UTERUS (ABNORMAL ANATOMY). 



689 



(Jig. 4-33.) it will be seen, that while the normal 

 cervix projects obliquely into the upper part 

 of the vagina, the f'ornix or blind extremity of 

 that canal forms the actual termination of the 

 tube, so that this arrangement, while it tends 

 materially to the preservation of the os and 

 cervix uteri from injury during congress, at 

 the same time exposes the cul de sac of the 

 vagina to a certain amount of pressure, which 

 various circumstances, such as rela-ive short- 

 ness of the vagina and other obvious condi- 

 tions, may render injurious. But exactly over 

 this spot lies the mass of lax fibrous tissue in 

 question, the meshes of which become easily 

 infiltrated under inflammation by serous or 

 fibrinous fluids supplied by the vessels, which 

 sections of this region show to be so abundant 

 in the neighbourhood. (Fig. 4-29.) 



Perimetrial inflammation occasionally reaches 

 the suppurative stage, and in this way are 

 formed some of those abscesses which burst 

 through the cervix, or form collections of 

 matter between the folds of the broad liga- 

 ment. 



3. Pathological conditions of the muscular or 

 proper coat. 



a. Diminished and increased consistence of 

 the uterine substance, although generally re- 

 sulting from obvious morbid processes, is yet 

 sometimes found without any apparent dis- 

 ease of the tissue. 



Diminished consistence may be found in 

 various degrees, from a slight friability or 

 softness to a nearly complete pulpiness (war- 

 ciditas). In these cases the texture of the 

 uterus may be pale and exsanguine, or in a 

 state of hyperaemia, with occasionally apo- 

 plectic effusion. Rokitansky associates the 

 latter condition with thickening, and some- 

 times ossification of the uterine arteries. 



b. Parencliymatom inflammation of the uterus. 

 Metrilis. Metritis parenchymatosa. Inflamma- 

 tion of the substance of the uterus, which in 

 the puerperal state is so commonly fatal, 

 seldom leads to death in the unimpregnated. 

 Hence opportunities for investigating the ana- 

 tomical condition of the organ in the non- 

 gravid state under conditions of inflammation 

 are of comparatively rare occurrence. From 

 such opportunities, however, aided by what 

 may be observed during life, the following 

 may he concluded as to the changes which 

 inflammation produces in the muscular and 

 fibrous coat. 



Under acute parenchymatous inflammation 

 the whole organ becomes increased in bulk, 

 and at the same time redder and softer. On 

 section blood flows freely from the divided 

 vessels, and the tissues are found permeated 

 by serous infiltration. Sometimes the highly 

 congested vessels have in parts given way, and 

 ecchymoses or larger apoplectic collections 

 have resulted. 



If no commensurate resorption of these 

 effusions takes place the organ continues of 

 abnormal size. This is more particularly ob- 

 servable when a portion of the uterus, as the 

 body or cervix, has been repeatedly inflamed. 

 The latter, especially, remains enlarged. The 

 Supp. 



os tincae is patulous, and one or both lips of 

 the cervix present an oedernatous hardness, 

 and occupy a larger space than usual in the 

 fornix of the vagina. 



Occasionally inflammation of the uterine 

 parenchyma reaches the suppurative stage, 

 resulting in collections of maiter which may 

 escape into the peritoneum between the folds 

 of the broad ligament, or externally by the 

 vagina or rectum. 



Chronic inflammation produces likewise a 

 general enlargement of the uterus, but more 

 commonly the cervix is principally or exclu- 

 sively involved, and the resulting enlargement 

 is especially observable in its vaginal portion, 

 the lips of which become increased in breadth, 

 or elongated and prominent. 



When chronic inflammation affects, on the 

 other hand, the parenchyma of the body of 

 the uterus chiefly, the walls of this part 

 become thickened and indurated, while the 

 cavity undergoes enlargement such as is exhi- 

 bited by the ventricles in excentric hypertro- 

 phy of the heart. Under chronic inflammation 

 the uterine tissue becomes indurated, so that 

 upon section it grates beneath the knife. This 

 induration is occasioned chiefly by hypertro- 

 phy of the fibrous element of this coat of the 

 uterus. 



c. Fibroid. Tumor Jibrosus uteri. Fibro- 

 muscular tumour. Hard fleshy tubercle of the 

 uterus (Baillie). These and numerous other 

 titles have been employed by different authors 

 to designate a form of degeneration of the 

 uterine tissue which is so common that, ac- 

 cording to the often quoted calculations of 

 Bayle, it may be found in every fifth case of 

 women who die after the age of thirty-five.* 



Fibroid of the uterus has for its basis the 

 same structure as fibrous tumours in general -j- 

 The surface of a section presents to the naked 

 eye a peculiar mottled appearance, caused by 

 the presence of numerous white lustrous 

 bands intersecting in all directions a more 

 homogeneous basis substance, which in these 

 uterine formations has always a greyish or 

 light brown colour, the latter being especially 

 distinct in spirit preparations. The difference 

 between these two, however, is more appa- 

 rent than real, consisting, as Paget suggests, 

 rather in the mode of arrangement than in an 

 actual differentiation of the component struc- 

 tures. These consist chiefly of very slender 

 filaments of fibrous tissue " undulating or 

 crooked," and exhibiting various degrees of 

 development in different specimens, being in 

 some large and wav\ , and in others very short, 

 and often intermixed with cytoblasts and nu- 

 clei. Along with this fibrous basis is found 

 a variable amount of smooth muscular fibre, 

 which in some cases, especially in the polypi 

 hereafter noticed, forms the chief bulk of the 



* Dr. West has furnished some interesting sta- 

 tistics upon this subject. (Lectures on the Diseases 

 of Women, Pt. i. p. '.'77. 1856.) 



f For an account of these see Paget's Surgical 

 Pathology, Vol. II. Lect.V. ; and also for those of 

 the uterus, Bidder, in Walter ueber nrbrose Kbrper 

 der Gebiirmutter. 



Y Y 



