UTERUS (ABNORMAL ANATOMY). 



are commonly deemed ulcerative, are admitted 

 by those who so describe them to possess 

 certain characteristic and exceptional features 

 by which they are distinguished from ulcers 

 of other parts. For it is truly asserted, 

 that " whatever the character of an inflam- 

 matory ulceration of the cervix the ulcerated 

 surface is never excavated ; it is always on a 

 level with, or above the non-ulcerated tissues 

 that limit it, and its margin never presents an 

 abrupt induration."* 



Further, with regard to the position of 

 these " sores," two principal circumstances 

 have been almost invariably noticed. As 

 seen by the aid of the speculum, they either 

 present the appearance of a red anil apparently 

 raw surface commencing, within the cervix, 

 or at the margin of the os tinea?, and spread- 

 ing outwardly to a limited extent over one or 

 both lips ; or they form numerous isolated 

 red spots, or sometimes depressions clotted 

 at nearly regular intervals over the whole 

 surface of the vaginal portion of the cervix, 

 and varying in size from a pin's head to a 

 millet seed. 



It will aid description to take advantage of 

 these peculiarities for the purpose of arrang- 

 ing in two groups or classes the various pa- 

 thological and other states of the uterine 

 cervix, which severally exhibit the characters 

 just mentioned. Many of these, however, 

 when minutely examined, and tested by the 

 aid of the microscope, so little fulfil the con- 

 ditions of true ulceration, as to make it appear 

 that such a term could only have been applied 

 to them under, in some instances perhaps a 

 misapprehended, and in others a strained, view 

 of their real nature. 



In the first class may be included those 

 cases in which the filiform papilla; of the 

 cervix are in an uncovered state, and either 

 of their natural size or hypertrophied ; ever- 

 sions of the cervical mucous membrane ; and 

 hypertrophic growths of the same. All, or 

 nearly all the non-excavated ulcers, so termed, 

 are referable to one or other of these con- 

 ditions. 



Beginning with the normal variety of struc- 

 ture already described, in which the central 

 columnar folds of the cervical mucous mem- 

 brane take a perpendicular direction (Jig. 424.), 

 and after running down to the very margin of 

 the os tincae terminate there in a narrow bor- 

 der, or tuft of filiform papillae, the simplest form 

 which has been viewed as abrasion, excoriation, 

 or ulcer, is thus produced. The velvety pile, 

 constituting one of the most common features 

 of pseudo-ulcer, being formed by these slightly 

 prominent papillae, fringing the margins of 

 the os. 



In a more marked degree of the same con- 

 dition, instead of a narrow line or margin, a 

 broader crescentic patch of uncovered filiform 

 papillae extends outwardly over either or both 

 lips. The papillae are gathered into little 

 groups, whose appearance, when magnified 

 by a common hand lens, may be compared to 



* J. H. Bennet, foe. cit. p. 79. 



695 



miniature wheat-sheaves heaped together. 

 Each papilla is perfectly free and possesses 

 its own proper epithelial coat.* This little 

 group, which may cover half the circum- 

 ference of the cervical lip, is encircled or 

 semi-encircled by a thin non-elevated margin, 

 where the ordinary pavement epithelium co- 

 vering the rest of the cervical lip terminates. 

 There is no appearance of any loss of tissue 

 here, beyond that occasioned by the absence 

 of a portion of that dense layer of epithelium, 

 which, like a sheet cast over the papillae, 

 usually invests them, as far as the inner bor- 

 ders of the cervical lips, with one common 

 covering, in addition to their own proper 

 coat. 



These papillae may retain their normal size, 

 or they may be hypertrophied. On account of 

 the large number of capillaries which they 

 contain, and from the circumstance that they 

 are uninvested by vaginal epithelium, they 

 present a florid anil often turgid aspect. 



When such a part is brushed over with 

 nitrate of silver, a line of demarcation is in- 

 stantly produced, the mucus entangled 

 among the naked villi is coagulated, and a 

 cloud of white chloride of silver is precipi- 

 tated among them, while the parts adjacent 

 which are covered by pavement epithelium 

 are less affected, and exhibit only a pinkish 

 white opalescence, that contrasts with the 

 dead white within, and with the abruptly 

 marked border of the epithelial edge. In 

 this way is produced another effect commonly 

 quoted as a test of ulceration.'f' 



Those bolder and more marked projections 

 of a florid red colour which begin also from 

 the inner margins of the os, and spread out- 

 wardly, looking like granulations, consist of 

 hypertrophies of pre-existing structures inter- 

 mixed occasionally, though more rarely, I be- 

 lieve, with pathological new formations. 



Such hypertrophies are chiefly the follow- 

 ing, viz. eversion of the cervical lining as 

 described at p. G93. ; hypertrophies of the 

 crested folds of that membrane, which when 

 everted, enlarged, and inflamed, constitute the 

 condition termed " cockscomb granulation ; " 

 and lastly, distended and closed muciparous 

 follicles gathered in groups around the os and 

 intermixed with the hypertrophied structures 

 just noticed. These latter add to the irre- 

 gularities and nodosities of the surface, and 

 together with fissures formed by deepened 

 natural folds, and varicose distensions of ves- 

 sels, constitute the more irregular forms of 

 hypertrophies which have been termed ulcers. 



The second class of pseudo-ulcers termed 

 commonly aphtha? and granulations, viz. those 

 which are dotted at regular intervals over the 

 lips of the cervix, but are often more endur- 

 ing than herpes, and do not usually in their 

 progress coalesce as herpetic spots when con- 

 tiguous almost invariably do; these consist of 



* Regarding tlie nature of tliis coat see p. 639. 



f Precisely .such an effect may be produced upon 

 mncus scraped with a piece of glass from the 

 tongne, and touched with argenti nitras. 



Y Y 4 



