698 



UTERUS AND ITS APPENDAGES. 



ings in the uterine walls ; or, if previous ad- 

 hesions are formed, the fluid may escape by 

 the vagina or rectum. Haematometra may 

 occur also in certain malformations of the 

 uterus, as already described (p. 680.). 



P/iysometra. Pneumatosis s. tympanites uteri. 

 This affection, known to Hippocrates* and 

 Aretaeusf, consists in a collection of air in 

 the cavity of the uterus, which makes its 

 escape from time to time by the vagina, with 

 or without explosion. The air may be dry, or 

 accompanied by more or less fluid (physometra 

 humida). In ordinary cases it is inodorous, 

 but occasionally it possesses a most offensive 

 odour. In these latter cases (physometra 

 putrida), the gas appears to be generated by 

 decomposition of some substance within the 

 uterus, as a putrid foetus, the remains of a pla- 

 centa left in utero, and the like, while the 

 generation of an inodorous gas, on the other 

 hand, without the presence of any such sub- 

 stances, within the uterus, can only be com- 

 pared with those sudden developments of air 

 in the stomach and intestines which often 

 take place in hysterical women. 



Hydatids. A case of acephalocysts within 

 the ovary has been given at p. 584., but this 

 is so rare an affection of the uterus that no 

 anatomical collection, 1 believe, in this city 

 contains an example of it. Rokitansky's 

 often-quoted casef appears to be the only 

 certain instance of acephalocysts in the ute- 

 rine cavity which pathologists in the present 

 day are able to adduce. 



In the " Lancet" of 1840, vol. i. p. 691., a 

 case is reported as one of uterine hydatids, 

 the nature of which is not very clear. That 

 they were not acephalocysts (echinococcus 

 vesicles) may be inferred from the description. 

 This case, which is quoted here as an example 

 of the more doubtful instances of hydatids, 

 was probably one of interstitial pregnancy (see 

 p. 621.) combined with the vesicular degene- 

 ration of the chorion described in the next 

 paragraph. 



Those vesicular masses and groups or strings 

 of watery vesicles, falsely termed hydatids, 

 which are so frequently expelled from the 

 uterus accompanied or preceded by abundant 

 serous discharges, combined with rapid dis- 

 tension of the abdomen and some symptoms 

 of pregnancy, consist invariably of moniliform 

 enlargements of the villi of an imperfectly de- 

 veloped chorion or placenta. 



It is almost needless to observe that the 

 presence of a true chorion structure, which 

 these substances invariably exhibit, even in 

 their most degenerated and abnormal forms $, 

 constitutes unquestionable evidence of a prior 

 act of impregnation. Connected with these, 

 when the degeneration is not much advanced, 

 may be sometimes found an embryo per- 



* De Morbis Mulierum. 

 t De Causis et Signis Morb. Diuturn. 

 j Loc. cit. vol. ii. p. 291. 



For descriptions and illustrations of these struc- 

 tures see Wedl, Pathological Histology (Syd. Soc.), 



P. A/. 



fectly or incompletely developed*, but in 

 higher grades of this abnormal state the em- 

 bryo invariably perishes or is unformed. 



Narrowing and obliteration of the uterine ca- 

 vity. Atresia. The defects which come under 

 this head may be either congenital or ac- 

 quired. They may consist in a simple nar- 

 rowing, or stricture of the cavities of the 

 uterus, or of the apertures leading to them, or 

 in a complete obliteration of some or all of 

 these. Probably most of the cases of atresia 

 which do not originate in the malformations 

 already described, have resulted from the or- 

 ganisation of the products of inflammation 

 affecting these parts. 



Obliteration of the external os uteri, either 

 partial or complete, is the most common of 

 these conditions. In minor degrees, where 

 the form of the parts is not lost in adhesions 

 with adjacent structures, the os is found closed 

 by narrow membranous threads or bands. If 

 the closure is not complete, pregnancy may 

 ensue, but labour is obstructed, and the original 

 seat of the os is then with difficulty traced, or 

 it cannot be found. 



The cervical canal may be e.ntirely oblite- 

 rated by the formation of fibrous tissue, in 

 which smooth muscular fibres have been some- 

 times found. 



Obliteration, or narrowing of the inner ute- 

 rine orifice, may occur in the progress of senile 

 atrophy, or as a result of the same processes 

 that cause obliterations lower down. All the 

 foregoing atresia? may result in the collections 

 of fluids within the uterine cavity recently de- 

 scribed. 



Lastly, the cavity of the uterine body may be 

 so completely closed that no trace of it can 

 be found. Such an example is delineated in 

 PI. 13. of Boivin's and Duges' Atlas, which 

 contains also the figure of another uterus, 

 the original seat of whose cavity is indicated 

 only by a narrow triangular band of white 

 tissue nearly as hard as cartilage. 



Pathologic conditions which may involve se- 

 veral of the uterine tissues. 



Cancer. The two main disorganising pro- 

 cesses by which the structure of the uterus is 

 metamorphosed or disintegrated and ultimately 

 more or less destroyed, are those under which 

 cancer and fibroid are respectively developed 

 in its tissues. Of these, regarded as destruc- 

 tive agents, cancer ranks second in point of 

 frequency, but first in potency. 



Cancer occurs in the uterus as in the ovaries, 

 under the three principal varieties of encepha- 

 loid, scirrhous, and colloid. But while in the 

 latter organ colloid as a primary disease is 

 certainly more common than either of the 

 other two ; in the uterus, on the other hand, 

 both scirrhous and colloid are rare, while ence- 

 phaloid constitutes the chief form under which 

 cancer is found. 



The development of cancer may undoubt- 

 edly commence in any portion of the uterus, 

 but the number of instances in which it occurs, 



* Granville, Graphic Illustrations of Abortion 

 pi. iv. and v. 



