These conditions of the uterine cervix in respect of their true pathological relations are exactly allied, in their different degrees, to the inflammatory conditions of the eyelid termed respectively Lippitudo, Ectropion and granular lid. Both are attended by like hypertrophies of structure and corresponding depravements of their healthy secretions. Both are reduced to their normal condition by similar or even identical methods of treat ment, and both are alike entirely removed from the category of ulcers.
Next to these may be enumerated the con ditions of the uterine neck which are distin guished by loss instead of hypertrophy of tissue. When this loss consists solely in de tachment of epithelium the term " epithelial exfoliation" appears to be a more appropri ate designation and preferable in many re spects to " excoriation or abrasion," — terms which seem to imply something of violence in the mode of production of these conditions.
Exfoliation of the tesselated epithelium covering the vaginal portion of the cervix ap pears to take place under some eircurnstances with great ease. In uterine catarrh for ex ample, this shedding of epithelimn com mences at the borders of the os, and extends outwardly. Or it may involve the entire epithelium of the vaginal portion of the cervix together even with that of the vagina itself, these being sometimes thrown off like a cast. In such cases, a fresh epithelium is formed beneath the old one that has been detached.* But if the epithelium is not renewed the villi remain denuded. This condition inay be precisely imitated after death by macerating the part for a few days, and then peeling off the epithelial covering. And it is probable that profuse discharges lying in constant con tact with these parts during life niay similarly assist in softening and detaching this struc ture. But it is deserving of consideration that the papilla: of the outer surface of' the os by this uncovering are merely reduced to the same anatomical condition as those of like form within the cervical canal. Whether this deprivation of a natural covering usually found here renders the villi of the outer cervix, which are probably specially sentient structures, more susceptible of irritation, particularly when in a hypertrophied state, is a matter for consider ation that would extend the present inquiry beyond its proper limits here. But it is pro
bable that in this way may be explained those constitutional and local erethisms which often accompany faulty states or the uterine cervix ; and which have led to such conditions being invested with a degree of importance often in excess of their true pathological value.
But the villi may be found in some speci mens denuded of vaginal epithelium, yet with out any evidence of inflammatory or other changes. Such a part may appear quite na tural. The villi upon the cervical lips, and those within the canal being in every respect identical and alike natural in appearance, so that the strictest microscopical investigation may fail to detect any difference between them. The examination of such specimens has satis fied me that the vaginal epithelium does not alwajs normally terminate precisely at the inner borders of the uterine lips, but may cease at some point short of this.* In the third place are to be noticed those cases in which the process of removal extends to tissues deeper than the epithelium, e. to the villi, the vascular and fibrous, and other tissues. The removal of such tissues here necessarily produces excavation with definite borders, and all the characters of a true ulce ration. Ulcers of the uterine cervix exhibiting these features are ahnost exclusively either syphilitic, phagedenic, cancerous, or cancroid, and such as occur upon the surface of a pro lapsed uterus. They are seldom, I believe, scrofulous, and more rarely if ever do ulcers occur upon the uterine neck as the result of simple inflammation, fulfilling the conditions that would entitle them to be admitted into the category of true ulcerations.
Distensions of the uterine cavity, by liquid or gaseous contents, constitute the affections termed respectively hydrometra, hainatometra, and physometra. These collections result usually from narrowing or atresia of some portion of the vagina or cervix, whereby the natural or morbid secretions of the uterus become pent up in its cavity. They -are generally accompanied by hypertrophy, but sometimes by atrophy of the uterine walls.