UTERUS (ABNORMAL ANATOMY). 



687 



body the walls may not exceed in thickness 

 or density those of the urinary bladder. Such 

 a condition may occur under dilatation of the 

 uterine cavity, which however is more com- 

 monly attended by an increase in the thick- 

 ness of the uterine parietes. The atrophy of 

 the uterine walls which is accompanied by 

 dilatation of the cavity, is distinguished as 

 eccentric, and that which occurs in combi- 

 nation with a diminished cavity as concentric 

 atrophy. 



Atrophy of the cervix may be combined 

 with partial atresia of its canal, and is often 

 associated with some malposition or morbid 

 growth of the uterine body or its appendages. 



b. Hypertrophy is of far more frequent .oc- 

 currence than uterine atrophy. According as 

 this condition affects the entire uterus or only 

 .some of its parts, the organ either presents 

 the ordinary figure but upon a larger scale, or 

 else a greater preponderance is given to one 

 portion, so that the uterus becomes malformed. 

 Hypertrophy of the entire uterus commonly 

 results from frequent pregnancy, from the 

 growth of tumours, or from accumulation of 

 fluid within the cavity. In the latter cases 

 the uterine walls may acquire the same thick- 

 ness as in pregnancy and the hypertrophy 

 is due also to the same cause, viz. to a deve- 

 lopment of smooth muscular fibre, such as 

 ordinarily takes place in the gravid uterus. 



Hypertrophy of the cervix is most fre- 

 quently observed in extreme prolapsus, of 

 which in the chronic stage it appears to 

 l)e a constant sequence. Here the hyper- 

 trophy produces usually a uniform enlarge- 

 ment of both lips, which form together an 

 annular tumour divided transversely by a wide 

 os tineas, jig, 472. 



Fig. 472. 



But the cervix may become hypertrophied 

 in the longitudinal direction also. From this 

 there results a remarkable elongation of the 

 uterine neck, which may- protrude to a con- 

 siderable distance beyond the vulva without a 

 corresponding degree of displacement or de- 

 scent of the body of the uterus. In the ac- 

 companying illustration, jig. 473, the manner 



of growth of the 



elongated cervix is shown. 



The body of the organ being only partially- 

 displaced, a gradual addition to the length of 



Fig. 473. 



va 



Hypertrophy of the os and cervix in prolapsus uteri. 

 (Ad J\ T at.) 



Elongation of the cervix uteri from longitudinal hy- 

 pertrophy. {Ad Nat.) 



f, fundus ; to, internal os uteri; cc, cervix; va, 

 vaginal walls. 



the neck occurs until the vaginal portion pro- 

 trudes at the vulva. The canal of the cervix 

 may now measure several inches in length. By 

 degrees the protruded part undergoes in addi- 

 tion the concentric and excentric hypertrophy 

 which is common to all cases of procidentia, 

 and the lips gradually acquire the same ap- 

 pearance as in jig. 472. 



Among the anomalies of size may also be 

 included those examples of imperfect involu- 

 tion of the uterus after pregnancy, in which 

 the organ retains for several months the or- 

 dinary size characteristic of it shortly after 

 labour. 



Pathological conditions of the separate tissues 

 of the uterus. Reserving for future notice the 

 affections of the gravid uterus, those morbid 

 states which are observed in the unimpreg- 

 nated organ will be at present considered. 

 These may be divided into such as belong to 

 (I) the peritoneum; (2) the subperitoneal 

 tissue; (3) the parenchyma; and (4) the 

 mucous lining of the uterus. 



1. Pathological conditions of the peritoneal 

 coat. 



a. The external position of the peritoneal 

 coat, and the small amount which it con- 

 tributes to the bulk of the uterus, combine to 



