These consist in irregular enlargement or diminution.

The former either occurs as precocious development, depending upon a congenital vice or accompanying early puberty, or it is the result of morbid increase of size, depending chiefly upon hypertrophy or dilatation.

Hypertrophy either affects the entire uterus uniformly, so that its normal form and the relations of the different parts in point of size and capacity are preserved, or it affects one segment alone, and this partial hypertrophy is particularly remarkable in the cervix.

The hypertrophy varies in degree; it not unfrequently reaches such an extent, that the uterus attains the size of a goose's egg, or of an ordinary fist, and that its parietes present a thickness of from six to nine lines.

In hypertrophy of the cervix, the coexistent malformation is remarkable. The two labia of the os tincae often enlarge uniformly, so as to form an annular tumor; they more frequently represent two cylindrical swellings, separated by lateral fissures or oblong tumors that are turned up outside; still more frequently we find the anterior lip to be the seat of hypertrophy, and it is often elongated so as to form a simple, cylindrical, or conical teat-like body, or if the cicatrices resulting from previous lacerations prevent the uniform enlargement, it assumes the appearance of an indented or lobulated appendix, and various other strange shapes.

Hypertrophy is caused by previous and repeated pregnancy, by idiopathic or consensual irritation of the uterus, the latter involving the frequent coincidence of hypertrophy of the uterus with diseases of the mammary glands, by prolapsus, and by tedious vaginal, and especially uterine catarrh. Morbid growths, and above all, fibrous tumors developed in the vicinity of the uterine mucous membrane, and projecting into the cavity of the uterus, are another common cause of hypertrophy; on account of the numerous peculiarities presented in these cases, we have hitherto excluded them from our investigation, and shall leave them to be discussed at a future period.

Among the cases of dilatation of the uterine cavity, we have first to notice the one in which it is complicated with hypertrophy caused by fibrous polypi, and which resembles pregnancy, and then those important cases in which the dilatation is the result of an accumulation and retention of the mucous secretion in blennorrhcea, and of tubercular pus in tuberculosis of the uterus. According to the seat of a stricture or of atresia at the internal, or at this and the external orifice of the womb, we find the uterus converted into a simple globular, or into an hourglass-shaped body; dilatation of the proper cavity of the uterus sometimes attains such a degree as to be capable of containing a hen's or even a goose's egg. We shall speak of this under the head of acquired anomalies of the shape, as well as under that of textural changes of the uterus.

Unusual smallness of the uterus occurs in the shape of arrested development, and is the more conspicuous if affecting individuals at or after the age of puberty. The entire uterus, but especially its neck and vaginal portion, is small, dense and hard in structure, and anaemic, its mucous membrane smooth and attenuated, the follicles and folds undeveloped, and the remainder of the sexual apparatus, and particularly the ovaries, in a corresponding state of imperfect development. The affection may also consist in an acquired diminution, reduction, or atrophy of the uterus.

Atrophy generally affects the entire uterus uniformly, though it sometimes predominates in the cervix.

Atrophy of the entire organ is presented in its most remarkable form as marasmus or senile atrophy; sometimes occurring very soon after the climacteric change, and especially in consequence of tedious catarrhs which have ceased with the cessation of the menstrual discharge; sometimes occurring even before this period from debility or exhaustion of the uterus, consequent upon a rapid succession of births, or upon blennorrhoea. This condition is generally combined with contraction of the uterine cavity (concentric atrophy), or with partial contractions, atresiae of the cervix, thinning (atrophy) of the uterine mucous membrane, and accompanied either by increase of density and coriaceous toughness of the uterine tissues, or by another change of peculiar importance, great friability and softness.

A thinning of the uterine walls is also observed to occur in various degrees, as excentric atrophy in the above-named dilatations of the uterus.

Atrophy of the cervix is of great importance on account of its occurrence in young subjects at the age of puberty, and from its probable evil influence upon conception. It has not been as yet clearly demonstrated how this affection is caused. The cervix becomes smaller in consequence of the condensation of its tissues, and at the same time the arch of the vagina is considerably diminished.

Atrophy of the entire cervix is often induced by the tension and traction resulting from the consecutive malpositions of the uterus, which accompany enlargements of the ovaries and large fibrous tumors of the uterus; in the latter case it is not unfrequently associated with hypertrophy of the body of the uterus. It is recognized in the living subject by the elongation of the vagina, and the concurrent disappearance of the cervix, and the conical shape of the vaginal fornix. In rare cases, which we shall have occasion to investigate more closely at a future period, the affection attains such a degree as to induce solutions of continuity in the cervix.

Diminution of the uterine cavity presents the various degrees of stricture, atresia, and obliteration.

Strictures and atresise occur generally at one or both orifices of the cervix, but rarely at other points; from here they occasionally extend so as to give rise to a partial or entire obliteration of the uterine cavity. The causes of their origin, both in reference to the physiological and pathological conditions of the organ, have not as yet been fully explained. Our own observations lead us to adopt the view that, in old persons, it is caused by an excessive concentric diminution from marasmus (a tendency in the retrograde organ to complete obliteration); in younger individuals, by chronic, and especially by gonorrhceal catarrh of the uterus.

Contraction of the internal orifice is caused by concentric atrophy, by curvature of the uterus, or sometimes by a fine duplicature of the mucous membrane. Atresia of the passage is either induced by delicate tendinous deposits of epithelium, or by agglutination of the mucous surfaces; the external orifice becomes contracted by inflammatory swelling, hypertrophy, and cancerous degeneration of the cervix; it is closed up by the formation of a whitish layer of epithelium, or by agglutination of the mucous membrane; or, in rare instances, by parenchymatous adhesion subsequent upon injury, inflammation,- and ulcerative loss of substance. The two orifices and the entire cervix may also be blocked or closed up by hypertrophied follicles, mucous polypi, cancerous growths, etc.