The anatomical conditions of these peri metrial inflammations are deep congestion of the vessels, accompanied by serous, and occasionally by sanguineous, and possibly fibrinous infiltration of the loose tissue of this part, which, on account of its extreme laxity, readily admits of a great degree of distension. In this way is rapidly formed a tumour which almost invariably occupies the space between the peritoneum and the posterior vvall of the uterus, at the point where the body joins the cervix (retro-uterine tumour).
The recognition of such a tumour or swell ing during life, by physical signs, is not difficult. The finger introduced into the vagina, so that its extremity reaches the point of reflexion of the posterior wall of that canal forwards on to the uterine neck, discovers, just above this spot, a hard or semi-elastic projection, which seems to grow out of the cervix just at its point of junction with the body of the uterus. The surface of the tumour towards the rec tum, upon which it encroaches, is convex, and is either smooth or irregularly nodulated, while between the tumour and the neck of the uterus is usually perceived a notch more or less deep, and comparable in form to that which separates the body from the neck of an ordinary retort. Hence this condition may easily be mistaken for the retorted uterus, which it closely resembles in many particu lars. The surface of the tumour is exquisitely tender, while the adjacent uterine structures are free from tenderness.
The comparative frequency of this affec tion*, and the constant and severe suffering which result from it, especially in married women, in whom it is usually found, may justify here a brief exposition of the peculiar anatomical condition and relation of parts wh ich appear to me to conduce to its production. From the view of the pelvic viscera given in (fig. 433.) it will be seen, that while the normal cervix projects obliquely into the upper part of the vagina, the fornix or blind extremity of that canal forms the actual termination of the tube, so that this arrangement, while it tends materially to the preservation of the os and cervix uteri from injury durinff contress, at the same time exposes the culeCle sac of the vagina to a certain amount of pressure, which various circuntstances, such as relative short ness of the vagina and other obvious condi tions, may render injurious. But exactly over
this spot lies the mass of lax fibrous tissue in question, the meshes of which become easily infiltrated under inflammation by serous or fibrinous fluids supplied by the vessels, which sections of this rezion show to be so abundant in the neighbourliood. (Fig. 429.) Perimetrial inflammation occasionally reaches the suppurative stage, and in this way are formed some of those abscesses which burst through the cervix, or form collections of matter between the folds of the broad liga ment.
3. Pathological conditions of the muscular or proper coat.
a. DiminLshed and increased consistence of the uterine substance, although generally re sulting from obvious morbid processes, is yet sometimes found without any apparent dis ease of the tissue.
Diminished consistence may be found in various degrees, from a slight friability or softness to a nearly complete pulpiness (mar ciditas). In these cases the texture of the uterus may be pale and exsanguine, or in a state of hyperwmia, with occasionally apo plectic effusion. Rokitansky associates the latter condition with thickening, and some times ossification of the uterine arteries.
b. Parenchymatous inflammation of the uterus.
Metritis parenchyrnatosa.—Inflamma tion of the substance of the uterus, which in the puerperal state is so commonly' fatal, seldom leads to death in the unimpregnated. Hence opportunities for investigating the ana tomical condition of the organ in the non gravid state under conditions of inflammation are of comparatively rare occurrence. From such opportunities, however, aided by w hat may be observed during life, the following may be concluded as to the changes which inflammation produces in the muscular and fibrous coat.
tinder acute parenchymatous inflammation the whole organ becomes increased in bulk, and at the same time redder and softer. On section blood flows freely from the divided vessels, and the tissues are found permeated by serous infiltration. Soinetimes the highly congested ve,sels have in parts given way, and ecchymoses or larger apoplectic collections have resulted.