Hydronietra results usually from a combina tion of chronic uterine catarrh with oblitera tion, absolute or relative. of the lower uterine orifices. Such obliteration, for example, may be caused by chronic disease of the cervix, by the presence of a submucous fibroid or a cer vical polypus obstructing the cervical canal, or by the pressure of an enlarged neighbour ing viscus, as the ovary*, or of a chronic ab scess. If, with these or similar conditions, uterine catarrh co-exists, the secretion from the mucous membrane collects in, and gradu ally distends, the cavity ; the walls of the uterus becoming at the same time hypertro phied, or sometimes atrophied.t The fluid which accumulates in such cases may be thin and watery, but it is more often puriform, and in some instances, as in Dr. Hooper's ex ample, which resulted from the opening. of an abscess into the uterine cavity, it consists of pure pus. To these cases, the term pyo-metra ould be perhaps more appropriate. Collec tions of these kinds amount usually to several ounces, or may reach one or two pounds. The uterus enlarges to the size of a fist, and, in rare examples, to the bulk of the gravid uterus at term.$ Pure hydrometra, e. without hmmatometra, can only occur after the cli macteric period, or in combination with ame norrhcea.
When the inner and outer os uteri are both closed, and the cervical and uterine cavities are at the same time distended, the organ re sembles an hourglass in form. This consti tutes the uterus biatmeratus vetularum of Mayer.
Hydrometra is to be distinguished from hydrorrhcea uteri, in which there is no ob struction, but a continual escape of a thin, watery fluid, often to a larae amount. This condition, which may occurzsboth in the unim pregnated and gravid uterus, is apparently dependent upon excessive activity of the fol licular structure of the cervix, and may be viewed as a coryza of that part.
licematometru consists in a collection of blood, usually menstrual, in the uterine ca vity. It is commonly associated with atresia of the vagina at some point, generally at the orifice, as when the hymen is imperforate, or when the orifice has become closed by inflam mation of the vulva in early infancy. Under these circumstances, when the menstrual age arrives, the fluid, for which there is no outlet, collects in, and distends, the cavity of the uterus, whose walls at the same time become hypertrophied, as in pregnancy ; or occasion ally attenuated, as in the case of hydrometra just stated. The fluid, which is generally dark-coloured, and of the consistence of trea cle, may, if not artificially evacuated, escape spontaneously in various ways, viz. into the abdominal cavity, by travelling along the ovi ducts, or through lacerated or ulcerated open ings in the uterine walls ; or, if previous ad hesions are formed, the fluid may escape by the vagina or rectum. Hwmatometra may
occur also in certain malformations of the uterus, as already described (p. 680.).
Physometra. Pneuniatosis s. tympanites uteri. —This affection, known to Hippocrates* and Aretmust, consists in a collection of air in the cavity of the uterus, which makes its escape from time to time by the vagina, with or without explosion. The air may be dry, or accompanied by more or less fluid (physometra humida). In ordinary cases it is inodorous, but occasionally it possesses a most offensive odour. In these latter cases (physonwtra putrida), the gas appears to be generated by decomposition of some substance within the uterus, as a putrid fcetus, the remains of a pla centa left in utero, and the like, while the generation of an inodorous gas, on the other hand, without the presence of any such sub stances, within the uterus, can only be com pared with those sudden developments of air in the stomach and intestines which often take place in hysterical women.
Hydatids.— A case of acephalocysts within the ovary has been given at p. 584., but this is so rare an affection of the uterus that no anatomical collection, I believe, in this city contains an example of it. Rokitansky's often-quoted easel appears to be the only certain instance of acephalocysts in the ute rine cavity which pathologists in the present day are able to adduce.
In the " Lancet" of 1840, vol. i. p. 691., a case is reported as one of uterine hydatids, the nature of which is not very clear. That they were not acephalocysts (echinococcus vesicles) may be inferred from the description. This case, which is quoted here as an example of the more doubtful instances of hydatids, was probably one of interstitial pregnancy (see p. 621.) combined with the vesicular degene ration of the chorion described in the next paragraph.
Those vesicular masses and groups or strings of watery vesicles, falsely termed hydatids, which are so frequently expelled from the uterus accompanied or preceded by abundant serous discharges, combined with rapid dis tension of the abdomen and some symptoms of pregnancy, consist invariably of moniliform enlargements of the villi of an iinperfectly de veloped chorion or placenta.
It is almost needless to observe that the presence of a true chorion structure, which these substances invariably exhibit, even in their niost degenerated and abnormal forms §, constitutes unquestionable evidence of a prior act of impregnation. Connected with these, when the degeneration is not much advanced, may be sometimes found an embryo per fectly or incompletely developed*, but in higher grades of this abnormal state the em bryo invariably perishes or is unformed.