Diseases of the Ovum - mucous, membrane, chronic, tissue, decidua, endometritis, cells and inflammation

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DISEASES OF THE OVUM.

Diseases of the Decidua.

Metritis proper is rare in pregnancy, as all authors admit, except when there is retroflexion or retroversion. Inflammations of the decidua are, however, frequent, and may be acute, as in the infectious diseases, cholera, typhus and variola, leading through apoplexy of the membranes to early abortion, to destruction of the ovum, and to the degeneration called fleshy mole. Again, the inflammation may be chronic, and then presents the three following essential varieties: 1. Chronic diffuse endometritis; 2. Polypoid endometritis; 3. Catarrhal endometritis, or hydrorrhcea gravida rum.

1. Chronic diffuse Endoinetritis.

This consists.in the development of connective tissue, partly white and partly yellow, forming a granulation tissue and causing thickening and induration of the decidua. There is hyperplasia of the mucous mem brane, in which the subjacent muscular fibres are involved, with the for mation of cysts. (Spiegelberg). Schroeder considers it to consist in chronic diffuse proliferation of the decidua vera and reflexa. The mu cous coat is thickened by the aggregation of the large cells of the deci dna; or, as a result of their proliferation, the mucous membrane, particu larly the deeper layers, presents a cavernous or cystic structure. These changes cause the death of the fcetus, and abortion may even occur from the irritation of the uterine nerves, occasioned by the inflammation of the mucous membrane. In other cases the inflammation is more chronic, the nutrition of the ovum is unaffected, pregnancy advances to full term, and inflammation is only recognized by examination of the membranes. M. Haschewarowa found, in the thick membranes of a fcetus at term, not only proliferating connective tissue and decidual cells, but also newly formed, smooth muscular fibres. Often this inflammatory thickening is merely partial.

Hofe described some decidure in which inflammation had caused pro tuberances as large as a grain of wheat, or larger. In some cases, accord ing to Schroeder and Spiegelberg, the proliferation of the decidual cells is secondary to death of the Retus. This happens, according to Duncan, particularly in those cases where, 'after the death of the fcetus, the ovum is retained. This is the adhesive endometritis of Brain'. According to him, the proliferation of Friedliinder's large cells does not occur in the decidua proper, and is accompanied by hyperremia and extravasations in the placenta. The disease, be says, is characterized during pregnancy by the fact that the fo3tal movements are painful, and that the women experience violent, colic-like pains described under the name of uterine rheumatism. It is chiefly caused by exposure to cold. When the disease

mainly attacks the utero-placental mucous membrane, it is much more dangerous for the fcetus, and in these cases abortion is generally caused by the persistent irritation and by the destruction of the mucous mem brane through hemorrhages. At the moment of delivery it may occasion difficulty by causing adhesions of the placenta,. M. IIaschewarowa has given, as causes, syphilis, or a chronic endometritis antedating pregnancy, efforts and difficult labor.

2. Polypoid Endometritis.

This condition, which is only a more advanced degree of the cases reported by Hofe, is characterized by thickening of the mucous mem brane, which may attain double or triple its normal thickness, and by prominences of different form and size, sometimes from one-fifth to one-half an inch high, but smooth, which are situated on the surface of the mucous membrane. (Fig. 19.) The excrescences are sometimes pediculated and sometimes sessile. Sometimes they form thick kernels. The uterine surface is rough and covered with coagula. According to Schroeder, the uterine glands are absent on the bright red surface of these excrescences, but are very apparent on all other parts of the mucous mem brane. The Whole mucous membrane, particularly in the papillre, is very vascular. Spiegelberg admits, as does Schroeder, that the outgrowths are more vascular than the rest of the membrane. The glandular ori fices are not numerous, are sometimes absent, and, particularly at the ex tremity of the prominences, have a small diameter. According to Vir chow, the microscope shows that the proliferating tissue is the interstitial tissue of the mucous membrane. In the midst of a slightly fibrillary tissue, we see large stellate cells which, on vertical section, appear as thick fasciculi. According to Spiegelberg and Dohrn, the characteristic elements of the proliferation are the decidual cells, which are remarkable for their large size and their large nucleus. They are concentrically ar ranged around the vessels and cause constriction of the gla,nds. In some isolated cases, where the decidua vera was absent, the change has been seen in the reflexa. (Dohni.) It has never been observed, save upon young abortive ova. Almost always the villi are secondarily changed. The embryo has, usually, disappeared. Upon an ovum, observed by Vir chow, they constituted long epithelial projections, generally very fine. In Gusserow's case they ended in club-shaped extremities, while the ova seen by Dohrn and Muller showed the beginning of a multiple myaoma of the villi.