The alkaline mucous discharge that hangs from the cervix, together with the congestion and infiltration, often pro duces an exfoliation of the squamous epithelium of the vaginal portion, with reproduction in the form of cylindrical epithelium. This condition is called simple erosion. The infiltration and swelling of the submucous tissues causes more or less of a rolling out, or eversion, of the mucous membrane of the cervical cavity, which is more pronounced on a lacerated cervix. More or less folding of the mucous membrane may give the ap pearance of a, papillary or granular sur face, which is called papillary erosion. Pockets may form in these folds and, to gether with the everted cervical glands, may become occluded, giving rise to a cystic condition called follicular erosion. These follicles may become so numerous, or one or ill() may become so large, that the normal cervical tissue is either dis placed or replaced by them, and cystic degeneration thus results. Sometimes localized hyperplasias are present, with projection of glandular polypoid masses. (See Colored Plate.) The uterine mucous membrane above the internal os has somewhat different characteristics from those of other mucous membranes which have different functions. Its glands are simple depres sions or epithelial tubules that extend to the muscular walls underneath. Instead of beitv: imbedded in firm connective tis sue as are the cervical glands, they are surrounded at their inferior extremities by muscular fibres projecting from the muscular walls, which constitute an ill defined muscular structure called the muscularis mucosa2. In the interglandu lar or intertubular spaces or fluid are found delicate connective-tissue fibers and round or oblong cells resembling lymph-cells.
-When subjected to intense prolonged congestion an infiltration of serum takes place, raising the epithelial surface and causing- a proliferation of the epithelial cells, with enlargement, as well as wrink ling, twisting:, or bending of the glandu lar tubules; or in severe cases a forma tion of new depressions or tubules, some of which may become closed by bending or swelling at their orifices.
Tt is not uncommon to have variations in the number, shape, and size of the uterine glands, and it is not right to call this endometritis even if it is clinically so. William H. Welch (.Med. Record, May 21, '98).
In some cases the epithelium prolifer ates within the glands, forming more than one layer. Round-cell infiltration and formation of new interglanclular tissue may take place, particularly if mild septic infection intervene. ln such cases agglomerations of glands sur rounded by a small amount of connective tissue project from the surface, forming polypoicl masses, which may spring from every part of the mucous surface.
Histotogieaity, the epithelium covering the mucous surface is composed chiefly of large, nucleated lencocytes; it is swelled and somewhat distorted. The uterine glands may be normal in part, but the months of the glands are very much swelled ana there are many pus cells present. ln chronic emlometritis the mucous membrane is highly granular and has an appearance like that of polypi.
The term g,rannlar endometritis is highly improper, and should be abandoned. Only forty-nine cases of endometritis found in eighteen hundred gymecological cases at the ,Tohns Hopkins Hospital. The treatment consists in dilating and curetting the uterus. Thomas S. Cullen (Med. Record, May 21, '98).
The uterine walls are usually also congested, and some round-cell tion takes place about the blood-vessels, which, in time, leads to the formation of adult connective tissue. Contraction in this connective tissue may finally cause amemia of the uterine walls and more or less atrophy of the muscular fibres.
The mucous membrane is hypertemie, softened, thickened, and dark red in color. In places it may have a mottled appearance, due to minute extravasa tions of blood. The surface is smooth, sometimes irregular, and is moistened with a thin, clear, grayish or pinkish mucus. The pouting mouths of the con gested and enlarged glands are visible. The uterine walls are slightly thicker and the uterine cavity somewhat longer than normal (from 2 1/2 to 3 inches deep from the external os to the fundus). This condition is that of glandular en dometritis, or hyperplasia of the endome trium, and is seldom the result of infec tion. It is, as a rule, chronic.
During the menstrual periods the con gestion is intense, and there is more or less extravasation of blood in the inter glandular spaces, and an extensive ex foliation of the epithelium.
When the congestion results suddenly from causes acting during or just before the menstrual period, it is also intense and accompanied by interglandular ex travasation and blood-stasis that inter fere with the menstrual discharge, and which, if not relieved, runs into the chronic form.
In acute septic endometritis the blood vessels of the endometrhun are engorged and increased in number. There is con siderable exfoliation and proliferation of the epithelial cells, sometimes to such an extent as to cause a superficial ne crosis. The interglandular spaces are crowded with round cells, leucocytes, and cocci which may extend into the muscularis mucosw and, if streptococci be present, a short distance into the uter ine walls. Congestion, extravasation of blood, serous and round-cell infiltration take place throughout the uterine tissue, and a fibrinous exudate may appear on the peritoneal surface.
Eighteen cases of infectious diseases, showing that the blood-vessels of the endometrium ITIV intensely congested, particularly the small veins and the cap illaries. Ecchymoses, either in patches or disseminated all over the surface of the mucous membrane, were present. The glandular epithelium was swelled, the cells were desquamated, and the lumina of tbe glands filled with cells, mucus, and blood-eorpuseles. The glands frequently penetrated very deeply into the muscular layer, this being a charac teristic sign of endometritis. An hadmor rbagic endometritis was found to be pres ent in all of these eases. :Hassel/ (Gaz. de Gyn., Mar. 15, '91).