A Text-book of Diseases of WomenPenrose, Charles B. (Charles Bingham)
Science
A Text-book of Diseases of Women
Penrose, Charles B. (Charles Bingham)
Women -- Diseases
An incomplete laceration of the cervix is sometimes found. In this
injury the tear has extended but part way through the wall of the
cervix. The mucous membrane of the cervical canal and the muscular
wall of the cervix are lacerated, but the injury does not involve
the mucous membrane of the vaginal aspect, beyond, perhaps, a slight
splitting of the external os (Fig. 100). The lesion is thus concealed,
and separation of the portions of the cervix is prevented. The injury
may be detected by introducing a sound in the cervical canal and
placing a finger on the vaginal aspect of the cervix, when it will
be found that at this spot the point of the sound and the finger are
separated only by the thickness of the vaginal mucous membrane, and not
by the normal thickness of the wall of the cervix.
[Illustration: FIG. 100.--Incomplete laceration of the cervix.]
The appearance of a lacerated cervix varies with the time that has
elapsed since the receipt of the injury. A few weeks or months after
the occurrence the torn portions of the cervix will be found, by
sight or touch, lying in more or less close apposition, the general
conical shape of the cervix being unaltered. After the lapse of a
longer period, however, the edges of the laceration become rounded,
and a certain amount of eversion, or turning out, of the portions of
the cervix takes place, so that the mucous membrane of the cervical
canal becomes exposed. This eversion is always most pronounced in
the bilateral laceration, and is especially striking when the tear
has extended entirely through the cervix into the lateral vaginal
fornices. In such cases the cervix assumes the shape of a split stalk
of celery (Fig. 101). The cases of laceration with eversion of the lips
are those in which the most marked symptoms are found. When eversion
occurs, and the mucous membrane of the cervical canal is exposed, the
shape and appearance of the cervix are very much altered from the
normal. Before the true nature of this lesion had been pointed out by
Emmet such a cervix was said to be ulcerated, the raw-looking surface,
corresponding to the exposed, irritated, and inflamed mucous membrane
of the cervical canal, having been mistaken for an ulcer. Even at the
present day such a mistake is not infrequently made.
[Illustration: FIG. 101.-Bilateral laceration of the cervix with
eversion. The dotted line shows the normal shape of the cervix.]
Microscopical examination of such raw-looking surfaces shows that they
are in no sense ulcers. “The surface is covered with a single layer
of epithelium; the cells are smaller than those which line the normal
cervical canal, and, being narrow and long, have a palisade-like
arrangement; the thin layer of cells allows the subjacent vascular
tissue to shine through, hence the redness of color. The surface is
further thrown into numerous folds, producing glandular recesses
and processes; these processes cause the granular appearance of the
surface” (Hart and Barbour).
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