. A Reference handbook of the medical sciences : embracing the entire range of scientific and practical medicine and allied science. this way the least firm adhesions are formed. Ad-hesions vary greatly in size and toughness. The large,tough ones are the result of often repeated attacks ofperitonitis. If no fresh attack occurs the adhesionstend to disappear very slowly. From being constantlystretched and worn by the respiratory and other move-ments, they may finally be absorbed. In spite of thisfact many adhesions persist for a lifetime ; hence theirimportance to gynaecologists. The cau
. A Reference handbook of the medical sciences : embracing the entire range of scientific and practical medicine and allied science. this way the least firm adhesions are formed. Ad-hesions vary greatly in size and toughness. The large,tough ones are the result of often repeated attacks ofperitonitis. If no fresh attack occurs the adhesionstend to disappear very slowly. From being constantlystretched and worn by the respiratory and other move-ments, they may finally be absorbed. In spite of thisfact many adhesions persist for a lifetime ; hence theirimportance to gynaecologists. The causes of this disease are various. Merely thecondition of retroversion may be the cause of a localperitonitis, and hence adhesions. Any local peritonitismay form such adhesions about a uterus in normal po-sition as to cause retroversion. The causes of local peri-tonitis are, then, the causes of adhesions. Among suchcauses Heitzmann considers irregularity and other an-omalies in menstruation as common, and therefore anychange in the uterus, tubes, or ovaries which causesthese irregularities, such as stenosis, congenital anteflex-. Fig. 432.—Retroversion with Adhesions. (Winckel.) A, A, Adhesionson the stretch ; B, bladder ; D, Douglass fossa: U, rectum ; J, vagina. ion, etc.; also taking cold during menstruation. Any ca-tarrhal inflammation of the uterus may extend throughthe tubes to the peritoneal cavity. This most frequentlyhappens with gonorrhceal endometritis ; ovaritis itselfmay be a cause, as may be also the rupture of a Graafianfollicle. The rubbing of a prolapsed ovary may be acause. Parametritis may cause peritonitis by direct ex-tension. There are various traumatic causes, such as di-rect injury to the peritoneum, falls, coition, the use ofthe vaginal douche, pessaries, and any intrauterine in-strumentation, such as passing a sound or dilating with 456 REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. UterineDisplacements. •1328.— Manner of Placing theRetroversion with
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