Glandular endometritis may be caused by interference with the menstrual func tion by taking cold, overexertion, coitus, laborious or sedentary occupations, uter ine displacements, obstinate constipa tion, etc. The same causes may act dur ing puerperal involution or after abor tion.
There is no specific organism for endo metritis of pregnancy, which is always secondary and always in existence be fore the pregnancy. The glandular form of endometritis is an hyperplasia of the mucosa, of which the causes act indi rectly upon the endometrium, such as onanism, sexual excesses, psychical in fluences, diseases of the ovaries, etc. The interstitial form is the result of infection or direct interference with the endometrinin. The glandular form is more frequently the cause of sterility than the interstitial variety. Veit (Zeit. f. Geburts. mid Gyniik., B. 32).
Excessive coitus, masturbation, ova ritis, uterine fibroids, inflammation in neighboring pelvic organs, and interfer ence with uterine drainage by stenosis may lead to it.
Gonorrlima of the iiterus produces in all cases au inflammation of the mucous membrane, designated as an interstitial endometritis with suppurative catarrh, and in a not inconsiderable number of cases the chronic course leads to increase the number of glands. IVertheim (Cearalb. f. Gyniik., No. 26, '95).
Alycosis of the cervical canal is prob ably a more frequent cause of obstinate catarrh than is generally supposed. Calpe (Centralb. f. G'yniik., No. 27, '95).
Endometritis fungosa may sometimes be found in virgins. The first character istic symptoms appear with the first menstruation. Infection with micro-or ganisms, masturbation, and traumatisms are etiological factors. Latolir (Revue Inter. de Med. et Chir. Prat., No. IS, '96).
Number of cases observed in which there was chronic catarrhal inflamma tion of the virgin uterus, and such marked eversion of the cervical lips as to give. the appearance of an ordinary puerperal laceration of the cervix. most instances the excision of the hyper trophie MUCOUS membrane and curetting of the endometrium will effect a cure. P. F. Muncie (Amer. Medico-Surg. Bull.,
May 30, '96).
Underlying a virginal or senile endo inetritis there is frequently a. condition of malnutrition, spoken of in a general_ way as "litluernia." Matthew D. Mann (Amer. Medico-Surg. Bull., May 30, '96).
Chronic septic inflammation may result from one or more acute attacks or from infection by objects introduced into thc vagina or uterine cavity whether by oper ation, examination, or improper at tempts at medication.
Some cases of foetid endometritis in aged women may be due to recurrence of simple endometritis of earlier life, or may be looked upon a.s the result of a necrotic process accompanying the elim ination of fibroinyomata from the uterus. It appears from five to fourteen years after the menopause, and attacks women who have borne. children rather than, nulliparfc. Maurange (La Presse 111M., Jan. 26, '95).
Case of endometritis in a person who was undoubtedly a virgin and who had not been subjected to previous local in strumentation never seen. Howard A. Kelly (Amer. Medico-Surg. Bull.,, May 30, '96).
Bacterial infection is by no means necessary for the production of many cases of chronic endometritis, although this condition may be the result of in vasion by organisms, especially those of sepsis and gonorylnua. Warbasse (Amer.. Jour. Med. Sei., Feb., '98).
Patholo,gy.—The mucous membrane of the cervical cavity presents the same changes as those of other mucous mem branes.
Cervical endometritis exhibits anom alies of secretion with reddening and swelling of mucosa. Gradual narrowing os; retention of seeretion: contrac tion. In consequence of retention, atro phy of mucous membrane. Huge (Cen tralb. f. (3yniik., No. 26, '95).
[Inge divides endometritis into the. glandular, interstitial, and mixed varie ties. The glandular variety is charac terized by an increase of the adenoid elements. the interstitial variety liy an increase in the fibrous tissue, with more or less destruction of the glands: in the mixed form there is an increase of both the interstitial and the glandular struc ture. H. J. I3oldt (New York Med. Jour., Dec. 20, 1902).