THE EXAMINATION OF THE PELVIC ORGANS.
I. METHODS OF EXAMINATION.
1. =Male Pelvis.= When the removal of the external genitals is
permitted the fundus of the bladder is taken in the left hand and
pulled toward the head of the cadaver while the anterior wall is
separated from the pubis. This can be done with the fingers of the
right hand or the point of the knife. The loose connective-tissue
is torn on both sides around the urethra and rectum until the hand
can be passed beneath the rectum, completely encircling it and the
prostate which must be freed as far as its anterior border. The
legs of the cadaver are then separated, and an incision is made
with the large section-knife, through the skin, beginning above at
the root of the penis, at the termination of the main incision, and
following the arch of the pubis around the external genitals down to
the left, passing around the anus to the coccyx. A similar incision
is then made on the right side of the external genitals to meet the
first incision behind the anus. The outer genitals are then held in
the left hand and pulled downward between the legs while they are
dissected from the pubis, cutting the suspensory ligament of the
penis, to the level of the posterior border of the symphysis. The
knife is then run through into the pelvis just beneath the symphysis,
and while traction is made upon the external genitals toward the
right, a sweeping cut is made downward to the left along the pubic
arch, severing the insertion of the cavernous portion of the penis on
that side. A similar cut is then made on the right side. The penis
thus freed is then pushed up beneath the symphysis into the pelvis
and the scrotum pulled up after it, putting the perineum on the
stretch and pulling up the anus so that it can be seen. While the
external genitals are forcibly pulled upward in the pelvic cavity
toward the head, the encircling incision behind the anus is deepened,
cutting the fat-tissue, connective-tissue, and muscle around and
behind the rectum, until the whole mass of genital organs and rectum
is so loosened that it strips up easily to the brim of the pelvis,
where any remaining attachments of peritoneum or blood-vessels are
severed and the entire mass removed for examination on the board.
The mass is laid upon the board with _rectum_ uppermost. The latter
is then opened from the anus, using the intestinal shears, and
scraping off the contents into a pail so as not to contaminate the
other tissues. The rectum is then separated from the base of the
bladder and prostate, guiding the incision along the outer muscular
layer of the rectum, and stripping off the latter until the _seminal
vesicles_ are wholly exposed. These are then examined by means of
transverse cuts, or are opened longitudinally with the knife or fine
probe-pointed scissors. The _prostate_ may also be sectioned from its
posterior surface, if it is desired to preserve the urethral side
intact. _Cowper’s glands_ are also accessible from this incision.
The organs are then turned over, the penis put on a stretch and the
anterior wall of the urethra cut in the median line from the meatus
to the bladder. A pair of strong, medium-sized probe-pointed scissors
should be used. The incision is extended through the anterior wall
of the bladder. The mouth of the _ureters_, _ejaculatory ducts_ and
ducts of _Cowper’s glands_ are examined. If the prostate has not
been examined from the rectal side it may now be examined by means
of transverse incisions across the urethra and extending entirely
through the gland. The section of the genitalia is then finished
by the examination of the _testicles_. The latter are removed by
enlarging the inguinal canal on each side, slipping the testicles
up through them, and bisecting each gland so that the incision
falls through the head of the epididymis. The testicles may also be
examined by means of incisions made in the scrotum over the glands,
which are forced through the incisions and then bisected. If the vasa
deferentia are to be preserved they should be dissected out before
the semicircular cuts on each side of the external genitals are made.
When the kidneys have been removed, and the ureters left uncut, to be
examined in connection with bladder and external genitals, they are
usually left lying on the thighs until the abdominal examination is
finished. They are then laid in the abdomen until the pelvic organs
have been separated up to the brim of the pelvis. At this point
care should be taken to see that the ureters are not cut when the
whole mass of pelvic organs, ureters and kidneys is removed. When
placed upon the board the ureters are laid straight and the kidneys
placed in their respective positions. The _ureters_ are sounded from
the bladder and when desired opened upward from the bladder to the
kidneys. The section of the kidneys may then proceed according to the
directions given in the last chapter.
