Often bending of the ureters by pelvic peritonitis residues, or imbed ding of the same in parametric residues, lead to dilatation of the ureters above the bent or compressed portion, causing secondary nephritis and death.
Rectal Symptome.—The frequent pseudo-membranous adhesions be tween the uterus, its appendages, and the colon, small intestine and omentnm, easily explain the functional disturbances of the intestinal canal often observed in women who have suffered from inflammatory pro cesses in their pelvic organs. Directly and indirectly, partly by traction on the tissues, partly by pressure on the blood-vessels and nerves, the circulation and innervation of the intestinal canal are interfered with, its nutrition and its peristaltic movements are altered. Slight functional disturbances depending upon weakening or hyperaemia of portions of the intestine, frequently give rise to rectal catarrh, constipation, diarrhoea, abnormal accumulation of gases, abnormal movements, etc., in these cases.
More rare are the cases in which these functional disturbances, partly by mechanical interference by these adhesions, partly by the influence of continued chronic inflammation, which lead to paralysis of portions of intestine, result in ileus and cause death.
Effect on the Reproductive Powers.—The changes caused by inflamma • tion of the uterus and its adnexa exert a bad influence upon the power of reproduction. This fact has been well appreciated by authors treating of sterility. Great attention has been paid to this by Griinewald, Mayrhofer, Chrobak, P. Miiller, F. Winckel and others, and H. Beigel has written an extensive treatise on this subject (" Pathological Anatomy of Sterility in Females"), in which the consequences of pelvic peritonitis processes are well illustratea.
The frequency of residues of inflammation, which according to our investigations are found in 33.3 per cent. in prostitutes and sterile women, 58.4 per cent, in women who have borne children, explains in most in stances absolute or relative sterility in married women In the first class sterility is usually caused by a catarrhal, cicatrized, and narrowed cervix, which has lost its functional power and has given rise to secondary perioophoritic and perisalpingitic residues, and also to morbid changes in the tubes and ovaries. In some cases the cause is azoOspermatism in the male. - The relation of azoospermatism in the male to residues of inflammation in sterile women is evident. Azoospermatism most frequently arises from gonorrhoea and inflammation of both testicles, and although the acute stage had ceased long before marriage, enough virus may remain to infect the wives.
In women who have borne children reproduction becomes usually limited by residues of inflammation in or about the ovaries and tubes. Conception is in the majority of these cases not quite impossible, but only rendered difficult, for even with very extensive residues one or both tubes may be found pervious and the ovaries wholly or partially able to perform their function. Therefore we must be guarded in our prognosis regard ing conception after severe inflammation in the pelvis, for cases in which both ovaries become encapsulated in pseudo-membranous sacs or bOth tubes rendered impervious are rare.
Symptoms from the Nervous System.—The relation of genital diseases in women to nervous affections was long ago recognized. The majority of authors believe the connection to be of frequent occurrence, while others deny it almost entirely; on both sides we find the most prominent representatives of the profession. It is a fact familiar to all physicians that with the most severe forms of disease in the genital tract, as ovarian cysts and sarcoma, uterine myoma and carcinoma, prolapse and inversion of the uterus, vesico-vaginal fistulae, etc., nervous disturbances are only rarely observed. This fact has been repeatedly emphasized by the op ponents of the above-mentioned relation. The fact, however, is not denied by those who believe in the intimate relation, and still in some cases of large fibroma or cystoids a reaction on the nervous system exists: so-called respiratory neurosis, troublesome cough at times, attacks of asthma, angina pectoris, etc., are frequently observed in connection with these tumors. But more frequently it may be observed that with small ovarian tumors, incarcerated in the pelvis, or by retroflexion of the uterus, annoying, tormenting pain in the pelvis and corresponding lower ex tremity, or in the upper half of the body, is caused, which disappears when the tumor or uterus are displaced from the pelvis; on the other hand, it frequently occurs that such tumors give rise to no symptoms, indeed it may happen that large tumors, or a retroflexed uterus, fill the whole pelvis and produce no pain or nervous phenomena These daily observations allow of no other conclusion than that ner vous phenomena can only be produced by sexual diseases, when morbid conditions in the nervous system itself exist.