After complete inversion, the uterus may remain incapable of replacement. Under these circumstances, the external surface of the protruding portion loses much of its original character of a mucous membrane, and be comes covered by a thicker epithelial layer. It continues, however, more vascular than the surface of an ordinary procident uterus, and is especially liable to abrasion and ulceration, from the friction to which it is exposed. When this displacement occurs during men strual life, and is permanent, the menstrual fluid may be observed at the periods exuding from the surface of the inverted organ.
The internal relations of an inverted uterus depend upon the extent of the inversion. In extreme cases the interior of the tumour con sists of a sac lined by the peritoneum, which originally formed the outer covering of the uterus. The centre indeed of the broad liga ment may be said to be inverted so as to form a pouch in which are contained the Fallopian tubes and ovaries, and occasionally a portion of small intestine (fig. 471.).
In minor degrees of inversion the uterus remains within the vagina, and the peritoneal pouch in its interior contains only the roots of the uterine appendages Cfig. 470.).
Anomalies of Size.
a. Alrophy.-17nder this head may be in cluded those examples in m hich the uterus appears to have been orizinally well deve loped, but has since suffered atrophy of its tissues. Such cases are to be distinguished on the one hand from the imperfectly deve loped and prepubertal forms already described ; and on the other from examples of senile atrophy as it occurs in its ordinary course. Whenever atrophy attacks the uterus before the climacteric change the condition is to be deemed abnormal. Such a wasting may affect the entire uterus or some of its parts. In either case the tissues become pale, soft, and nearly bloodless. In atrophy of the uterine Nody the walls rutty not exceed in thickness or (Ierisity those of' the urinary bladder. Such a comErion rosy occur under daatation of the uterine cavity, which however is more com monly attended by an increase in the thick ness of the uterine pruietes. The atrophy of the uterine walls which is accompanied by dilatation of the cavity, is tfistinguished as excentri4 and that which occurs in combi nation with a efirranished cavity as concentric 2.1213P17
Atrophy of the cervix may be combined with partial gstresia of its esinA, and is often associated with some malposition or morbid growth of the uterine body or its appendages.
b. 11.upertrophy is of far !more frequent oc currence than aterine atrophy. Accord-nlg as this condition affects the entire 'uterus or only some oi its parts, the organ either presents the onEnary figure bat upon a larg,er scale, or else a greater preponderance is given to one portion, so that the uterus becomes mrlformeti. Hypertrophy of the entire uterus commonly results from frequent pregnancy, from the growth of tumours, or from accumulation of fluid -within the cavity. In the latter cases the uterine walls may acquire the same thick ness as in pregnancy—and the hypertrophy is_doe also to the same canse, via to a deve lopment of smooth muscular fibre, Stith as onfmaraly takes place in the grarid uterus.
Hypertrophy of the cervix is most fre quently observed in extreme prolapsns, of whirl) in the chronic starje it appears to be a constant sequence. Here the hyper trophy prodoces usually a uniform enlarge ment of both lips, which form tog,ether an annular tumour divided transversely by a wide os tirame,/g. 472.
But the cervix may become hypertrophied in the longitudinal direction zdso. From this there results a remarhaillc elongation of the uterine neck, which may protrude to a con siderable distance beyond the vulva without a corresponding degree of displacement or de scent of the body of the uterus. In the ac companying illustration,fig. 473, the manner of growth of the elongated cervix is shown. The body of the organ being only partially displaced, a gradual addition to the len,gth of the neck °emirs until the vaginal portion pro trudes at the vulva. The canal of the cervix may now measure several inches in length. By degrees the protruded part undergoes in addi tion the concentric and excentic hypertrophy which is common to all cases of procidentia, and the Frps gradually acquire the same ap pearance as in fig. 472.
Among the a.noinalies of size may also be included those examples of imperfect involu tion of the uterus after preg,nancy, in which the organ retains for several months the or dinary ci7e characteristic of it shortly after labour.