[Illustration: FIG. 45.—Section of male pelvic organs. Arrows mark
line of incisions through prostate and rectum. (After Nauwerck.)]
When the external genitals cannot be removed, the _testicles_ can be
examined by enlarging the inguinal rings and canal, and forcing each
testicle up from below, through the ring. The gland is then sectioned
and, after examination, returned to the scrotum. The anterior wall
of the bladder is then separated from the pubis and the tissues
about rectum and prostate loosened until the hand can completely
encircle the rectum and prostate. These organs and the bladder are
then pulled up firmly toward the head of the cadaver, and with the
cartilage-knife hugging the pubic bone the rectum is cut just above
the internal sphincter, and the urethra just anteriorly to the
prostate. When it is desired to get as much of the penis as possible,
its attachments to the pubis are cut from the pelvic side, and the
body of the penis pulled up into the pelvis, while the skin of the
organ is loosened as far as the glans. The body of the penis may be
severed from the glans or the glans may be freed from the prepuce
and removed with the entire organ, leaving only the skin to be used
for the restoration of the part. After the rectum and urethra are
severed, the mass of pelvic organs is stripped up to the brim of the
pelvis and removed, as given above. They are examined upon the board,
opening first the _rectum_, then the _seminal vesicles_, _prostatic
urethra_, _bladder_ and _prostate_. The prostatic urethra and
anterior bladder-wall are cut with the small probe-pointed shears,
while the prostate is cut transversely with the long section-knife.
The _bladder_, _prostate_ and _seminal vesicles_ may be examined
in situ, or separated from the rectum and examined outside of the
body. The anterior wall of the bladder is freed from the pubis,
and the lateral connections of the prostate separated. The bladder
is then opened in its anterior wall by an incision from its fundus
into the prostatic portion of the urethra. The prostate is then
cut transversely at about its middle, the cut extending entirely
through the organ. The fore-finger of the left hand is then hooked
underneath the prostate, and the bladder stripped forcibly from the
rectum, upward toward the pelvic brim. The base of the bladder is
thus brought up into view, exposing the seminal vesicles, which are
examined by transverse incisions.
In the employment of any one of these methods, the urine, if it is to
be saved for examination, should first be drawn through a catheter.
This is also the cleanest way of emptying the bladder, particularly
when it is greatly distended. The employment of force to squeeze the
urine out of the bladder through the urethra is not advisable when
there is any disease of bladder or urethra present.
[Illustration: FIG. 46.—Section of female pelvic organs. Urinary
bladder bisected and vagina opened in anterior median line. Arrows
show direction of incisions. (After Nauwerck.)]
2. =Female Pelvis.= The contents of the pelvis and the external
genitalia are removed from the female cadaver in the same way as in
the male. The anterior wall of the bladder is first freed from the
pubis and the tissues separated around and behind the rectum so
that the hand can be carried around the vagina and rectum. When the
external genitalia are to be removed with the internal organs, an
encircling incision is made on both sides of the external genitals,
beginning above at the termination of the main incision at the
beginning of the anterior commissure, and meeting behind the anus.
The external genitals are then dissected away from the arch of the
pubis until the knife can be passed up beneath the symphysis and the
attachments to the posterior border of the arch cut on both sides,
so that the vulva can be pulled up beneath the pelvic arch, putting
the perineum on the stretch. The posterior portion of the encircling
incision is then deepened until the entire mass of external genitals
and anus can be stripped up with the internal organs to the brim of
the pelvis, where they are held up perpendicularly and any remaining
attachments of peritoneum and blood-vessels cut, care being taken to
cut outside of the ovaries and tubes. The mass thus removed is laid
on the board with _rectum_ uppermost and the latter opened first.
