Pain may be felt in the sacral or lum bar region, and may' extend across the back or up the spine to the occipital region, or down the course of the sciatic nerve. Cntting or cramping pains across the lower abdomen or pubic region may be complained of, depending upon pain ful uterine contractions due to the expul sion or attempted expulsion of uterine discharges. Irritability of the bladder or rectum, or pain in the vagina or pubic bones, may be prominent. Feelings of weight in the vagina, and sensations as of prolapse of the pelvic organs are pres ent in some cases. Intercostal neuralgia is not uncommon.
Menstrual pain of a burning or aching character may be felt in tbe pelvis and back, or the pain may be suprapubic and colicky. It may last one or more days ot throughout the period, and even for sev eral days afterward. When the mucous membrane is exfoliated the uterine con tractions are frequent and excessively painful, and last until the membrane is expelled.
Gaseous distension of the intestines, constipation, impaired dig-estion—with its accompanying reflexes, photophobia, and pain in the eyes after prolonged at tempts at reading—are the ordinary re flex disturbances. Mental depression, worry, and the various manifestations of ' hysteria and neurasthenia are sometimes classed among the reflexes, although they are, as a rule, largely dependent upon other conditions and circumstances.
Chills, fever, and the other general symptoms of inflammation and sepsis are observed in acute endometritis.
In chronic cases anxmia and nervous debility are often present.
Diagnosis.—Endometritis must be dif ferentiated from angionia, tuberculosis, carcinoma, and myoma of the uterine mucous meinbrane.
Besides the symptoms, tenderness of the uterus, as evidenced by bimanual palpation, and sensitiveness of the endo metrium at the internal os and fundus, as demonstrated by the passage of the sound, are of diagnostic value. The withdrawal of the sound may be followed by a moderate flow of blood or mucus.
Differential diagnosis between catarrh limited to the cervix and eervico-cor poreal catarrh: (1) thin, purulent dis charge indicates catarrh of corporeal en dometritutt; (2) cervical catarrhs sel dom occur in multiparat; (3) reflex symptoms point to trouble of mucosa; (4) cervical catarrhs are rare in virgin.s, cervical and corporeal eatarrh still more so. Van Tussenbroek and de Leon (Archiv f. Gyniik., B. 47, '94).
Endoscopy recommended in the study of endo-uterine affections; the technique is not difficult. Bumut (La Semaine June 15, '95).
[It is certainly doubtful whether the examination of the uterus by the endo scope affords information that justifies the dangers of carrying infection to the uterine cavity. E. E. 31o:stv.,omEnv,
Assoe. Ed., Annual, "96.] The pronounced tenderness of the en dometrimn on the touch of the sound is characteristic of painful endometritis. As a rule, only certain localities (fundits and tubal insertions) give rise to the attacks of pain. The use of the curette brought recovery; a glandular hyper plasia could gentrally he found in the (/(lbris. Pinkuss (Monats. f. Geb. u. Gyn., B. 11, S. 90S, 1900).
It is difficult to distinguish ANGIOMA from hxmorrhagic glandular endome tritis except by the aid of the curette, which, in the latter case, will bring out some of the hyperplastic MUCOUS mem brane.
in TUBERCULOSIS of the endometrium the curette will find necrotic, cheesy par ticles and perhaps tuberculous tissue. An accompanying bilateral salpingitis and pelvic peritonitis with encysted ascites, particularly in virgins, indicate the condition. Tuberculosis elsewhere, and a slowly progressive ancernia, add probability.
in CARCINOMA and sARcomA watery discharges, fcetor, gradually-increasing metrorrhagia, rapid progress and the mi croscopical examination of the findings of the curette are diagnostic. Carcino matous infiltration of the cervix produces a globular enlargement that affects the supravaginal portion as much or more than the vaginal. Carcinomatous ulcer ation is excavated, fissured, pale red or grayish, with vascular spots that are fri able and bleed easily upon being touched. A tenaculum tears it easily and causes abundant hemorrhage, but will hold firmly in an inflamed cervix. When there is cystic degeneration the tenacu lum may tear out easily, but it causes a flow of mucus from the lacerated follicles with or without some limmorrhage. The inflamed cervix is usually soft and elastic, the carcinomatous either hard or friable.
Two cases of endometritis closely simulating cancer of the fundus in order to emphasize the fact that the micro scope as a means of exclusion is quite as valuable as in the positive diagnosis of cancer. The microscopical examina tions of uterine scrapings in cases of suspected carcinoma may be of value in differential diag,nosis either as a posi tive or negative factor. It is positive when the examination shows without question the presence of cancer; it is of just as great value when it as cer tainly reveals the benign nature of a pathological process which has given rise to symptoms characteristic of can cer. Anspach (Univ. of Penna. Med. Bull., May, 1901).