REMNANTS OF INFLAMMATION IN THE NEIGHBORHOOD OF THE UTERUS AND ITS ADNEXA.
inflammatory processes of the para- and perimetrium, and of the appendages of the uterus, are so intimately connected with those of the uterus itself, that it is quite impossible to treat of the products of the first without mentioning the latter.
By these inflammatory processes, changes are ordinarily produced in the involved tissues, which never entirely disappear, and can be felt by bi manual examination after the lapse of years, or demonstrated on the cada vers of women who have been affected during life Since these pathological changes may exist without giving rise to the slightest pain or sensation, we can not very well call them chronic in flammatory processes, and therefore they are best designated as " rem nants " of an antecedent inflammatory process. We will, therefore, treat of these cases, which often form a peculiar form of disease, in a separate chapter.
Since the removal of the diseased, slightly enlarged ovaries, and of the dropsical tubes and broad ligaments, has beconie an everyday topic of gynecological surgery, this subject is of great importance and we have added a number of original illustrations. The pathological changes caused by these inflammations are often very slight, and only by careful bi-manual palpation or rigid examination of a specimen can we frequently determine the slight alterations. In order to be able to recognize such alterations, it is above all necessary to be familiar with the normal con dition of the uterus and its surroundings, both in the living and the dead. Thus we may learn to distinguish the changes which miscarriage, labor. or slight inflammatory process may impress on the pelvic organs.
The Frequency of these " Remnants" and their Influence upon the Pelvic Organs, especially on the Axis and Position of the Uterus.
It is of great importance to recognize the frequency of these rem nants, in order to be able to diagnosticate pathological changes of this nature in women who for years have had no complaint from the side of the genital tract.
If we divide the cases as examined post mortem into: 1, children before menstruation; 2, menstruating virgins; 3, prostitutes and sterile women; 4, women who have borne children, and compare our observa tions on the living, we get an insight into the etiology of inflammation of the uterus and its appendages, and we learn that the inflammation of the uterus and its appendages has a somewhat different form in girls and sterile women than in women who have given birth to children, being in the first category usually confined to the neighborhood of the ovaries and tubes.
On the cadavers of thirty children under twelve years, which I ex amined in Professor Wiederhofer's hospital for children, there was twice inflammation of the cervix, once dilatation of the uterine cavity and di latation of one tube, and once inflammation of the cervix, adhesions be tween the left tube and ovary by pseudo-membranes of long standing.
In menstruating virgins remnants of inflammation are rare. My experience with these cases is limited, but still sufficient to show that in flammations in girls with intact hymen is more rare than in the two fol lowing classes. In six cases I found once traces of metritis colli, with dilatation of the cavity by mucus, and union between both ovaries and tubes, and their surroundings, by pseudo-membranous adhesions of long standing.
In prostitutes and sterile women residues of inflammation of the uterus and its surroundings are very frequently found. Out of thirty cases in the Rudolph hospital, I found them in ten (33.3 per cent.).
They are found either limited to the uterus, usually to the cervix, or they involve the parametrium and peritoneum. According to the case, the uterus offers various changes, during life and on the cadaver. We will first describe the slighter pathological changes around the cervix.
If we compare a normal uterus with one which is surrounded by these inflammatory remnants, the preparation will be found to differ considera bly. The cervix cuts with more difficulty, the section is paler near the mucous membrane or throughout. The canal is dilated by hyaline, gray or yellowish mucus containing pus cells, and usually also micrococci. The dilatation may be limited to the lower half or extend throughout the whole cervix. The walls are rather thinned than thickened. The dilatation is more marked in the posterior than the anterior wall. The external os is either normal in width, although firmer or contracted; the internal os is either normal or contracted, but in either case a sound is introduced with difficulty. Often the dilatation does not reach to the internal os, in which case the os internum is simulated at the middle of the cervix. In such cases the body of the uterus is usually normal.