UTERUS (ABNORMAL ANATOMY). 



of that structure, including a variable propor- 

 tion of the sublying cervical fibrous tissue. 

 In size they range from a pea to a walnut, 

 and occasionally their peduncle measures se- 

 veral inches in length, so that they may pro- 



Fig. 478. 



Ptdunculated polypus of the cervix uteri. (After 

 Boivin and Duges.) 



trude to a considerable distance beyond the 

 vulva. Their form is generally that of an 

 elongated pear. The surface is smooth, though 

 not uniform, being usually nodulated or lobed, 

 and in parts roughened by minute papillary 

 growths. Sometimes one or two of the cer- 

 vical folds or rugae, scarcely altered in cha- 

 racter from their ordinary condition in the 

 healthy cervix, are distinctly visible upon 

 them. These more solid tumours are covered 

 by cylinder or pavement epithelium and hy- 

 pertrophied mucous membrane. Internally 

 they are composed of loose inelastic fibrous 

 tissue, containing a few enlarged and ob- 

 structed follicles, one or two of which may 

 grow more than the rest, and form a cavity 

 distended by a slimy fluid. 



The growth of both these forms appears to 

 be limited, and they never attain to the size 

 which the fibrous polypi often reach. With 

 the hypertrophies of the follicular structures 

 are also to be classed those single cysts, of 

 the size of a pea, or larger, and sometimes 

 pedunculated, which are very commonly found 

 lying between the cervical folds, or protrud- 

 ing from the os uteri. These consist almost 

 exclusively of distended Nabothian follicles. 



c. Hypertrophy of the filiform papilla of 

 the cervix. A variety in the condition of 



693 



the filiform papillrc upon the vaginal portion 

 of the cervix has been described at p. 639. 

 These papillae, : nstead of being short, and 

 covered by pavement epithelium up to the 

 very margin of the os uteri, as they are upon 

 the rest of the cervical lips, may present the 

 same condition which they have within the 

 cervix, where they are longer and larger, and 

 are not bound down by a continuous layer of 

 covering epithelium. These papilla? often 

 appear at the margin of the os, and form 

 there little tufts, or extend over the lips of 

 the cervix in the crescentic manner already 

 described at p. 639. They then constitute 

 one of those conditions to which, in the pre- 

 sent day, the term ulceration is very fre- 

 quently applied ; yet there*is no more reason 

 for asserting that these are pathological for- 

 mations or conditions, than there is for as- 

 serting the same of the villi within the canal, 

 for both are identical in form. They can only 

 be regarded as pathological structures when 

 they obviously exceed the natural conditions 

 already described. Then, indeed, they may 

 be classed among the hypertrophies of special 

 structures of the cervix, and they will bear 

 the same relation to the natural papillae, that 

 the hypertrophied follicular structures, form- 

 ing the cysts and polypi recently described, 

 bear to the cervical follicles in a healthy con- 

 dition. Both the hypertrophied and the na- 

 tural papillae give to the finger that peculiar 

 velvety or mossy sensation which is usually 

 classed among the diagnostic signs of ulcera- 

 tion of the os uteri. 



d. Simple inflammatory hypertrophy, with 

 extroversion of the cervical mucous membrane. 

 The mucous membrane lining the canal of 

 the cervix uteri under chronic inflammation 

 becomes frequently partly everted, so that a 

 portion of the inner surface of one or both 

 walls of the neck is rendered visible at the 

 lower orifice, taking here the place ordinarily 

 occupied by the inner border of the lips of 

 the os tincae. This affection is usually com- 

 bined with a corresponding hypertrophy of 

 the proper tissue of the cervix, and may be 

 compared in its effects to that thickening of 

 the upper lip common in strumous children, 

 which causes the part to become everted. 



Figures 7. and 8. Plate IX. in Boivin and 

 Duges' Atlas represent an extreme degree of 

 this affection, in which the cervical mucous 

 membrane protrudes to an unusual extent, 

 so that the palmae plicatae and middle raphe' 

 on both sides are seen. In the more common 

 minor degree of hypertrophy with eversion, a 

 crescentic protrusion only of the cervical mu- 

 cous lining occurs. The unevenness of the 

 surface, caused by the slightly swollen and 

 prominent rugae, and as often by the numerous 

 little depressions consisting of enlarged mu- 

 cous crypts, according as one or the other of 

 these is the predominant normal structure in 

 the cervix *, gives to the part during life the 

 appearance of a raw or granular surface, while 



For a description of these varieties, see p 640. 



Y Y 3 



