UTERUS (ABNORMAL ANATOMY). 



sition. Fibroid growths retained within the 

 uterine walls, are at first almost invariably 

 spherical, but in course of growth become 

 ovate or flattened. Those which project from 

 the outer surface are usually nearly round, 

 while the polypi of the cavity, and those 

 which extend into the vagina, are pyriform, 

 and possess longer or shorter peduncles. The 

 greater part proceed from the fund us, com- 

 paratively few from the walls of the body, 

 and scarcely any of this kind from the cervix. 

 The latter are usually of a more spongy or 

 cellular character than the former, which con- 

 sist of a denser fibrous tissue. 



The power of gro\\th of fibroid tumours 

 appears to be nearly unlimited. The known 

 extremes in such cases are, in point of num- 

 ber, from one to forty ; and in respect of 

 weight, from a few grains to seventy pounds. 



Fibroid exercises a considerable influence 

 upon the form and position of the uterus. 

 Tumours within, or external to it, change the 

 position of the organ in various ways, pro- 

 ducing elevation, prolapsus, lateral obliquity, 

 and especially retroversion, according to the 

 seat which they occupy. Polypi distend the 

 cavity of the body and cervix, and the os 

 uteri, and sometimes produce prolapsus and 

 inversion of the uterus. 



The influence of fibroid upon the thickness 

 of the uterine walls is also considerable. Ge- 

 nerally a marked hypertrophy, equal some- 

 times to that of pregnancy, takes place, while 

 in parts a thinning of the walls occurs. The 

 latter is especially observable in cases where 

 the tumours are numerous, as in Jig. 476. 

 These sometimes appear to grow at the ex- 

 pense of the whole uterine substance, so that 

 the original organ is \vith difficulty discovered 

 among the hypertrophied mass. 



Fig. 476. 



The uterus surrounded by outgrowths of fibroid which 

 hate pushed the peritoneum before them, several 

 having become pedunculated. (Ad J\~at. ) 



The uterus, at the expense of whose tissues the 

 tumours are formed, can scarcely be discovered in the 

 midst of the mass. 



Important consecutive changes take place 

 during the process of growth of fibroid. So 

 long as the structure retains its original hard- 

 ness, the increase is comparatively slow, con- 



691 



sisting in a simple and uniform multiplication 

 of the elements already described. Occasion- 

 ally an increase of density is produced by cal- 

 cification of certain portions of the mass, and 

 in this way the so-called bony tumours of the 

 uterus are formed. Or, on the other hand, 

 under rapid growth, the tumour may become 

 softer, in consequence of serous infiltration 

 into its tissues ; the fluid occasionally collect- 

 ing in the centre of the tumour and forming 

 there a species of dropsy. Or, a process of 

 inflammation being set up, suppuration, and 

 sometimes sloughing, result. In the more 

 vascular fibroids the vessels may dilate and 

 burst, and the tumour then becomes infiltrated 

 with extravasated blood. It has been doubted 

 whether fibroid ever undergoes absorption. 

 I have reason to think, from occasionally wit- 

 nessing a marked diminution in bulk, that 

 this may sometimes occur. The explanation 

 of this is indeed easy when the mass of the 

 tumour consists of hypertrophied muscular 

 tissue, which in such cases has been found to 

 undergo fatty degeneration, and so its disper- 

 sion may be effected. 



Subperitoneal and interstitial fibroid, when 

 extensive, interferes with pregnancy, and also 

 renders labour difficult or perilous, by weaken- 

 ing the expulsive power of the uterus and pre- 

 disposing the organ to rupture. Submucous 

 fibroid, in the form of polypi, may prevent 

 impregnation or shorten gestation. In the 

 unimpregnated uterus, all forms, but especially 

 the submucous and interstitial, are apt to be 

 accompanied by severe recurrent haemorrhage, 

 producing excessive anaemia and occasionally 

 death. 



Lastly, it may be observed, in reference to 

 tumours which are commonly termed polypi, 

 that the present state of pathology demands a 

 separation of these, according to their struc- 

 tural differences, such as has long been esta- 

 blished, upon a similar basis, among those 

 objects of the animal kingdom whose sup- 

 posed resemblance, distant indeed, and at the 

 best fanciful, has given a name to this form of 

 tumour. For, as in that prototypal group of 

 animal forms, once termed polypi, three widely 

 separated classes at least are now known to 

 have been combined, so those pathological for- 

 mations, which are still familiarly termed po- 

 lypi, exhibit a more than equal number of va- 

 rieties, each marked by distinct differences of 

 structure. These may be distinguished as the 

 fibrous, including the cellular, which are com- 

 posed of a looser fibrous tissue ; the muscular; 

 the mucous, also frequently containing much 

 fibrous tissue, and the cancerous or malignant 

 polypi. And to these have been added the 

 so-called Jibrinous or blood polypi. 



The fibrous polypus has been already de- 

 scribed, and the second, or muscular, may here 

 also be classed with it, as having its origin in 

 the middle coat of the uterus, but consisting 

 of muscular rather than of fibrous tissue. 



These muscular polypi are comparatively 

 rare. Their structure, as exhibited in the ac- 

 companying Jig. 477., is precisely that of the 

 proper muscular coat of the uterus. 



Y Y 2 



