68fi 



UTERUS AND ITS APPENDAGES. 



me in a case which I witnessed of an aged 

 woman whose uterus became completely in- 



verted during a convulsion. In this instance, 

 the only apparent predisposing cause was the 



Fig. 470. 



Incomplete inversion of the uterus. (After J. G. Forbes.) 



The fundus is beginning to protrude through the os uteri, dragging after it the Fallopian tubes, which 

 are drawn into the hollow formed by the inverted organ. 



dilatation of the uterine cavity by a tumour 

 the size of a flattened apricot, which was ex- 

 pelled at the moment when the uterus came 



Fig. 471. 



Complete inversion of the uterus. (Diagram.) 



down completely inverted, the violent ac- 

 tion of the abdominal muscles and diaphragm 

 probably here producing or aiding the ever- 

 sion. 



After complete inversion, the uterus may 

 remain incapable of replacement. Under these 

 circumstances, the external surface of the 

 protruding portion loses much of its original 

 character of a mucous membrane, and be- 

 comes covered by a thicker epithelial layer. 

 It continues, however, more vascular than the 



surface of an ordinary procident uterus, and 

 is especially liable to abrasion and ulceration, 

 from the friction to which it is exposed. 

 When this displacement occurs during men- 

 strual life, and is permanent, the menstrual 

 fluid may be observed at the periods exuding 

 from the surface of the inverted organ. 



The internal relations of an inverted uterus 

 depend upon the extent of the inversion. In 

 extreme cases the interior of the tumour con- 

 sists of a sac lined by the peritoneum, which 

 originally formed the outer covering of the 

 uterus. The centre indeed of the broad liga- 

 ment mav be said to be inverted so as to form 

 a pouch in which are contained the Fallopian 

 tubes and ovaries, and occasionally a portion 

 of small intestine (fig. 471.). 



In minor degrees of inversion the uterus 

 remains within the vagina, and the peritoneal 

 pouch in its interior contains only the roots 

 of the uterine appendages {fig- 470.). 



Anomalies of Size. 



a. Atrophy. Under this head maybe in- 

 cluded those examples in which the uterus 

 appears to have been originally well deve- 

 loped, but has since suffered atrophy of its 

 tissues. Such cases are to be distinguished 

 on the one hand from the imperfectly deve- 

 loped and prepubertal forms already described ; 

 and on the other from examples of senile 

 atrophy as it occurs in its ordinary course. 

 Whenever atrophy attacks the uterus before 

 the climacteric change the condition is to be 

 deemed abnormal. Such a wasting may affect 

 the entire uterus or some of its parts. In 

 either case the tissues become pale, soft, and 

 nearly bloodless. In atrophy of the uterine 



