Acute specific catarrh of the vagina (gon orrhcea), as well as simple catarrh of that canal, may be associated with the foregoing affections.
Ulceration of the MUCOUS coat. Metro-hel cosis. Granular ulcer. Simple erosion,abra sion and excoriation.—These terms have been severally employed to designate certain con ditions of the os and cervix uteri, regarding the nature, frequency and pathological import ance of v‘hich, as is very well known, great diversities of opinion are in the present day entertained.
The affections of the cervix uteri, which are commonly deemed ulcerative, are admitted by those who so describe them to possess certain characteristic arid exceptional features by which they are distinguished froin ulcers of other parts. For it is truly asserted, that " whatever the character of an inflam matory ulceration of the cervix the ulcerated surfice is never excavated ; it is always on a level with, or above the non-ulcerated tissues that limit it, and its margin never presents an abrupt induration."* Further, with regard to the position of these " sores;' two principal circumstances have been almost invariably noticed. As seen by the aid of the speculum, they either present the appearance of a red and apparently raw surface commencing, within the cervix, or at the margin of the os tincm, and spread ing outwardly to a limited extent over one or both lips ; or they form numerous isolated red spots, or sometimes depressions dotted at nearly regular intervals over the whole surface of the vaginal portion of the cervix, and varying in size from a pin's head to a millet seed.
It will aid description to take advantage of these peculiarities for the purpose of arrang ing in two groups or classes the various pa thological and other states of the uterine cervix, which severally' exhibit the characters just mentioned. Many of these, however, when minutely examined, and tested by the aid of the microscope, so little fulfil the con ditions of true ulceration, as to make it appear that such a term could only have been applied to them under, in some instances perhaps a misapprehended, and in others a strained, view of their real nature.
In the first class may' be included those cases in which the filiform papillm of the cervix are in an uncovered state, and either of their natural size or hypertrophied ; ever sions of the cervical mucous membrane ; and hypertrophic growths of the same. All, or nearly all the non-excavated ulcers, so termed, are referable to one or other of these con ditions.
Beginning with the normal variety of struc ture already described, in which the central columnar folds of the cervical mucous mem brane take a perpendicular direction ( fig. 424.), and after running down to the very margin of the os tincm terminate there in a narrow bor der, or tuft of filiform papillm, the simplest form which has been viewed as abrasion, excoriation, or ulcer, is thus produced. The velvety pile, constituting one of the most common features of pseudo-ulcer, being formed by these slightly prominent papillre, fringing the margins of the os.
In a more marked degree of the same con dition, instead of a narrow line or margin, a broader crescentic patch of uncovered filiform papillm extends outwardly over either or both lips. The papillm are gathered into little groups, whose appearance, when magnified by a common hand lens, may be compared to miniature wheat-sheaves heaped together. Each papilla is perfectly free and possesses its own proper epithelial coat.* This little group, which may cover half the circum ference of the cervical lip, is encircled or semi-encircled by a thin non-elevated margin, where the ordinary pavement epithelium co vering the rest of the cervical lip terminates. There is no appearance of any loss of tissue here, beyond that occasioned by the absence of a portion of that dense layer of epithelium, which, like a sheet cast over the papillm, usually invests them, as far as the inner bor ders of the cervical lips, with one common covering, in addition to their own proper coat.
These papillm may retain their normal size, or they may be hypertrophied. On account of the large number of capillaries which they contain, and from the circumstance that they are uninvested by vaginal epithelium, they present a florid and often turgid aspect.