618 Diseases of the Genital Organs 



force causes a rent in a diseased part already infected in 

 many cases. More frequently the force abrades the mucous 

 membrane, affording innumerable openings to bacterial in- 

 vasion. The peril is frequently accentuated by the presence 

 of metritis, often with retained fetal membranes which 

 undergo decomposition so that the cervix is submerged by 

 infective discharges and putrefying membranes. Under 

 these conditions each parturition leaves its mark upon the 

 cervix. 



The simplest clinical evidence of cervicitis is a swelling of 

 the first annular cervical ring, which pushes the margins of 

 the lips of the os uteri externum apart, so that the ring be- 

 comes visible lying within the cervical canal, deeply injected 

 and bright scarlet or dark red in color. Next appears the 

 prolapse or ectropia of the first mucous ring through the os 

 uteri externum. As the annular ring prolapses farther and 

 the infection increases, the longitudinal foldings of the cer- 

 vical mucosa become increasingly evident, and the hyper- 

 trophied mucosa of the annular cervical fold evolves into an 

 encircling series of club-shaped tumors. The second an- 

 nular ring may participate. Finally the hypertrophy may 

 become very gross and the tumefied cervical mucosa pro- 

 trude out into the vagina like a cauliflower, four, six or 

 more inches in diameter, scarlet or dark red in color, and 

 highly vascular, bleeding at touch. The extremes are illus- 

 trated in Fig. 194 and in Colored Plate VI. Between these 

 extremes every possible variation appears. 



The cervical secretions in cervicitis are as variable as 

 the tumefaction and hypertrophy. If two or more pairs of 

 uterine forceps are fixed upon the cervix, traction applied, 

 and the forceps handles spread apart, the vaginal portion 

 of the cervix, as a rule, is brought freely into view, and the 

 inflamed cervical mucosa is open to visual examination. In 

 the milder types illustrated in Fig. 194. no secretion of 

 notable character is observed. It' the visual examination is 

 supplemented by inserting the dilator into the cervical canal, 

 and the jaws are opened, there may ooze out between them 

 a drop or two of muco-pus. It the uterine catheter is in- 



