This condition may be observed upon only one lip, or upon both simultaneously. It re quires special notice here, not so much for its pathological importance, which appears to me to have been overrated, as on account of cer tain views of late connected with it, under the belief that it constitutes another form of ulcer of the os or cervix uteri.
e. Catarrhal injfamnzation of the mucous coat. Endo-metritis. Illetritis catarrhalis. i'Vle trorrhcea. Catarrhus uteri. Acute and chronic catarrh. Leucorrhea. Fluor albus.
The ordinary inflammatory affections of the uterine mucous membrane in the unimpreg nated state, which were formerly known only by the discharges to which they give rise, and which were consequently confounded with similar affections of the vagina, have in recent times been more accurately examined, and traced to their real seat. That the lining membrane of the uterus, and its cervix in a state of acute or chronic inflammation, is the principal source of many of these discharges, is now well ascertained, and the similarity of these affections to the catarrhs of other mu cous surfaces is now also generally admitted. Hence the term uterine catarrh, under the various forms above quoted, has been employed in most recent works on uterine pathology to designate these affections. Inflammation, whether acute or chronic, may involve the entire uterine mucous membrane, or it may be limited to that of the body or cervix.* The ordinary anatomical conditions of this membrane under inflammation are, first, deep hypermic congestion, so that the surface presents a uniform florid red colour, or it is mottled with patches of red, intermixed with paler and less vascular parts. In congestion of the mucous membrane lining the body of the uterus, the superficial capillaries, whose healthy forms are represented infujs. 439 a and b, become intensely loaded, so that rupture occasionally takes place, followed by effusions into the substance of the membrane. A se rous or sero-sanguinolent, and in more ad vanced stages, a muco-purulent fluid, covers the surface, while the entire mucous mem brane becomes swollen, softened, and infil trated with serum. An abrupt line of demar cation, when the congestion is liniited to the uterine body, marks the boundary between that cavity and the cervix, the lining mem brane of which may retain its natural pale colour,—just such an abrupt line of demarca tion between the highly congested membrane of the uterine body and the paler lining of the cervix, as occurs during menstruation or in early pregnancy.*
When inflammation affects chiefly or ex clusively the cervical 'bacons membrane, this becomes turgid and swollen, and its vessels congested. The congestion affects more par ticularly the capillaries of the vaginal portion of the cervix, and of the interior of the canal near the orifice. The lips of the os tincx are at the same time tumid, the os is enlarged, and the cervical canal expanded ; changes which indicate that the structures immediately beneath the mucous membrane are then also involved. A lobs of epithelium in the neigh bourhood of the external orifice, more or less extensive, may occasionally accompany the severer forms of this affection. From this it results that the turgid and vascular papillw beneath becomes exposed, and when these are also hypertrophied, the surface acquires the condition commonly termed granular.
The natural or healthy secretions of the cervix become materially altered under ca tarrh. In a normal state the cervical secretion is sufficient in quantity to cover the mucous folds, and to fill the crypts and furrows, and occasionally to block up the entire canal. It consists of a viscid, tenacious, and nearly transparent fluid, enveloping numerous mu cous corpuscles, granules, and epithelial scales.
When the catarrhal state ensues, this fluid is greatly increased in quantity, and. according to the severity of the affection, it passes through the various conditions of a viscid transparent jelly, resembling clear starch or white of egg, of a thicker cream-like fluid, or of a puriform mucus, in colour nearly resem bling pus. Blood also is occasionally found mixed with these secretions.t The ordinary secretions of the cervix, as shown by Dr. Whitehead, have an alkaline reaction within that canal, but they speedily become acid when mixed with the vaginal secretions, which also cause the previously transparent cervical products to become opaque as they pass through the vagina.