The organs are then turned over, and the _urethra_ and _bladder_
opened in the anterior median line with the probe-pointed shears. The
_vagina_ and _uterus_ are then opened in the anterior median line,
bisecting the urethra and bladder. A heavy pair of shears having one
blunt-pointed blade should be used. If it is desired to save the
bladder and urethra, they can be dissected over to the right, or the
vaginal wall can be cut on its left side. When the cervical canal
will not admit the scissors the _uterus_ may be cut in the median
line with a knife. The horns may then be opened with the scissors.
Additional cuts may be made into the uterine wall as desired (tumors,
placental site, etc.). The _tubes_ may be sounded from the abdominal
extremity and then opened for their entire length with the fine
probe-pointed shears, or they may be examined by means of transverse
cuts. The _ovaries_ are held with their flat surfaces between
thumb and index-finger and then sectioned in the plane of greatest
dimension from the convex border to the hilus. The _broad ligaments_,
_parametrium_, _parovarium_ and _lymphnodes_ are examined by means of
cuts made parallel with the sides of the uterus.
When the external genitals cannot be removed, the vagina and rectum,
after they have been freed from the surrounding tissues, are put on
the stretch toward the head of the body and cut through as close
to the pubic outlet as possible. When this is carefully done it is
possible to secure the inner labia and the urethra intact. The rectum
is cut as close to the anus as possible. The organs are then stripped
up to the brim of the pelvis, then held up perpendicularly while
the remaining connections are severed. The organs thus removed are
examined on the board in the same manner as given above. When the
organs cannot be removed from the body, the bladder and urethra are
examined by an anterior median incision after they have been freed
from the symphysis. The uterus and vagina are then cut with the knife
in the anterior median line, either through the bladder or after
the latter has been dissected away. The ovaries, tubes and broad
ligaments are then examined as directed above. The uterus and vagina
may also be dissected from the rectum and opened by a posterior
median incision. This method is used in medicolegal examinations.
To facilitate the removal of the genital organs in either sex a
symphysiotomy may be performed and the pubic arch pulled apart, or
a portion of the pubis may be cut out with the saw.
When permission to open the body by means of the usual
main-incision cannot be obtained, it is possible to remove the
thoracic and abdominal organs through the vagina or rectum. The
cadaver is placed on its back, with buttocks near the end of the
table, the thighs separated as widely as possible and flexed upon
the body. In the male the scrotum is drawn up out of the way. A
circular perineal incision is then made, beginning anteriorly at
the perineoscrotal junction and extending around the anus. The arm
may be introduced through this opening after the removal of the
rectum and the abdominal and thoracic organs pulled downward and
removed. In the female the uterus and vagina are removed through
the vaginal opening; the arm is then introduced and the abdominal
and thoracic organs removed.
II. POINTS TO BE NOTED IN THE EXAMINATION OF THE PELVIS.
=I. MALE PELVIS.= 1. =Penis.= Size, anomalies, condition, character
of prepuce, evidence of circumcision, presence of smegma, character
of meatus, discharge, wounds, scars (on and back of corona),
evidence of syphilis, neoplasms, etc. Postmortem priapism occurs
particularly in leukæmia. It may be caused also by traumatic or
infective thrombosis and hæmorrhage, tumor-metastases, inflammatory
infiltrations, and in death from hanging. The most important
pathologic conditions of the penis are: inflammations (balanitis,
posthitis, cavernitis, gonorrhœa, etc.), gangrene, phimosis,
paraphimosis, præputial concretions, soft chancre, hard chancre,
secondary syphilides, traumatic lesions (fracture, hæmorrhage,
urine-infiltrations, etc.), anomalies (hypospadias, epispadias,
etc.), tuberculosis (rare), condylomata, elephantiasis, cornu
cutaneum, carcinoma, sarcoma (rare; melanotic sarcoma the most common
form), secondary carcinoma (primary in prostate), lipoma, angioma and
teratoma.
2. =Scrotum.= The most important pathologic conditions of the scrotum
are: œdema, inflammation, gangrene, trauma, burns, elephantiasis,
carcinoma, melanotic sarcoma, lipoma, fibroma, myofibroma,
lymphangioma and teratoma.
