Puerperal metrophlebitis.—Inflammation of the veins of the uterus occurs most frequently in cotnbination with, and is, to a certain extent, secondary to, the conditions last de scribed ; but it may occur also as a primary affection, and continue for a time the chief or only morbid state of the organ. The inflam mation is seldom confined throughout to the veins of the uterus. It appears to commence in some of the orifices of the venous sinuses, which, after labour, terminate open mouthed upon the inner surface of the uterus, over the placental place, and thence spreading through those sinuses which occupy the utenne walls, it may extend to the spermatic and hypogas tric veins and their tributaries, either upon one or both sides, and ultimately involve more distant vessels.
The condition of the veins in uterine phle bitis varies according to the intensity and duration of the inflammation. The inner coat may be pale or stained with the colour ing matter of the blood. It may have lost its polish, or have become adherent to the con tents of the vessel, where these are of a solid nature. The coats of the vessels affected may be thickened and opake, and the sur rounding tissues infiltered by various co louring fluids, or softened and in a state of putrescence.
Regarding the contents of the vessels, these consist sometimes of firm plugs of fibrine coagulated from the blood, but more often of these in a softened grumous state, intermixed with portions of a yellow grey or whitish colour. The interior of such coagula may consist of a fluid not easily distinguishable from pus, but resulting from metamorphic changes in the fibrine, subsequent to its co agulation within the vessels. Or the veins may be distended by a brownish sanies, or a yellow or greenish yellow viscid pus, so that tipon section of the uterine walls numerous collections of the latter, resembling separate abscesses, are displayed.
In the more severe cases of metrophlebitis the proper tissue of the uterus is deeply in volved, being discoloured and in a state of disorganisation and putrescence throughout its entire thickness ; or exhibiting at different points smaller or larger abscesses, the con tents of which may have been discharged into the general cavity, or form ramified sinuses or fistulm in the uterine substance. Such ab scesses most probably arise frorn the suppu rative inflammation extending beyond the coats of the veins, and involving the surround ing parenchyma.
Uterine phlebitis is often associated with inflammation of the uterine lymphatics (Lymphangioitis). These vessels, like the veins, become distended and varicose, and filled with a yellow or greenish puriform fluid, so that their course, together with that of the Fallopian tubes and ovaries, which are generally conjointly affected, may be easily traced into the corresponding hypogastric and lumbar lymphatic plexuses and glands.
Puerperal metro-peritonitis, or inflammation of the peritoneal coat of the uterus, is asso ciated with either or both of the foregoing affections, or it occurs as the primary local disease, and sometimes constitutes through out the sole apparent morbid condition of the uterus. The inflammation may be limited to the peritoneal covering of the uterus and its appendages, or it may involve that of the en tire pelvic and abdominal regions. The mem
brane itself, which often exhibits little vas cular congestion, may have retained its polish, or may be covered by exudative products of very various characters. These may be only small in amount, and partially distributed, or abundant and copious. They consist of firm fibrinous concretions, or softer and more pulpy yellow or greenish exudations, consist ing of coagulable lymph loosened by serous or purulent infiltration, or thick purulent fluid, or semi-fluid matter, or lastly serous or sa nious fluids the latter being often discoloured and rendered turbid bv intermixture with the before-mentioned prOducts, especially with fibrinous flocculi and puriform and sangui neous effusions.
These several pathological conditions of the uterus, which appear to be incompatible with the progress of those normal changes in the condition of the organ that constitute the process of involution (see p. 658.), are ac companied almost invariably by a marked in terference with those processes, so that the act of retrogression is either altogether ar rested, or is in a high degree retarded.
The foregoing puerperal affections of the uterus exhibit numerous points of great pa thological interest. These, even in their milder forms, cannot be generally regarded as purely topical affections, fOr they commonly, in their progress, become associated with like conditions of other and often distant organs, whose connection with the original, or at least principal, seat of disease, can only be explained upon the hypothesis of a general dyscrasis of' the blood. It is probable that in some cases, of those, for example, whose commencement is apparently dependent upon miasmatic influences, inoculation with cada veric matter and the like, a primary infection of the blood precedes the development of the topical condition, which may be viewed as the local expression of the former. In a large number of instances, however, the affection of distant parts may be considered as the re sult of a secondary blood infection, i. e. of a poisoning of the blood by the introduction of some products from the original nidus of dis ease, and particularly of venous pus and sames in metrophlebitis.# The occurrences which immediately ensue upon the act of parturition, offer a ready ex planation of the mode in which these and other extraneous matters may gain access to the general circulating fluid. For by the se paration and removal of the placenta, together with a large portion of the decidua, the con tents of the uterine cavity, consisting of va rious puerperal products now exposed to the direct influence of the atmosphere, are brought into iminediate relation with the patent ori fice of the uterine veins terminating upon the placental space. Through these a copious reception of the exudated products of inflam mation or of septic matters resulting from decomposition within the uterus, or of in fecting matter derived from sources still more external, may readily take place, and so pro duce either the primary or secondary dys erases of the blood just noticed.