Identifier: manualofgynecolo01hart (find matches)
Title: Manual of gynecology
Year: 1883 (1880s)
Authors: Hart, D. Berry (David Berry), 1851-1920 Barbour, A. H. Freeland (Alexander Hugh Freeland), 1856-
Subjects: Gynecology Gynecology
Publisher: New York : Wood
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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across the fundus of the bladder and on to the anterior surface of theuterus at or below the level of the os internum (Fig. 40). There is thusproduced a utero-abdominal pouch (Fig. 40). The peritoneum covers the whole of the anterior surface of the uterusabove the os internum, passes over the fundus and down the posteriorsurface, which it covers almost completely. From this it descends still 40 MANUAL OF GYNECOLOGY. deeper, on to the posterior aspect of the posterior vaginal wall for aboutone inch (Fig. 38). The amount of its dip varies, however. In one sec-tion by Pirogoff (Fig. 41) the peritoneum runs down on the posteriorvaginal wall till within about an inch from the vaginal orifice. This ex-tent of posterior peritoneal duplicature is, of course, abnormal. Thedepth of the peritoneal pouch behind the uterus is greater on the left sidethan on the right. That its depth varies is quite evident on section, as insome sections it ends at the level of the posterior fornix (Fig. 39), while
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Pig. 40. Section (spirit-hardened) showing peritoneum when uterus is drawn back by posterior pelvic cellulitis (Hart). in others it is seen passing as deeply as has been already described (Figs.38, 41). This descent of the peritoneum behind the uterus is of the high-est importance practically, and forms the well-known pouch of Douglas.This pouch is best denned as follows :—Its upper lateral boundaries arethe utero-sacral ligaments; its anterior boundary is the uppermost inchof the posterior vaginal wall and posterior aspect of the supra-vaginalportion of cervix; its posterior boundary is the sacrum and rectum, cov-ered by peritoneum. It is the lowest part of the peritoneal cavity, andfrom its relation to the posterior vaginal wall can be explored through the ANATOMY OF THE FEMALE PELVIC ORGANS. 41 posterior vaginal fornix. It is partially filled by intestine when the uteruslies to the front, which becomes displaced when the uterus is retrovertedor retroflected. 2. TJie Disposition o

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