3. =Testis and Epididymis.= Testis and epididymis weigh 15-30 grms.
Note _size_, _form_ and _consistence_. Normal color of cut-surface
is grayish yellow; becomes brown in atrophy. Note character of
tunics (color, lustre, smoothness, consistence, etc.), and contents
of sacs (hydrocele, hæmatocele, empyema, etc.). The most important
conditions affecting the testes are: inflammation (orchitis,
epididymitis, vaginitis, abscess, hæmatogenous inflammations in
pyemia, mumps, scarlet fever, typhoid fever, variola, chronic fibroid
orchitis in syphilis, gonorrhœal epididymitis), tuberculosis,
gonorrhœa, syphilis, actinomycosis, leprosy, leukæmic infiltrations,
atrophy, compensatory hypertrophy, cryptorchidism, hydrocele,
varicocele, spermatocele, cysts, malignant teratomata (syncytioma,
cysts, cystocarcinoma, adenocarcinoma, adenoma, adenosarcoma,
cystosarcoma, rhabdomyosarcoma, chondroma, osteoma, myxoma, etc.),
carcinoma, sarcoma, lipoma, fibroma, etc., metastatic sarcoma and
carcinoma, dermoid cysts, benign teratoma, parasites (echinococcus
is rare). Tuberculosis is most common in the epididymis; syphilis
more frequently affects the body of the testis. Torsion of the vas
deferens may occur; atrophy of the testis may result. Twisting
or thrombosis of the spermatic vessels may cause gangrene of the
testicle.
4. =Rectum=. Note _contents_ (amount, color, consistence, odor,
etc.), _color_ and _character of mucosa_ (normally grayish red
or reddish gray, smooth and translucent, solitary follicles just
visible). Normally the rectum should contain formed brownish féces;
in catarrh the contents are fluid and not formed, while the mucosa is
covered with a thick glassy mucus. In obstruction of the gall-ducts
the féces are gray (“clay-color”). In catarrhs and chronic passive
congestion the mucosa is red. Decubital ulcers are often green from
the imbibition of bile, and are surrounded by hæmorrhages. They are
circular or correspond in shape to the fécal mass pressing upon them.
Traumatic ulcers, hæmorrhages, diphtheritic inflammation, follicular
ulcers, foreign bodies, stricture, fécal impaction, hæmorrhoids,
fissures, fistulous tracts, tuberculosis, syphilis, adenomatous
polyps and carcinoma are the most common pathologic conditions. The
oxyuris vermicularis is the most common animal parasite. Gonorrhœa
of the rectum is not uncommon. Stricture is most commonly caused by
syphilis.
5. =Prostate.= Normal size is about that of a walnut or
horse-chestnut. Weighs 19-25 grm. Average dimensions are 2.7
cm. long, 4.0 cm. broad, 2.0 cm. thick. Note form, consistence,
color of cut-surface (smooth or granular), amount of secretion,
corpora amylacea (color brown to black), size of gland-spaces,
cysts, abscesses, tubercles, neoplasms. The most common pathologic
conditions are: hyperplasia (usually inflammatory, the result of
old gonorrhœal infection, less commonly due to chronic pyogenic
infection), neoplasms (carcinoma is relatively common, usually
developed in a prostate showing chronic inflammatory hyperplasia,
adenoma, myoma, fibroma, myofibroma), cysts, acute inflammation
(usually gonorrhœal), typhoid prostatitis, abscesses, tuberculosis,
syphilis (rare) and atrophy. Thrombosis and the formation of
phleboliths are very common in the prostatic veins; they are usually
associated with gonorrhœal infection. The inflammatory hyperplasia
may involve one or all three lobes of the prostate. In old men
showing no evidences of prostatic inflammation the prostate may be
atrophic.
6. =Seminal Vesicles and Duct.= Should be symmetrical. Note size,
contents, character of wall, and appearance of lining membrane. They
measure 3-5 cm. long, 1-2 cm. broad and 0.7-1.5 cm. thick. Gonorrhœal
inflammations and tuberculosis are the most common conditions. In
old men the vesicles contain a brownish-yellow mucoid substance.
