Diseases of the Body of the Uterus.—A by far smaller group of dis eases than the affections which we have studied in connection with the cer vix, can, starting from the uterus, interfere with the process of generation, but in their final results they seem to surpass the first It is especially the inflammatory processes which are here considered, and chiefly the inflam mations of the mucous membrane of the uterus. Chronic endometrins is all the more important as a cause of sterility, since it is a very frequent ac companiment of genital affection& Even as many of these alone may serve as a cause of unfruitfulness, so their action may become intensified by the addition of the catarrhal inflammation. On the other hand. in dividual affections, which otherwise could not interfere with conception, can by this combination act as a cause of sterility.
The manner after which sterility is produced is undoubtedly different. The swelling of the mucous membrane cannot, where the uterine cavity is spacious, and where the walls are in simple approximation, offer a mechanical obstruction to the forward movements of the spermatozoa; but it is necessary to query if the morbid secretion, like that of the cer vix and vagina, may not from its chemical nature have a deleterious effect on the semen. The secretion is often decidedly purulent. It is not impossible that it acts as does leucorrhcea, since its constitution is similar. It is questionable if the secretion may be so profuse as to sim ply wash away the spermatozoa. It is generally the fact that this secre tion is much less in quantity than that of the cervix and vagina.
It is the universal opinion that in chronic endometritis the sterility is not due to any mechanical obstruction which prevents the migration of the semen, but that the impregnated ovum upon entering the uterine cavity does not find in the degenerated mucous membrane the proper soil for its growth and further development. We have not to deal, there fore, with a sterility in the true sense of the word, since the ovum has already become impregnated, but only with an impotelitra gestandi—that is to say, the ovum is unable to develop. Still the shedding of the ovum occurs so soon, so shortly after conception, and generally without symp toms, that it is hard to say in the majority of the cases whether the ono or the other is the cause of the sterility, and since the anatomical cause and the directed line of treatment are alike, this impotenlia geslantit is to be considered the same as sterility.
This non-fixation of the impregnated evum is to be sought in a deeply seated change in the mucous membrane. Pathological anatomists and clinicians who have exhaustively studied this condition (of the former I would especially mention Blob and Blebs) are agreed that the uterine mucous membrane is at first more swollen and secretes more, and that in protracted cases the condition changes from the hyperplastic to the atro phic. The mucosa of the uterus is increased in thickness, becomes smooth, the glands beeome cysts or degenemte, and the cylindrical epithelium as sumes the squamous form. The secretion becomes diminished in quan tity, and the menstrual flow is scanty. The mucous membrane is not iu a condition, upon conception, although there is a strong flow of blood t,o the genital organs, to develop into a rapidly growing decidua, so that the impregnated ovum ou its entering the uterine cavity does not fix itself within the folds of the mucosa. In consequence of the existing smooth ness of the cavity and its capaciousness (i.e., in the simple approximation of its walls) the ovum glides down through the uterus and miscarriage occurs. The process is about like that which we consider as happening in cases of placenta prxvia, with tho exception that in this case the ovum becomes fixed at the os internum. Since placenta prmvia occurs mostly in multiparte, where the uterus has lost tone because of the many preced ing pregnancies, this explanation is justified. Undoubtedly in such a condition as this, sterility becomes the rule and pregnancy the exception. This is explained in the same way as is abdominal pregnancy. The peri toneum, to which the atrophied mucous membrane bears a strong resem blance in its microscopical structure, is not adapted for the reception and nounshment of the ovum. Were this not the case, then an extra-uterine pregnancy would naturally be more frequent, since the supposition is warranted that many impregnated ova, on account of insufficient con duction, do not reach the tubes, but wander into the peritoneal cavity. and here under favorable, though seldom occurring circumstances, de velop. That these favorable circumstances, in case of uterine disease, are to be explained by the fact that the whole mucosa does not atrophy, but that isolated portions may remain intact, can be formulated, but so far as I know this has not been demonstrated anatomically.