacerated or cicatrized cervix. In this way a chain of residues exists which begins at the cervix and extends to the broad ligaments, tubes and ovaries, from thence to different points of the intestinal canal, sometimes to the lower border of the omentum and pelvic peritoneum, and also to higher points of the same and to the thickened connective tissue behind it.
Residues between the Cervix, Body of the Uterus and Bladder.—These are more frequently found in the cadavers of women belonging to the last class than iu the former. They are usually found in the tissue con
necting the cervix with the bladder, and sometimes they extend from the body of the uterus to the peritoneal covering of the bladder, as small or large pseudo-membranous threads, plates or strings. They were found twice in the 76 cases described above.
Simultaneous Disease of the Oraries and together with the residues in the'uterus and parametrium textural changes are found in the ovaries and tubes, besides the phenomena of perioophoritis and perisalpingitis which have also been caused by the former inflamma tion.
They are more frequent in the parous than in nulliparm.
The ovaries are frequently found enlarged and softened, and often contain small blood cysts. These varieties explain how sometimes ex cessive hemorrhage from the rupture of a follicle and the formation of hematocele takes place. Often the ovaries are found to be of normal size or smaller, but harder than normal. Often they undergo cystic de generation and assume a mulberry form as in Fig. 28. The stroma fre quently becomes dense, and but little follicular tissue remains. Often only the outer layer becomes very dense.
, A frequent finding in these cases is encapsulation of one or both ovaries in psendo-membranous sacs, so that on the specimen the ovaries cannot be seen (see Fig. 29). These pseudo-membranous sacs are often adherent and matted together with the colon and its surroundings. These pathological conditions of the ovaries and their surroundings render ovariotomy, salpingotomy or removal of all the appendages very difficult or impossible.
Of just as frequent occurrence is disease of the tubes; in nearly half of the cases with residues of inflammation in the pant- and perimetrium one or both tubes are found more or less diseased. The practically most important form of this disease is hydrops tubse, to a greater or less extent, as presented in Figs. 26, 27, 28 and 29. The size most frequently met with is that of the three first figures; rarely do the organs become as large as in Fig. 29, or reach the size of a child's fist, and still more rarely the size of a man's fist.