Symptoms and life instances are best observed in prostitutes and nulliparre; while in women who have given birth to chil dren, the changes are obecured by pathological alterations resulting from previous inflammations.
Frequently this form of the disease presents no marked symptoms at the beginning. We often find clinically in girls and young women, ap plying only for advice on account of leucorrhcea or irregular menstruation or sterility, smaller or larger swellings, adhesions between tubes and ova ries and their surroundings, and yet the patients can give no hikory of antecedent inflammatory trouble, or on points bearing on the onset of the affection.
In the majority of cases the patients will, however, recollect, when questioned, that years ago they had suffered from inflammation of the womb for a longer or shorter time, enabling us to diagnosticate the pri mary seat of the affection.
In many cases the patients 'report that suddenly or gradually, usually at the period of menstruation, during which the mucous membrane is more prone to infection, pain in the neighborhood of the uterus, without or with slight fever, set in. Further we learn in many cases that since the first symptoms the menses have become altered, prolonged and more frequent, sometimes that there has been irregular bleeding, that leucor rhcea was nearly always present, later dyspareunia and in a few months dysmenorrhcea had developed.
Now and then the pain, especially in the ovarian region, is severe, accompanied by slight fever, and the patients are confined to bed for one or several weeks.
This form of disease, with a painless or painful course, is most fre quently observed in prostitutes (the so-called colica scortorum), and the resulting pathological changes, together with endo-ccrvicitis, are as a rule, the cause of their sterility. This condition is so frequently observed in prostitutes that I once believed that with shut eyes, by bi-manual ex amination, they could be identified, but by more extended practice I. learned that the same condition, usually less intense, might exist in girls and very frequently in sterile women. We have often had occasion to fol
low the whole course of this disease, beginning in the cervix and extend ing especially to the neighborhood of the tubes and ovaries, in recently married women (see Figs. 22 to 25).
Judging from the latter symptoms during life, and from the post mortem findings in women who have given birth to children, peri- and parametritis frequently occur in the described form after parturition and abortion, running their course without or with slight pain and fever, lasting only a short time.
In women who have once suffered from inflammatory disease of the genital tract, especially after parturition or abortion, the course of this form of disease cannot be closely followed. The first symptoms of relapses are usually observed by the existing pathological changes in the pelvic organs. Gradually the symptoms reappear, pain during intercourse, micturition, defecation; the surroundings of the uterus are sensitive, and often fever is present. After a few nays rest in bed, the symptoms of inflammation disappear, but the old symptoms are aggravated for some time. There are cases in which the patients are confined to their bed for weeks. Frequently the disease seems to have terminated, but sud denly it reappears and a condition of sickness and tolerable health alter nates for years.
symptoms are present at the beginning of the disease, the diagnosis is easily made by the local pain in the uterus and its sur roundings.
In girls and sterile women we can diagnosticate this disease when during the menstrual period, or at any other time, with or without fever, there exist deep-seated pain in the pelvis and more or less tenderness over the lower portion of the abdomen. If the symptoms are, as is usually the case, confined to one side, the process is most probably present in the form of a perisalpingitis and perioophoritis.
If the symptoms appear in patients who have suffered before from pelvic inflammation, it is simply a relapse which, as shown by runs its course most frequently in the pelvic peritoneum.