694 



UTERUS AND ITS APPENDAGES. 



the natural boundary between the lower edges 

 of the cervical canal and the lips of the os 

 tinea? being now transferred on to the latter 

 in consequence of this eversion, an abrupt 

 semicircular line becomes visible, which, while 

 it only indicates the natural termination here 

 of the vaginal epithelium (see p. 640.), is fre- 

 quently mistaken for the margin of an ulcer. 



This condition may be observed upon only 

 one lip, or upon both simultaneously. It re- 

 quires special notice here, not so much for its 

 pathological importance, which appears to me 

 to have been overrated, as on account of cer- 

 tain views of late connected witli it, under 

 the belief that it constitutes another form of 

 ulcer of the os or cervix uteri. 



c. Calarrhal inflammation of the mucous 

 run/. Endo-metritis. Metritis catarrhalis. Mc- 

 trnrrhtca. Catarrhus ulcri. Acute and cltronic 

 catarrh. Lcitcorrhca. Fluor a/bus. 



The ordinary inflammatory affections of the 

 uterine mucous membrane in the nnimpreg- 

 nated state, which were formerly known only 

 by the discharges to which they give rise, and 

 which were consequently confounded with 

 similar affections of the vagina, have in recent 

 times been more accurately examined, and 

 traced to their real seat. That the lining 

 membrane of the uterus, and its cervix in a 

 state of acute or chronic inflammation, is the 

 principal source of many of these discharges, 

 is now well ascertained, and the similarity of 

 these affections to the catarrhs of other mu- 

 cous surfaces is now also generally admitted. 

 Hence the term uterine catarrh, under the 

 various forms above quoted, has been employed 

 in most recent works on uterine pathology 

 to designate these affections. Inflammation, 

 whether acute or chronic, may involve the 

 entire uterine mucous membrane, or it may 

 be limited to that of the body or cervix.* 

 The ordinary anatomical conditions of this 

 membrane under inflammation are, first, deep 

 hyperaemic congestion, so that the surface 

 presents a uniform florid red colour, or it is 

 mottled with patches of red, intermixed with 

 paler ami less vascular parts. In congestion 

 of the mucous membrane lining the body of 

 the uterus, the superficial capillaries, whose 

 healthy forms are represented in^/zgs. 4-39 and 

 t>, become intensely loaded, so that rupture 

 occasionally takes place, followed by effusions 

 into the substance of the membrane. A se- 

 rous or sero-sanguinolent, and in more ad- 

 vanced stages, a muco-purulent fluid, covers 

 the surface, while the entire mucous mem- 

 brane becomes swollen, softened, and infil- 

 trated with serum. An abrupt line of demar- 

 cation, when the congestion is limited to the 

 uterine body, marks the boundary between 

 that cavity and the cervix, the lining mem- 

 brane of which may retain its natural pale 

 colour, just such an abrupt line of demarca- 

 tion between the highly congested membrane 



* Tliis distinction, not usually observed by con- 

 tinental authors, has been emphatically made by 

 Dr. II. Bennet. A Practical Treatise on Inflamma- 

 tion of the Uterus. 3d edit. 1853. 



of the uterine body and the paler lining of the 

 cervix, as occurs during menstruation or in 

 early pregnancy.* 



When inflammation affects chiefly or ex- 

 clusively the cervical mucous membrane, this 

 becomes turgid and swollen, and its vessels 

 congested. The congestion affects more par- 

 ticularly the capillaries .of the vaginal portion 

 of the cervix, anil of the interior of the canal 

 near the orifice. The lips of the os tincae are 

 at the same time tumid, the os is enlarged, 

 and the cervical canal expanded ; changes 

 which indicate that the structures immediately 

 beneath the mucous membrane are then also 

 involved. A loss of epithelium in the neigh- 

 bourhood of the external orifice, more or less 

 extensive, may occasionally accompany the 

 severer forms of this affection. From this it 

 results that the turgid and vascular papillse 

 beneath becomes exposed, and when these 

 are also hypertrophied, the surface acquires 

 the condition commonly termed granular. 



The natural or healthy secretions of the 

 cervix become materially altered under ca- 

 tarrh. In a normal state the cervical secretion 

 is sufficient in quantity to cover the mucous 

 folds, and to fill the crypts and furrows, and 

 occasionally to block up the entire canal. It 

 consists of a viscid, tenacious, and nearly 

 transparent fluid, enveloping numerous mu- 

 cous corpuscles, granules, and epithelial scales. 

 When the catarrhal state ensues, this fluid 

 is greatly increased in quantity, and, according 

 to the severity of the affection, it passes 

 through the various conditions of a viscid 

 transparent jelly, resembling clear starch or 

 white of egg, of a thicker cream-like fluid, or 

 of a puriform mucus, in colour nearly resem- 

 bling pus. Blood also is occasionally found 

 mixed with these secretions.f 



The ordinary secretions of the cervix, as 

 shown by Dr. Whitehead, have an alkaline 

 reaction within that canal, but they speedily 

 become acid when mixed with the vaginal 

 secretions, which also cause the previously 

 transparent cervical products tobecomeopaque 

 as they pass through the vagina. 



Acute specific catarrh of the vagina (gon- 

 orrhoea), as well as simple catarrh of that 

 canal, may be associated with the foregoing 

 affections. 



Ulceration of the mucous coat. Mclro-hel- 

 cosis. Granular ulcer. Simple erosion, abra- 

 sion and excoriation. These terms have been 

 severally employed to designate certain con- 

 ditions of the os and cervix uteri, regarding 

 the nature, frequency and pathological import- 

 ance of which, as is very well known, great 

 diversities of opinion are in the present day 

 entertained. 



The affections of the cervix uteri, which 



* This point, under both these conditions, is 

 illustrated with great fidelity in the coloured de- 

 lineations of Boivin and Duges. See Atlas, PI. I. 

 fig. 4., and PI. II. fig. 6. 



f A descriptive account of some of these fluids, 

 accompanied by illustrations, will be found in the 

 paper of Dr. Tyler Smith, in Vol. XXXV. of the 

 Mud. Chir. Trans. 



