UTERUS (ABNORMAL ANATOMY). 



697 



the epithelial covering. And it is probable 

 that profuse discharges lying in constant con- 

 tact with these parts during life may similarly 

 assist in softening and detaching this struc- 

 ture. But it is deserving of consideration 

 that the papilla; of the outer surface of the os 

 by this uncovering are merely reduced to the 

 same anatomical condition as those of like 

 form within the cervical canal. Whether this 

 deprivation of a natural covering usually found 

 here renders the villi of the outer cervix, which 

 are probably specially sentient structures, more 

 susceptible of irritation, particularly when in 

 a hypertrophied state, is a matter for consider- 

 ation that would extend the present inquiry 

 beyond its proper limits here. But it is pro- 

 bable that in this way may be explained those 

 constitutional and local erethisms \\hich often 

 accompany faulty states of the uterine cervix ; 

 and which have led to such conditions being 

 invested with a degree of importance often in 

 excess of their true pathological value. 



But the villi may be found in some speci- 

 mens denuded of vaginal epithelium, yet with- 

 out any evidence of inflammatory or other 

 changes. Such a part may appear quite na- 

 tural. The villi upon the cervical lips, and 

 those within the canal being in every respect 

 identical and alike natural in appearance, so 

 that the strictest microscopical investigation 

 may fail to detect any difference between them. 

 The examination of such specimens has satis- 

 fied me that the vaginal epithelium does not 

 always normally terminate precisely at the 

 inner borders of the uterine lips, but may cease 

 at some point short of this.* 



In the third place are to be noticed those 

 cases in which the process of removal extends 

 to tissues deeper than the epithelium, i. e. to 

 the villi, the vascular and fibrous, and other 

 tissues. The removal of such tissues here 

 necessarily produces excavation with definite 

 borders, and all the characters of a true ulce- 

 ration. Ulcers of the uterine cervix exhibiting 

 these features are almost exclusively either 

 syphilitic, phagedenic, cancerous, or cancroid, 

 and such as occur upon the surface of a pro- 

 lapsed uterus. They are seldom, I believe, 

 scrofulous, and more rarely if ever do ulcers 

 occur upon the uterine neck as the result of 

 simple inflammation, fulfilling the conditions 

 that would entitle them to be admitted into 

 the category of true ulcerations. 



Distensions of the uterine cavity, by liquid 

 or gaseous contents, constitute the affections 

 termed respectively kydrometra, heematometra, 

 and physonietra. These collections result 

 usually from narrowing or atresia of some 

 portion of the vagina or cervix, whereby the 

 natural or morbid secretions of the uterus 

 become pent up in its cavity. They are 

 generally accompanied by hypertrophy, but 

 sometimes by atrophy of the uterine walls. 



* Some of these morphological varieties have 

 been described in a preceding page; and such, to- 

 gether with many of the hypertrophies already 

 noticed, have been repeatedly submitted to me 

 during life as examples of ulcers of the uterine neck. 



Hydrometra results usually from a combina- 

 tion of chronic uterine catarrh with oblitera- 

 tion, absolute or relative, of the lower uterine 

 orifices. Such obliteration, for example, may 

 be caused by chronic disease of the cervix, by 

 the presence of a submucous fibroid or a cer- 

 vical polypus obstructing the cervical canal, 

 or by the pressure of an enlarged neighbour- 

 ing viscus, as the ovary *, or of a chronic ab- 

 scess. If, with these or similar conditions, 

 uterine catarrh co-exists, the secretion from 

 the mucous membrane collects in, and gradu- 

 ally distends, the cavity ; the walls of the 

 uterus becoming at the same time hypertro- 

 phied, or sometimes atrophied.-)- The fluid 

 which accumulates in such cases may be thin 

 and watery, but it is more often puriform, and 

 in some instances, as in Dr. Hooper's ex- 

 ample, which resulted from the opening of an 

 abscess into the uterine cavity, it consists of 

 pure pus. To these cases, the term pyo-metra 

 would be perhaps more appropriate. Collec- 

 tions of these kinds amount usually to several 

 ounces, or may reach one or two pounds. The 

 uterus enlarges to the size of a fist, and, in 

 rare examples, to the bulk of the gravid uterus 

 at term.J Pure hydrometra, i e. without 

 haematometra, can only occur after the cli- 

 macteric period, or in combination with ame- 

 norrhcea. 



When the inner and outer os uteri are both 

 closed, and the cervical and uterine cavities 

 are at the same time distended, the organ re- 

 sembles an hourglass in form. This consti- 

 tutes the uterus bicameratus vetularum of 

 Mayer. 



Hydrometra is to be distinguished from 

 hydrarrheea uteri, in which there is no ob- 

 struction, but a continual escape of a thin, 

 watery fluid, often to a large amount. This 

 condition, which may occur both in the unim- 

 pregnated and gravid uterus, is apparently 

 dependent upon excessive activity of the fol- 

 licular structure of the cervix, and may be 

 viewed as a coryza of that part. 



Hcematometra consists in a collection of 

 blood, usually menstrual, in the uterine ca- 

 vity. It is commonly associated with atresia 

 of the vagina at some point, generally at the 

 orifice, as when the hj men is imperforate, or 

 when the orifice has become closed by inflam- 

 mation of the vulva in early infancy. Under 

 these circumstances, when the menstrual age 

 arrives, the fluid, for which there is no outlet, 

 collects in, and distends, the cavity of the 

 uterus, whose walls at the same time become 

 hypertrophied, as in pregnancy ; or occasion- 

 ally attenuated, as in the case of hydrometra 

 just stated. The fluid, which is generally 

 dark-coloured, and of the consistence of trea- 

 cle, may, if not artificially evacuated, escape 

 spontaneously in various ways, viz. into the 

 abdominal cavity, by travelling along the ovi- 

 ducts, or through lacerated or ulcerated open- 



* Scanzoni, he. cit. p. 1G5. 

 f Hooper, Morbid Anat. of Uterus, pi. III. 

 J Case. Dr. A. T. Thomson, Aled. Chir. Trans, 

 vol. xiii. 



