UTERUS (ABNORMAL ANATOMY). 



701 



Upon the question of the nature of this 

 form of ulceration Foerster gives a useful 

 hint. After describing a case which fell un- 

 der his notice, and where he could find no 

 traces of either encephaloid or epithelial can- 

 cer in the base of the ulcer, he mentions 

 another which also to the naked eye ap- 

 peared to have no cancerous basis, and yet 

 on microscopic examination the entire ba.se 

 of the ulcer, to the depth of a line, was 

 found to consist of cancer structure.* May 

 not the thinness of this layer, by limiting 

 the pabulum \\hich feeds the progress of the 

 ulcer, explain the slow advances of the latter 

 observable in some cases of corroding ulcer ? 

 Tubercle rarely effects the uterus, and still 

 more rarely is it a primary disease of that 

 organ. 



Tubercle of the uterus exhibits the follow- 

 ing peculiarities. The tuberculous deposit is 

 limited in the first instance to the mucous 

 membrane of the body of the organ. Here 

 it occurs either in the form of tuberculous 

 granulations, isolated or collected in groups, 

 or more often as a uniform infiltration, limited 

 at first to the mucous membrane, but ulti- 

 mately penetrating more or less deeply the 

 sublying uterine parenchyma, and accompa- 

 nied by hypertrophy of the muscular coat. 

 In the subsequent metamorphosis of the tu- 

 bercular formation the infiltered membrane 

 softens and melts down, so that the cavity 

 becomes filled by a purulent pulpy fluid. The 

 tubercular infiltration terminates abruptly at 

 the inner uterine orifice -j- ; or if rarely it 

 penetrates the cervical canal or appears upon 

 the vaginal portion, it is then only in the 

 form of isolated tubercular granulations, which 

 latter may probably pass into tubercular ul- 

 cers. 



Tuberculosis of the uterus is usually as- 

 sociated with a corresponding condition of 

 the mucous membrane lining the Fallopian 

 tubes. These latter are found distended and 

 their canals filled by caseous tuberculous 

 matter. 



Solutions of Continuity. 



Laceration of the walls of the uterus occurs 

 under various circumstances. It happens 

 rarely in the unimpregnated organ, more fre- 

 quently during pregnancy, and most commonly 

 during labour. 



Rupture of the walls of the unimpregnated 

 uterus can only occur under abnormal condi- 

 tions of the organ, as from considerable 

 growths of fibroid, or from great distension of 

 the cavity by watery, puriform, or sanguineous 

 fluids, such* as occur in hydro- and haema- 

 tometra. See p. 697. 



Rupture during pregnancy may happen at 

 almost any period, but chiefly during the 

 latter half* although it may take place even 

 as early as the second month, as from vo- 

 miting.}: Or it may be occasioned by violent 



* Handbuch der speciellen pathologischen Ana- 

 tomic, 1854, p. 318. 



f Boivin and Duges' Atlas, pi. xvi. 



J Case by Collineau. Journal Gen. de Med. 1808. 



spasmodic contraction, or from contusion or 

 sudden concussion. It is most likely to 

 happen in the case of the imperfectly de- 

 veloped uterus, as in the uterus unicornis, of 

 which a description has been already given 

 (p. 679.), or in the case of gestation in the 

 uterine portion of the Fallopian tube (gra- 

 viditas interstitialis, p. 621.). 



Rupture of the uterus may occur upon 

 only very slight exertion, as in the act of 

 stooping*, or even without any obvious cause, 

 as during sleep.f Most of the recorded cases, 

 however, of spontaneous rupture of the uterus 

 have occurred during labour, under violent 

 uterine action, combined with some unusual 

 resistance to the passage of the child, such as 

 is occasioned by a distorted or fractured 

 pelvis, a tumour, an unyielding state of the os 

 and cervix uteri, or by some malposition or 

 unusual bulk of the child. It may also occur 

 from violence in instrumental delivery, or from 

 injudicious efforts to turn the child. 



The seat of rupture is most commonly the 

 neighbourhood of the cervix, the laceration 

 extending very often through the os to the 

 vagina, or upwards, so as to involve more or 

 less of the body of the uterus. It occurs 

 oftenest at the sides, less frequently in the 

 anterior or posterior walls, and least of all 

 at the fundus. 



The course of the laceration is generally 

 oblique, rarely in the* horizontal direction. 

 It may, however, extend round the whole 

 circumference of the cervix, the lower seg- 

 ment of the uterus being forced off in a sin- 

 gle piece, before the presenting part of the 

 child.J 



The length of the rupture may be such as 

 to admit of the child escaping into the ab- 

 domen, among the intestines, or it may be 

 only very slight. All the coats of the uterus 

 are not necessarily involved. The peritoneum 

 alone may be torn, numerous rents (4060) 

 occurring in this coat, without extending to 

 the muscular tissue.^ 



These lacerations occur in most instances 

 where the uterine tissues are perfectly healthy. 

 In some cases the walls of the uterus have 

 been apparently attenuated, the attenuation 

 being attributed to pressure upon the spine or 

 pelvic bones, or there has been more or less 

 evidence of antecedent inflammation near the 

 seat of the accident. 



Perforation of the uterine walls occurs in 

 cancer, (Jig. 479.) followed by the establish- 

 ment of fistulous communications with the 

 bladder and rectum ; or from penetrating 

 abscess at the surface of the uterus ; or as a 

 consequence of adhesions formed between the 

 uterus and an ovarian cyst, the contents of 



* Mr. Glen's case in the eighth month of gestation, 

 related by Dr. Merriman. Synopsis of Difficult 

 Parturition, 1826, p. 268. 



t Mr. Ilott's case, sixth month. Med. Repository, 

 vol. vii. 



J Mr. Scott's case. Medico- Chirurgical Transac- 

 tions, 1821. 



Trans, for the Improvement of Med. and Surg. 

 Knowledge, vol. iii. 



