THE FEMALE GENITAL TEACT. 831 



mucous muscle-bundles send delicate prolongations into the 

 mucosa, and take a circular course around the openings of the 

 Fallopian tubes. 



The arteries of the uterus are marked by a winding, spiral 

 course and a heavy muscle-coat; they branch usually at the 

 boundary of the middle uterine muscle-layer the so-called 

 stratum vasculare. The capillary net-work is richest in the 

 mucosa close above the epithelium. The veins are character- 

 ized by their thin walls and numerous sinuosities ; they produce 

 a narrow plexus in the stratum vasculare, and a coarse plexus on 

 both sides of the body of the uterus. The lymphatics form a 

 capillary plexus, with numerous blind terminations, in the mu- 

 cosa, and another plexus in the subserous connective tissue, while 

 the muscle-layers have fewer lymphatics. As to the termination 

 of the nerves, nothing positive is known. 



The tissue-changes that occur in menstruation are understood only in part, 

 as shown by the following article. Still more obscure are the tissue-changes 

 during pregnancy and involution. The source of the enormous new formation 

 of myxomatous tissue, resulting in the production of the placenta and the 

 very abundant increase of the muscle-tissue of the uterus in pregnancy, are 

 still puzzles, notwithstanding the amount of literature treating of this subject. 



The pathology of the uterus needs a more careful microscopical study than 

 has yet been made. The origin of tumors to which it is subject is littles' 

 understood. Among these are the common myo-fibroma, myxo-adenoma, 

 myxo-angioma, as representatives of the benign type, and carcinoma usually 

 starting from the cervical portion, and exceptionally from the mucosa of the 

 body and the fundus uteri as a representative of the malignant type. 

 Peculiar tumors are the lymph-adenoma or myxo-adenoma of the mucosa, 

 which are considered to be the result of chronic endometritis. The tissue of 

 these tumors of which I have examined quite a number consists of lymph- 

 tissue with interspersed utricular glands ; this structure bears a close resem- 

 blance to myxo-myeloma ; and, nevertheless, experience teaches that by a 

 thorough removal of the newly formed tissue with the curette a permanent 

 cure can sometimes be obtained. The boundary between lymph-adenoma and 

 myxo-myeloma has not yet been denned. 



A peculiar complication, misleading the microscopist, occurred in the fol- 

 lowing case : Dr. D. brought me a tumor the size of a pigeon's egg, claiming 

 that it was removed from the uterus. Under the microscope it proved to be 

 colloid cancer therefore, malignant. A few days later, Dr. M. brought shreds 

 which he had gouged out from the " internal genitals "; microscopic exam- 

 ination revealed cicatricial connective tissue therefore, something benign. 

 Both specimens proved to have come from a lady with an ulcerating cavity 

 behind the uterus, which had perforated the posterior cul-de-sac into the 

 vagina. The main tumor was colloid cancer, evidently starting from the rec- 

 tum, while the shreds had been removed from a place previously operated 

 upon therefore, a cicatrix. Dr. M., anxious to clear up the case, gouged out 



