ENDOMETRITIS.—Gr., .E'1,0v, within, and m;',.-z-pc,c, the uterus.
Deflnition.—..kn inflammation or hy perplasia of the uterine mucous mem brane involving, to a greater or less ex tent, the parenchyma of the uterus. Varieties.—It is convenient, both in a clinical and a pathologic sense, to divide the disease into two varieties, viz.: (1) interstitial or functional endometritis; and (2) glandular or functional endome tritis, or hyperplasia. Either of these two varieties may exist in the acute and chronic form, but the chronic form may follow a mild and overlooked acute at tack, or may supervene in a gradual man ner without being preceded by a recog nizable acute attack.
There are three varieties of encloine tritis: the glandular, interstitial, and fungous. The form described as endo metritis decidua is a combination of the glandular and interstitial forms, while gonorrliccal endometritis is of the inter stitial variety and similar to senile entlometritis. Winekel (Miinellener med. Woch., July 31, '94).
Endometritis is exceedingly rare; only abont one ease in fifty that come to the clinies is really endometritis. H. A. Kelly (Med. Record, May 21, =9S).
Patients with painful endometritis are apt to complain of general nervous symp toms rather than local; hence they are often regarded as purely neurotic. This error is also due to superficial examina tions and the failure to test the sensitive ness of the endometriurn, the uterus being regarded as normal because it is not enlarged. There is an intimate re lation between the sympathetic nerves of the pelvis and the lumbar plexus, as shown by the pains on the inner aspect of the thighs in connection with painful endornetritis. SnegnireIT (Archly f. clyntik., 1;. 59, 11. 2, MOO).
Symptoms.—The symptoms may be divided into (1) disturbances of the sex ual functions, (2) intermenstrual dis charges, (3) pain and discomfort in and about the uterus or radiating from the uterus, (4) reflex disturbances, and (5) general symptonis.
Menorrhagia is one of the most fre quent symptoms in the early stages and in the glandular variety it often persists for a long time as the most prominent one.
The flow may be moderately increased in amount, or be a. profuse hicmorrhage with the passage of clots; it may be pro longed, or may recur too often. In the later stages of septic or interstitial en dometritis the menses are sometimes scanty. In certain acute attacks the menstrual flow is suppressed.
Dysmenorrhcea is common in cases connected with flexion, puerile cervix, or inflammation of the appendages.
llysinenorrlicea and menorrhagia from which many young, girls sutler are due to endometritis, and the chief causes leading to this condition are tight eor sets, exposure of the feet to wet and cold, chronic constipation. A. Lapthorn Smith (Amer. Medico-Surg. Bull., May 30, '96).
Dyspareunia and sterility may be pres ent under the same conditions.
Sterility in woman is most frequently dile to catarrhal endometritis, resulting from a previous, miscarriage. The prin cipal causes are: the absence of a suit able habitat for the ovum in the uterine cavity; obstruction of the cervical canal by muens; and increased alkalinity of the cervical secretions, corresponding, to an exaggerated alkaline condition of the vaginal mucus. IV. P. Manton (Amer. Jour. of Obst., No. 4, '92).
Leucorrlicea is usually noticeable in the glandular variety and in the early stages of the septic. In the former the corpus secretes a thin, and the cervix a thick, clear mucus, both of which may be transformed into minute white co agula, at the external os, by the acid vaginal secretion, and appear at the vulva as a white or greenish-white dis charge. In some cases the mucus is intermittingly tinged with blood. The leucorrhoea may last throughout the month, or only for a few days after the cessation of the monthly flow. In the septic variety the discharge is at first purulent, but later becomes muco-puru lent, and in time may be mucous or even watery in character. It sometimes has a disagreeable odor.