During life these uteri have lost none of their mobility, their cervices are firmer to the touch, and they present more or less the phenomena of anteflexion at a deeper or higher point.
We were obliged to describe this less marked inflammatory variety of the disease since it is often the consequence of other inflammatory affec tions which leave traces around the tubes and ovaries of unmarried and sterile women.
That the cervix possesses different motions has been proved by irri tating the nerves supplying it, and when this mobility is impaired by disease, catarrhal secretions, blood, and semen will not be normally ejected or received, and when infection is introduced by dirty' fingers, foreign bodies, or gonorrhoeal poison, the organ offers a favorable soil for the development of cocci and bacteria, which may cause inflammation espec ially during the menstrual period. The extension of the process does not usually take place through the cavity of the uterus, however, since the body of the organ and the proximal ends of the tubes are usually normal, but extension is by means of the lymphatics.
Fig. 22 illustrates a preparation of the uterus of a virgin twenty-four years old, with thickening and dilatation of the lower half of the cervix, and adhesion by a pseudo-membrane (p, r) between the left ovary and tube. Both are slight but evident residues of a former inflammatory process. The left tube is slightly dilated by mucus, and in the prepar ation a pseudo-membranous band extends from the same ovary to Doug • las's cul-de.sac, whereby during life the ovary was somewhat fixed, dis placed and made more easily palpable on examination.
A uterus diseased in this way shows during life an angle of flexion di rested anteriorly in the middle of the cervix, which can be obliterated by a distended bladder. In a great many cases belonging to this class, resi dues, besides those described, are found in the parametric tissue, also very frequently in the muscular structure of the folds of Douglas and in the connective tissue and peritoneum surrounding them.
The residues of a parametritis are slighter and more obscure in the cadaver than those of peritonitis, but by comparison with normal organs they can easily be recognized. The peritoneum at its point of attach
ment to the cervix, at Douglas's sac, is less movable and is some times fixed to the cervix, and the same is thickened posteriorly (see Figs.
23 and 24), and often displaced by cicatricial shortenings of the parame trium and peritoneum. The layers of the broad ligaments near the cervix, and at times to quite a distance, can be separated only with difficulty.
Fig. 23 illustrates the posterior surface and neighborhood of the right half of the uterus of a young nullipara. The whole cervix and the sur rounding parametric tissue (p, c) in the preparation show the described changes conspicuously. The outer layer of the ovary is thickened, and the organ is displaced by a pseudo-membranous band towards Douglas's the peritoneum of which (Pp) is thickened by the inflamma tory process, being shortened and rendered more prominent by the changed cellular tissue surrounding the utero-sacral ligaments; the right tube is distended by catarrhal secretion and shows in its walls phenomena of a former inflammation.
During life the mobility of a uterus diseased in this way is diminished, the cervix is usually displaced posteriorly, often having a horizontal po sition in the centre or inclining to one side, according to whether the inflammation was symmetrical or to one side. The vaginal portion appears in these cases to be elongated, but this is not really the case, as the exam ining finger only pushes the vagina higher up on the hardened and more or less fixed cervix, the shortened parametric connective tissue also pull ing the vagina higher up on the cervix. The cervix when compared with the body of the uterus seems to be more voluminous, and this is not due to an increase of its muscular or connective tissue, but to the fact that the examining finger feels the adherent parametric tissue together with it.
According to whether the uterus was originally thinner or thicker, smaller or larger, the inflammatory process produces different forms of anteflexion.