THE INFLUENCE OF THESE RESIDUES ON THE HEALTH OF THE WOMAN.
Symptoms.--These differ according to the locality and extent of the residues. The uterine symptoms caused by them have been fully de scribed by Fritsch, and will be briefly referred to here only in so far as is necessary.
Endometritis.—Leucorrlicea differing in color, quantity and consist ency, is present in nearly every case where inflammatory processes have existed in the uterus. Its course is usually as follows: Endometritis of the cervix or body of the uterus almost always spreads to the entire uterus and its surroundings; the inflammatory process subsides, leaving in the affected tissues the described changes; the mucous membrane of the cervix and body of the uterus remains the seat of a catarrhal process, and by the altered circulation and nutrition, frequently by the narrowed channels of exit from obstruction in the mouths of the glands, and impaired function of the wall, its extension is favored.
Metrorrhayia, too Frequent Menstruation and Irregular Hentorrhayes. —These symptoms either follow closely on the inflammatory process, im prove or disappear for a while or reappear only after a long time, or even after years. Endometritis is usually found only in women who have suf fered from inflammation of the uterus and its surroundings. The changes left by these in the blood-vessels and nerves supplying the uterus cause a deficient replacement of the mucous membrane after menstruation, or prevent it entirely, or lead to different thickenings and smaller or larger polypoid growths. Endometritis decidualis also almost exclusively takes place only in uteri that have been inflamed, and the frequent occurrence of abortion in these cases is explained by it. Endometritis in an organ with normal walls and surroundings is extremely rare. Diminished menstruation and amenorrhoea occur in rare cases, where by parametric residues the blood-vessels become gradually compressed, and the uterus either atrophied or in a hyperplastic bloodless condition.
Different varieties of dysmenorrhoea and pain in the intervals of menstruation, the latter especially in women who have given birth to children or aborted frequently, accompany these conditions.
The constant leucorrhcea, continued menorrhagia, produce in these women more or less marked anwmia, which weakens their nervous system and the functional power of all the organs, especially the stomach and intestinal canal. This fact forms an important link in the chain connect ing genital diseases of women with nervous affections and diseases of the stomach and intestinal canal.
every woman who has her uterus fixed by residues of inflammation in the parametrium suffers from unpleasant symptoms, since each step or forcible motion calls her attention to the fixed uterus; many feel a constant pressure in the pelvis or a bearing-down sensation in the course of the broad and round ligaments; others feel distinct pain, either localized at a definite point or at different points deep in the pelvis. Bi-manual examination causes pain only when an attempt is made to move the uterus, especially from behind forwards or from above downwards, on account of the traction made on the nerves bound down by cicatrices in the parametrium.
Still more disagreeable and often more painful is this condition when the residues are extensive in the surroundings of the uterus, and when the broad ligaments are cicatrized in different ways, or when both ovaries, normal or diseased, are fixed abnormally to the side of the uterus by peritoneal residues in the broad ligaments, or when they are, together with the diseased tubes, displaced towards Douglas's cul-de-sac and more or less fixed there. The more enlarged and more fixed the ovaries the greater is the suffering. The pain is partly due to pressure caused by the enlarged ovaries and partly to constant traction on the parametric residues. Daring examination pain is usually not felt in the ovaries themselves, except when an attempt is made to move them.