Regarding the structure of these cancroid formations, they are, according to Virchow, at the commencement simple papillary growths, and later assume the characters of cancroid. At first they appear in the form of small vil ions projections from the surface, composed of an outer very thick layer of peripheral epithelial plates, and an inner one or cylinder ephitheliwn, the interior of the villus consist ing of large blood-vessels. These vessels are chiefly colossal thin-walled capillaries, which either form shnple loops at the extremities of the villi between the layers of epithelium, or ramify in compound loops over the surface, or lastly, present a retiform arrangement. The great size, tenuity, and superficial posi tion of these vessels explains the profuse dis charge of watery fluid, and frequent bleedings, which constitute such striking features in the progress of the cauliflower excrescence, as well as the entire collapse and almost total disappearance of those tumours after death, so that only slight traces of them are found on post-mortem examination.
At the commencement the papillw are single and close-set, so that the surface, as Clarke describes it, is merely granular. The peculiar cauliflower form is occasioned by the branching of the papillx, which ultimately form fringes an inch in length. After this superficial process of growth has continued for a certain time, cancroid alveolar spaces begin to be formed at the base, between the fibrous and muscular layers of the organ. At first these appear as siniple spaces, with epithelial contents, but later are found alveoli, from whose parietes new papillre spring, which also become ramified, constituting arborescent proliferous growths.
Corroding Here may be noticed an affection of the uterine cervix, whose exact pathological relations have not been deter mined with sufficient accuracy'. The corrod ing ulcer, first described by Dr. John Clarke, and coinpared by Rokitansky to a phagede nie (cancerous) sore of the skin, differs niainly from cancer in the absence of a cancer basis, or of cancerous infiltration of adjacent tissues, while it resembles the destructive march of cancer in its mode of gradually dis integrating, and destroying the os and cervix, and even portions of the body' of the uterus, and extending to the bladder, rectum, and ad jacent structures. The characters of this ulcer are those of a ragged, irregular-margined sore, with a brownish or greyish base, from which issues a thick purulent or copious watery secretion. The margins and base may
be thickened by inflammation, but there are no granulations.
Upon the question of the nature of this form of ulceration Foerster gives a useful hint. After describing a case which fell un der his notice, and where he could find no traces of either encephaloid or epithelial can cer in the base of the ulcer, he mentions another which also to the naked eye ap peared to have no cancerous basis, and yet on microscopic examination the entire base of the ulcer, to the depth of a line, was found to consist of cancer structure.* May not the thinness of this layer, by limiting the pabulum hich feeds the progress of the ulcer, explain the slow advances of the latter observable in some cases of corroding ulcer ? Tubercle rarely effects the uterus, and still more rarely is it a primary disease of that organ.
Tubercle of the uterus exhibits the follow ing peculiarities. The tuberculous deposit is limited in the first instance to the ntucous membrane of the body of the organ. Here it occurs either in the form of tuberculous granulations, isolated or collected in groups, or more often as a uniform infiltration, limited at first to the mucous menibrane, but ulti mately penetrating more or less deeply the sublying uterine parenchyma, and accompa nied by hypertrophy of the muscular coat. In the subsequent metamorphosis of the tu bercular formation the infiltered membrane softens and melts down, so that the cavity becomes filled by a purulent pulpy fluid. The tubercular infiltiation terminates abruptly at the inner uterine orificet ; or if rarely it penetrates the cervical canal or appears upon the vaginal portion, it is then only in the form of isolated tubercular granulations, which latter may probably pass into tubercular ul cers.
Tuberculosis of the uterus is usually as sociated with a corresponding condition of the mucous membrane lining the Fallopian tubes. These latter are found distended and their canals filled by cascous tuberculous matter.
Solutions of Continuity.
Laceration of the walls of the uterus occurs under various circumstances. It happens rarely in the unimpregnated organ, more fre quently during pregnancy, and most comnaonly during labour.
Rupture of the walls of the nnimpregnated uterus can only occur under abnormal condi tions of the organ, as from considerable growths of' fibroid, or from great distension of the cavity by watery, puriform, or sanguineous fluids, such as occur in hydro- and hmma tometra. See p. 697.