Small intra-uterine and submucous MYOMATA usually cause marked enlarge ment of the uterine cavity, and can sometimes be felt by the sound. Digi tal examination of the endometrium through the dilated and incised cervix is of great value in discovering this, as also of other 'conditions, although the pro cedure is a mutilating one and only ad visable in rare instances.
Etiology.—Acute endometritis may re sult from trauma or taking cold during the menstrual congestion, such as sup pression of menstruation from exposure to cold, excessive coitus, overexertion, or blows upon the lower abdomen during menstruation. It may also be caused by infection, such as inoculation by gonor rhceal pus during or following coitus, in fection of retained secundines, or the ex tension of sepsis from vaginal inflamma tion.
-Bacteriological examination of the en dometriurn in twenty-five cases of endo metritis made and fourteen distinct spe cies of micro-organisms were found. Brandt (Med. Chronicle, Apr., '92).
The pyogenic form is most common in puerperm. The streptococcus pyogenes is nearly always the active agent, though staphylococci, gonococci, and the bac terium coli commune may be etiological factors. Doderlein (Centrath. f. Gyniik., .No. 26, '95).
Endometritis is the result of infection with pathogenic micro-organisms which are carried into the uterus during the puerperal state, by means of examina tions with unclean instruments; by means of sterilized instruments used in the vagina which has not been disin fected; by the gonococcus in about 35 per cent. of the eases, and by the bacillus of tuberculosis in 12 per cent. Every case should be submitted to radical treatment by means of the sharp curette and drainage with iodofortn gauze. J. T..Telks (Inter. Jour. of Surg., Feb., '96).
One hundred and seventy-nine cases of puerperal endometritis studied and placed in three principal groups:— 1. Pyogenic form due to streptococcus pyogenes (74 cases); the pyogenie form due to staphylococcus pyogenes auretts (4 cases).
2. Gonorrhccal form (50 cases).
3. "Putrid." form due to saprogenic bacteria (50 cases).
Six fatal cases recorded, and in all the infection WaS dile to streptococci. In some of the cases the infection appeared to be of a mixed form. _EliTnig (l'Ob
stetrique, Jan., '97).
Endometritis may also follow trauma tism with immediate or subsequent infec tion, such as lacerations of the cervix during labor or by instrumental dilation, curettage of the endometrium, the in troduction into the uterus of strong irri tants, the use of intra-uterine stem pessaries or poorly-fitting vaginal pes saries, irritating and unclean tampons, etc.
Experiments demonstrating the bac tericidal property of vaginal secretion. With the exception of the gonococcus, bacteria cannot vegetate for any con siderable leng,th of time in the uterine canal. Menge (Deutsche med. Woch., Nos. 46 and 48, '94).
In Oventy-nine cases of endometritis of body no trace of bacteria found by micro seopical examination or cultivation. Dis ease of mucous membrane not therefore kept up by bacteria in this region. This does not exclude the fa.ct that disease of the mucous membrane arises from acute septic or gonorrhoeal infection. Bumm (Centralb. f. Gyniik., No. 26, '95).
Secretion obtained from the cavity of the uterus of 60 cases and examined microscopically and by cultures with the following results: In 21 patients, mostly eases of fungoid cmlometritis, no bacteria were fonntl, and in most of the cases repeated examinations gave negative re sults. SeVell of the 21 cases showed the presence of bacteria of some kind after frequent intra-uterine manipulation, probably dile to inoculation by the in struments. The bacteria, however, were not pathogenic. The 39 remaining cases in which bacteria were found may be divided into two groups: those in which staphylococci were found and those in which non-pathogenic bacteria were pres ent. S.treptococci Were absent in all cases examined. S. Gottschalk and Rob ert Immerwahr (Arehiv f. Gyn., No. 3, p. 40(f, '96).
Case of a woman in which cause of endometritis was found to be the pres ence of oxyuris vermicularis in the vagina and uterus. E. M. Simons (Ccntralb. f. Gyniik., July 1, '99).
Traumatism or reinfection may con vert a chronic into an acute endometritis. Poisons, such as phosphorus and the es sential oils, are occasional causes.