If no commensurate resorption of these effusions takes place the organ continues of abnormal size. This is more particularly ob servable when a portion of the uterus as the body or cervix, has been repeatedly inflamed. The latter, especially, remains enlarged. The os tincw is patulous, and one or both lips of the cervix present an cedematous hardness, and occupy a larger space than usual in the fornix of the vag,ina.
Occasionally inflammation of the uterine parenchyma reaches the suppurative stage, resulting in collections of matter which may escape into the peritoneum between the folds of the broad ligament, or externally by the vag,ina or rectum.
Chronic inflammation produces likewise a general enlargement of the uterus, but more commonly the cervix is principally or exclu sively involved, and the resulting enlargement is especially observable in its vaginal portion, the lips of w hich become increased in breadth, or elongated and prominent.
When chronic inflammation affects, on the other hand, the parenchyma of the body of the uterus chiefly, the walls of this part become thickened and indurated, m hile the cavity undergoes enlargement such as is exhi bited by the ventricles in excentric pertro phy of the heart. tinder chronic inflammation the uterine tissue becomes indurated, so that upon section it grates beneath the knife. This induration is occasioned chiefly by hypertro phy of the fibrous element of this coat of the uterus.
c. Fibroid. Tumor fibrosus uteri. Fibro muscular tumour. Hard fieshy tubercle of the uterus (Baillie).—These and numerous other titles have been employed by different authors to designate a form of degeneration of the uterine tissue which is so common that, ac cording to the often quoted calculations of Boyle, it may be found in every fifth case of vvomen who die after the age of thirty-five.* Fibroid of the uterus has for its basis the same structure as fibrous tumours in general The surface of a section presents to the naked eye a peculiar mottled appearance, caused by the presence of numerous white lustrous bands intersecting in all directions a more homogeneous basis substance, which in these uterine formations has always a greyish or light brown colour, the latter being especially distinct in spirit preparations. The difference between these two, hovvever, is more appa rent than real, consisting, as Paget suggests, rather in the mode of arrangement than in an actual differentiation of the component struc tures. These consist chiefly of very slender filaments of fibrous tissue " undulating or crooked," and exhibiting various degrees of development in different specimens, being in some large and wavy, and in others very short, and often intermixed with cy tobla.sts and nu clei. Along with this fibrous basis is found a variable amount of smooth muscular fibre, which in some cases, especially in the polypi hereafter noticed, forms the chief bulk of the mass, so that a muscular rather than a fibrous tissue results. A small quantity of elastic
fibre is also occasionally found in these ute rine formations.
it may be easily detached and turned out of its investing capsule (fig. 475 ).
The structural variations observable in fibroid of the uterus, are dependent chiefly upon the peculiarities in arrangement of these component elements. In the more dense formations, the white shining fibrous bands enclosing little pellets of the browner sub stance, form numerous small compact masses, which are again closely united together by a somewhat looser fibrous tissue that serves to combine the whole into lobes or lobules, va rying in size from a pea to that of a man's head. The variation in density- of these masses depends, further, upon their vascula rity. In the softer kinds, bloodvessels that may be injected permeate the mass, running along the bands and layers of fibrous tissue connecting the lobules. Such tumours are sometimes of a deep red colour. The denser masses, on the other hand, are apparently nearly bloodless; at least, injections cannot be made to penetrate them.
The different configurations which these niasses of uterine fibroid assume, appear to depend in a great measure upon accidental conditions. In this particular three varieties may be noticed.
1st var. Interstitial fibroid. — The mass here forms a growth, sometimes of immense size, but still contained within the proper boundaries of the organ, occupying one or other uterine wall, but neither encroaching upon the uterine cavity, nor protruding ex ternally. Such is the case represented in fig. 475., in which the external appearances were those of the ordinary gravid uterus in the seventh month. Such masses appear oc casionally at their periphery to merge gra dually into the healthy tissues of the uterus, but more commonly there exists a distinct boundary formed by loose cellular tissue with which the tumour is so lightly connected that 2nd var. Subperitoneal prod. — In this variety the fibroid mass or masses protrude from the external surface of the uterus. Here one or several round or oval tumours are formed which seem to grow out of the uterine substance by a narrower or broader base, or they remain attached to it by a peduncle. These masses consist entirely of fibroid, having either simply an investment of perito neum, or beneath that also, in many instances, a layer more or less thick of uterine sub stance which is usually laminated, so that a capsule composed of the natural tissues of the uterus is formed around the tumour (fig.476.).