Study of Uterine Cervix

The initial problem of this investigation was to develop a standard technique which would provide critical photomicrographs of the whole of the visible surface of the vaginal portion of the cervix uteri and of its capillary blood supply at a magnification of 30 diameters. Judged by the quality of the 72 illustrations included in the monograph, the author has solved this technical problem with signal success. With few exceptions the capillary blood-vessels approach the clear definition of the retinal blood-vessels when visualized by the ophthalmoscope. Their actual size can be measured ; any abnormality in their number or configuration can be easily identified and it is possible to demonstrate, beyond all reasonable doubt, that there is a highly significant difference between the capillary pattern of innocent inflammatory lesions of the cervix and that which accompanies squamous cell carcinoma. The author has devoted several years to this investigation. In one group of 100 women he has defined the capillary architecture of the normal cervix, including its endoand ecto-cervical mucous membrane and transition zone and the changes in the normal pattern which accompany menstruation, infection, inflammation, innocent ulceration, true cervical erosion, and polyposis. At a magnification of 24 diameters the capillary pattern of established malignant disease of the cervix was studied in 127 women, including Ill cases having an infiltrating squamous-cell carcinoma. The pattern found was similar to that which has been deduced from histological examination of the growing margin of the majority of malignant new growths, but, as the capillaries were intact, the picture is far more realistic and convincing. There was a grossly abnormal profusion of wide, imperfectly constructed capillaries of remarkably uneven calibre showing irregular branching and abnormal configuration. The general pattern was reminiscent of the primitive capillary circulation of the organs during foetal development, or of adult tissues undergoing exceptionally rapid regeneration such as that which follows removal or destruction of a substantial fraction of the liver. The monograph includes a description of the capillary pattern of the cervix in 25 women in whom smears and biopsies of the cervix were suggestive of carcinoma in situ or showed a suspicious localized instability of the surface epithelium. In this small group the cytological and histological changes showed wide variation, and an equal degree of variation was demonstrated in the capillary architecture of the cervix. The author is well aware that the number of women in this important group is far too small to decide if his technique can be of material assistance in diagnosis, but he regards the results as being encouraging enough to justify a full investigation, and there is a possibility that photomicrography of the surface of the cervix may provide valuable diagnostic evidence of cervical cancer in its early curable stage. In addition to a detailed account of the photographic technique and its preliminary application to the normal and diseased cervix there is a full and well-documented account of the remarkably large number of investigations which have been made during the last 60 years on the blood supply of malignant growths, including those which occur in the cervix uteri. The author regards his monograph as an introduction to the subject. We can therefore expect that it will be followed by another dealing with the clinical application of this realistic and scientific approach on a larger scale.