As a result of chronic inflammation the walls of the vesicles are
thickened, often hyaline; the lumen is sometimes wholly obliterated.
Calcification of the wall is not uncommon. Concretions are found in
the vesicles following obstruction. Cystic dilatation may occur.
Primary neoplasms (carcinoma and sarcoma) are rare.
7. =Urethra.= Mucosa should be grayish-red, smooth, shining and
transparent. The most common and important pathologic condition
is gonorrhœa (acute, chronic, anterior, posterior, erosions,
ulcers, abscesses, perforation, stricture, periurethral abscess,
cavernitis, etc.). Non-gonorrhœal urethritis is rare (colon- and
influenza-bacillus, streptococcus, pneumococcus, etc.). Trauma
(crushing, laceration, perforation, urine-infiltration, hæmorrhage,
periurethral abscess, phlegmon, gangrene, stricture, urinary fistula,
etc.), soft chancre, hard chancre, secondary and tertiary syphilitic
lesions (gumma), tuberculosis (lupus), leprosy and neoplasms
(rare: adenoma, carcinoma, melanotic and round-cell sarcomata
[lymphosarcoma], fibroma, angioma) may occur. The most common
anomalies are hypospadias and epispadias.
8. =Bladder.= _Size_, _degree of distention_, _amount_ and
_character of contents_, _character_ and _color of mucosa_ (normally
gray-red, smooth and transparent), _muscle-coats_ (hypertrophic,
atrophic). The most common pathologic conditions are: anomalies
(ectopia, ecstrophia, vesica bipartita, vesica bilocularis,
diverticula), congestion, œdema, cystitis (acute and chronic
catarrh, cystitis granulosa, cystica, purulent, phlegmonous,
diphtheritic, emphysematous, interstitial, peri- and paracystitis,
erosions, ulcers, gangrene, malakoplakia), tuberculosis, dilatation,
trauma (rupture, perforation, fistula), neoplasms (papillary
fibro-epithelioma, carcinoma, adenoma, myxoma, myoma, rhabdomyoma,
angioma cavernosum, sarcoma, dermoids, secondary carcinoma [usually
from prostate], and sarcoma [melanotic sarcoma]), concretions
(urates, uric acid, oxalates, phosphates, carbonates, cystin and
xanthin), and parasites (filaria sanguinis, distomum hæmatobium,
echinococcus, trichomonas, ascaris and oxyuris).
=II. FEMALE PELVIS.= =1. Rectum.= Note same things as given above
for the examination of the rectum in the male. Gonorrhœa, stricture
due to syphilis and traumatic fistula (due to child-birth) are more
common in the female.
2. =Vulva.= The most important pathologic conditions are:
congestion, œdema, hæmorrhage, hæmatoma, trauma (laceration),
vulvitis (catarrhal, gonorrhœal, chronic, diphtheritic, gangrenous,
phlegmonous, ulcerative, abscess), erythema, eczema, herpes, acne,
furunculosis, pruritus, kraurosis vulvæ, leukoplakia, Bartholinitis,
retention-cysts, cysts of the glands of Bartholin, hydrocele
muliebris, syphilis (primary, secondary and tertiary lesions),
tuberculosis (lupus), elephantiasis, condylomata, neoplasms (lipoma,
fibroma, lymphangioma, papilloma, fibromyxoma, fibromyoma, chondroma,
neuroma, carcinoma [usually very malignant in type], sarcoma [rare]
and metastatic tumors [very rare]).
3. =Urethra.= Same conditions as noted above for the male. Small
polypoid granulomata (caruncles) are very common; usually gonorrhœal
in origin. Primary carcinoma is more common in the male.
4. =Bladder.= Note same conditions as given above. Rectovesical and
vesicovaginal fistulas are not rare as the result of child-birth.
