When such a part is brushed over with nitrate of silver, a line of demarcation is in stantly produced, the mucus entangled among the naked villi is coagulated, and a cloud of white chloride of silver is precipi tated among them, while the parts adjacent which are covered by pavement epithelium are less affected, and exhibit only a pinkish white opalescence, that contrasts with the (lead white within, and with the abruptly marked border of the epithelial edge. In this way is produced another effect commonly quoted as a test of ulceration.t Those bolder and more marked projections of a florid red colour which begin also from the inner margins of the os, and spread out wardly, looking like granulations, consist of hypertrophies of pre-existing structures inter mixed occasionally, though more rarely, I be lieve, with pathological new formations.
Such hypertrophies are chiefly the follow ing, viz. eversion of the cervical lining as described at p. 693. ; hypertrophies of the crested folds of that membrane, which when everted, enlarged, and inflamed, constitute the condition termed " cockscomb granulation ; " and lastly, distended and closed muciparous follicles gathered in groups around the os and intermixed with the hypertrophied structures just noticed. These latter add to the irre gularities and nodosities of the surface, and together with fissures formed by deepened natural folds, and varicose distensions of ves sels, constitute the more irregular forms of hypertrophies which have been termed ulcers.
The second class of pseudo-ulcers termed commonly aphthm and granulations, viz. those which are dotted at regular intervals over the lips of the cervix, but are often more endur ing than herpes, and do not usually in their progress coalesce as herpetic spots when con tiguous almost invariably do; these consist of enlarged muciparbus follicles*, which in three different conditions or stages correspond with three varieties of pseudo-ulcers of the aph thous kind. In the first variety the follicles are closed and project like millet seeds above the general level of the cervix. They contain a little glairy fluid, and may be compared to the distended closed follicles described at p. 640., as occurring within the cervical and uterine cavities. They are almost always placed at such regular intervals apart, that they must be regarded as natural structures enlarged, rather than as pathological new for mations.
The second variety consists not of closed but open follicles similarly arranged. Within and at the bottom of many of these may be seen the filiform papillw enclosed, cup-like, and resembling the stamens in a half opened flower. Similar follicles to these occur some times within the cervix under ordinary circum stances.
When these papillm become hypertrophied and sprout out above the enp-like level of the containing follicles they form florid-looking and elevated spots resembling granulations in appearance, and these constitute a third va riety — the "granulations simples sans ulce rations" of Pichard.f
The foregoing examples have been here passed in review for the purpose of illustrat ing the principal anatomical and pathological conditions of the uterine cervix, which when viewed by the speculum during life exhibit appearances that are regarded by many ob servers in the present day as affording un inistakeable characteristics of ulceration. With this object they have been here grouped to gether, but they do not form a class ; many of them indeed have no pathological relation ship, and to few can the term ulceration be regarded as appropriate. In order, therefore, to eliminate from the category those condi tions which have no title to be considered as ulcers, it is needful to apply to them the test of a definition. With this view, and also for the purpose of avoiding the confusion which from the time of Hunter downwards has at tended the employment of various terms for the designation of ulcerative processes, of those at least by which the particles of open or exposed surfaces ure removed, it may be well to adopt some such distinction as that proposed by Mr. Paget, namely', to regard as abrasions or excoriations those conditions in which the epithelium or epidermis of an in flamed part is alone removed, and those only as ulcerations in which the removal extends further to the vascular or proper tissues be neath the epidermis.t Judged by this test, there may be excluded, first, all those apparent sores which, begin ning invariably from within the margins of the os, and appearing to spread outwardly more or less over the cervical lips, present a florid and often granular aspect, and being on a level with surrounding parts, and without de finite edges or raised border, fulfil all the con ditions commonly assigned to ulcers of the uterine neck. These, almost without excep tion, consist of the inflarmnatory conditions already described as hypertrophies and ever sions of the cervical mucous membrane. The apparently raw surface exposed to the eye is not usually any portion of the outer cervix, but the swollen inner surface of the walls of the cervical canal now everted and brought into view, just as the interior of the lip is brought into view in common strdmous thickening about the mouth. The margin of this apparent ulcer is the normal boundary of the os, or line of demarcation between the vaginal and cervical mucous membrane, now disturbed and thrown out of its natural place. The granulations upon this surface are the thickened and inflamed follicles, and rugw of the cervical canal. The edges are not raised because they. simply form the boundary between the vaginal and cervical epithelium, and the centre is not depressed, because there is no erosion nor any loss of tissue.