Pathological conditions of ihe reparcite tissues qf the saerus.—Reserving for future nuti cc the affections of the gravid uterus, those morbid states which are observed in the unimpreg nated organ will be at present considered. These may be divided into such as belong to (1) the peritoneum ; (2) the subperitoneal tissue; (3) the parenc.hyrna ; and (4) the =CMS lining of the uterus.
1. Pathological conditions of the peritoneal coat.
a. The external position of the peritoneal coat, and the small amount which it con tributes to the bulk of the uterus, combine to render the morbid conditions of this coat, re garded singly, of less pathological importance than the abnormal states of the other tissues. The pathological conditions of the serous coat are chiefly those of acute or chonic metroperi Ionia:, terminating often in exudative processes and the subsequent formation of adhesions be tween those portions of the uterus which are invested by peritoneum and adjacent struc tures, such as the Fallopian tubes, ovaries, fig. 420., small intestines, and the like.
These adhesions are occasionally so exten sive as to affect the figure of the uterus, and in most instances they deprive it of its natural mo bility, and impede or destroy the functions of the parts or organs appended to it, so that an abiding sterility frequently results. The ova ries becoming invested by a capsule of false membrane, are tied down and atrophied, while the tubes lose their power of motion or their canals become obliterated.
The uterine peritoneum is sometimes alone affected, while the appendages escape. IF the inflammation has not proceeded to the form ation of bands of adhesion, there may result only some slight processes of false membrane which remain and fringe the surface of the organ. These little fringes or processes, con sisting of delicate folds of membrane, often contain vessels which are easily injected.
The peritoneum suffers considerable dis tension with correlative hypertrophy in the case of tumours which project from the outer surface of the uterus. These become inva riably covered by an extension of the peri toneum, which is especially strong about the base of the peduncle occasionally acquired by such tumours.
2. Pathological conditions of the sub-peri toneal fibrous tissue.
a. Perinzetritis. Partial chronic metritis. Peri-uterine phlegnzon. Retro-uterine tumours. —The subperitoneal fibrous tissue which con nects the peritoneum with the uterine sub stance, like the peritoneal coat itself, is subject to inflammation. In those situations where the union of the outer and middle coats of the uterus is very intimate, the distinction be tween a peritoneal and a subperitoneal inflam mation may not be possible, but where this connexion is very loose, and is effected by the interposition of a lax fibrous tissue, inflamma tion may apparently have an independent seat without affecting at all, or with only a par tial inclusion of the uterine parenchyma, and sometimes of its peritoneal investment.
The term "peri-uterine" has been employed by some authors*, with a view perhaps of avoiding confusion, though at the cost of a solecisra, to distinguish these affections from others commonly termed perimetrial. In this article, however, inflammation of the subpe ritoneal fibrous tissue will be designated peri metritis, while inflammation of the peritoneum itself, which some include in the latter term, is distinguished as metro-peritonitis.
Perimetritis consists in an acute, or more often a chronic inflammation of the tissue, which loosely attaches the peritoneum form ing the base of the broad ligainent to the proper substance of the neck and lower por tion of the body of the uterus. The relation of the peritoneum and of' the loose fibrous tissue surrounding the cervix uteri have been described at page 631.,where also attention was called to the peculiar lax tissue of this kind which unites the posterior cervical wall with the portion of peritoneum forming the retro-ute rine pouch (fig. 433. G.). Here, particularly, this inflammatory affection has its seat, although it occasionally extends around the sides of the cervix, so as partially to encircle that part, or more rarely it may involve only the fibrous tissue connecting the anterior cervical wall with the posterior surface of the bladder (fig. 426. b b, and fig. 433. F.).