Secondary carcinoma is more common than in the male (from uterus and
cervix), primary carcinoma more rare. Ascaris and oxyuris may enter
bladder from vagina through a rectal fistula.
5. =Vagina.= Note size (about 5-8 cm. long), contents (foreign
bodies, pus, blood, etc.), color of membrane, condition of rugæ,
hymen, etc. The color of the mucosa varies from a delicate rosy
red to a bluish purple in the late stages of pregnancy. The most
important conditions are: colpitis (acute and chronic, catarrhal,
diphtheritic, gangrenous, emphysematous, granular, nodular, adhæsiva,
exfoliativa, vetularum, ulcerative; gonorrhœa the chief cause;
also caused by mercuric chloride and other poisons; occurs also in
cholera, typhoid fever, variola, scarlatina, diphtheria and other
infections), ulcers, abscesses, erosions, strictures, varices,
prolapse, atresia, trauma (lacerations, rupture, hæmatoma, fistula),
tuberculosis (rare), syphilis (primary less common than on vulva,
secondary lesions common, gumma rare), thrush, cysts (retention,
remains of Müllerian and Wolffian ducts, gas-cysts), neoplasms
(papillary fibro-epithelioma, fibroma, myxoma, myoma, rhabdomyoma,
rhabdomyosarcoma, myxosarcoma), carcinoma (primary rare, secondary
relatively common, particularly of malignant chorio-epithelioma;
primary ectopic chorio-epithelial tumors occur in vagina also),
and parasites (trichomonas vaginalis, oxyuris vermicularis). Note
particularly condition of hymen.
6. =Uterus.= The developed uterus weighs 33-41 grms. In women who
have not borne children the dimensions are 7-8 cm. long, 4 cm. broad,
2.5 cm. thick; in women who have borne children the dimensions are
8-9 cm. long, 5-6 cm. broad, and 3 cm. thick. The dimensions of the
postpartum uterus vary greatly, where normal contraction has taken
place the length is 8-9 cm., breadth 5-6.1 cm., thickness 3.2-3.6
cm., and weight 102-120 grms. Note _size_, _shape_, _character of
peritoneal coat_, _consistence, character of cut-surface_, _size_
and _contents of cavity_. Length of uterine cavity 5.2-5.7 cm.
Note relations between body of uterus and cervix. In adults the
circumference of the body of the uterus is greater than that of
the cervix; before the age of puberty it is less than that of the
neck. In old age the entire organ contracts, but the body more than
the cervix, so that the organ again assumes an infantile form. The
external os in the virgin uterus is round or oval; in women who have
borne children it appears as a transverse cleft. The most common
conditions of the cervix are the so-called erosion and ectropion,
cystic glands (ovula Nabothi), cervical catarrh, hyperplasia, ulcers,
polypi, myofibroma and carcinoma. Note contents of cervical canal
(normally glassy, tough mucus; in catarrh becomes thin, cloudy or
purulent); length and shape of canal (elongations, dilatations,
stenosis, etc.). Color of mucosa should be grayish-red; the folds
should be distinct and symmetrical. Purulent and diphtheritic
inflammations, lacerations, polypi, cysts, fibromyoma, carcinoma and
tuberculosis are the most common conditions affecting the cervical
canal.
The uterine cavity is normally empty; during menstruation or as
the result of inflammation it may contain blood and bloody mucus;
and the mucosa may be deep-red. The normal mucosa is gray-red
and 0.5-1.0 mm. thick. In the puerperal uterus portions of the
placenta, fœtal membrane, purulent or bloody lochial discharges
are present. The placental site is shown by its uneven surface and
presence of blood-clots. Gangrenous and purulent areas are greenish,
gray, brownish-green, and black, with opaque and ragged surface.
Gas-bubbles may be present. The normal consistence of the uterus
is firm, diminished in the puerperal uterus, increased in chronic
metritis. The cut-surface is smooth in the virgin uterus, rough in
the uteri of women who have borne children and in chronic metritis.
The most common pathologic conditions of the uterus are: abortion,
hæmorrhage, apoplexia uteri, hæmatometra, hydrometra, pyometra,
rupture, perforation, traumatic lesions, endometritis (acute,
chronic, hæmorrhagic, interstitialis, glandularis, hyperplastica,
cystica, polyposa, adenomatosa, infective, decidual, atrophic, etc.),
foreign bodies, tuberculosis, syphilis, actinomycosis, hyperplasia,
metritis (acute, chronic, hyperplastic, atrophic), perimetritis,
parametritis, atrophy, neoplasms (myoma and myofibroma the most
common; adenoma, adenomyoma, adenomatous polypi are very common;
carcinoma [adenocarcinoma, cystocarcinoma, medullary, papillary,
colloid, scirrhous, squamous-celled, malignant chorio-epithelioma]
very common; sarcoma less common but it is not rare [myosarcoma the
most common form; often represents a sarcomatous transformation
of a myofibroma]; metastatic carcinoma and sarcoma are rare), and
parasites (echinococcus).
7. =Tubes.= Note _length_, _thickness_, _shape_, _character of
peritoneum_, _patency_, _fimbriated extremities_ (swelling, redness,
exudate, tubercles, hæmorrhage), _contents_, _color_ and _thickness
of mucous membrane_, _thickness_ and _consistence of entire wall_.
Tubes should be straight, not tortuous; in inflammation they are
usually twisted, tortuous or bent. Hæmatosalpinx is usually caused
by a tubal gestation. The most common pathologic conditions are:
salpingitis (usually gonorrhœal, acute, chronic, catarrhal, purulent,
pyosalpinx, hydrosalpinx, interstitial, perisalpingitis, tubo-ovarian
abscesses and cysts), tuberculosis, actinomycosis (rare), syphilis
(very rare), hæmatoma (ectopic gestation relatively frequent),
neoplasms (rare: adenomyoma, fibromyoma, fibroma, myosarcoma,
sarcoma, carcinoma, chorio-epithelioma and teratoma; secondary
carcinoma from uterus, ovary and intestine).
8. =Ovaries.= Note _size_, _form_, _consistence_, _color_, _character
of cut-surface_, number of Graafian follicles, corpus luteum, etc.
Ovary at puberty weighs about 10 grm., measures 4-5.2 cm. long,
2-2.7 cm. broad, 1.0-1.1 cm. thick. The adult ovary weighs about
7 grm., and measures 2-4 cm. long, 1.4-1.6 cm. broad, 0.7-0.9 cm.
thick. A corpus luteum is 1.0-2.0 cm. in diameter. Ovary is compared
to an almond in size and shape. In young individuals the surface
is grayish-white and smooth; with age the surface becomes more
and more irregular, the organ smaller and its consistence firmer.
The cut-surface in young individuals is normally very moist (this
should not be regarded as œdema). The most important conditions
are: inflammation (acute and chronic, hæmorrhagic, purulent, etc.,
oöphoritis, abscess), tuberculosis, cystic follicles, lutein-cysts,
cystadenoma (multilocular, monolocular, surface papilloma, simplex,
papillary), parovarian cysts, carcinoma, fibroma, sarcoma, dermoid
cysts, teratomata, malignant teratomata, embryoma, parasites
(echinococcus is very rare).
9. =Uterine Ligaments, Vessels and Lymphatics.= Peritoneum over the
broad ligament should be moist-shining, delicate and transparent.
Inflammatory processes are very common in the parametrium,
particularly in puerperal cases. The peritoneum is cloudy, opaque,
injected, or covered with fibrinous or purulent exudate. Great
numbers of small cysts containing clear fluid are often found in the
peritoneum of the broad ligament as the sequelæ of inflammation. Note
contents of blood-vessels (thrombi, concretions, neoplasms), and
character of walls. Parovarian cysts, myomata, adenomyomata (round
ligament), secondary carcinoma, chronic inflammations, hæmatoma and
tubercles are the most common pathologic conditions.