There is a more or less abundant flow of pus from the endometrium.
In chronic septic endometritis round cells and leueoeytes crowd the inter glandular spaces, compressing the glands and in places penetrating and destroying them. After a time the formation of contracting adult connective tissue com presses and obliterates some glands, and obstructs the mouths of others, convert ing them into small cysts. The epi thelium in the atrophic glands and on the surface also degenerates; so that in old and senile cases the mucous mem brane may be represented by a thin layer of sclerotic connective with only vestiges of epithelial structure.
The -uterine walls, at first hyperfemic and infiltrated to a greater or less depth with serum and round cells, are thicker and softer than normal, but later, owing to the contraction of the inflammatory tissue, become hardened. The atrophy of the mnscular tissue and absorption of the serum, as well as the senile changes, may finally lead to a diminution in size of the entire organ.
Endometritis occurring in connection with abortion may interfere with the atrophy of the decidua, and masses of decidual cells may be found in the en dometrium in connection with the round cell infiltration.
In some cases the menstrual conges tion is so great that an acute attack is practically lighted up at each period. The stroma-cells are enlarged and re semble clecidual cells, and the tissues are crowded with leucocytes. The conges tion is so great that there is an abundant extravasation of blood in the intergland ular spaces, which loosens the superficial portion to the extent of causing its ex foliation in places or even entire, as a more or less complete cast of the uterine cavity.
After the menopause the cervix may become stenotic, and the discharges be retained. The uterine cavity may then become distended, and the uterine walls attenuated by an offensive and purulent fluid.
The menopause does not exercise a curative influence upon endometritis and its resulting. lencorrhcea. Jacobs (Amer.
Jour. Med. Sciences, Apr., '94).
The characteristic pathological features of acute senile endometritis are a thick ened endometrium, the free surface of which is devoid of its epithelial layer; increased vascularity with peculiar ar rangement of small blood-vessels; small round-celled infiltration; diminished glandular elements; degeneration of the coats of the arteries of the muscular layer of the organ; in not one section examined from various parts of the organ could there be found any increase of con nective tissue. L. H. Dunning (Jour. Amer. Med. Assoc., Nov. 3, 1900).
Prognosis.—The prognosis of acute metritis in the puerperal state or after abortion is grave. The patient may die of septicemia, or the disease may extend to the Fallopian tubes, ovaries, and peri toneum, or into the veins or lymphatics of the broad ligament, or it may result in chronic endometritis and stibinvolution.
When not connected with pregnancy the disease seldom terminates fatally, but is apt to extend to the adnexa or become chronic.
Acute cervical metritis may end in re covery, but, as a rule, becomes chronic.
Chronic cervical metritis may get well, but, as a rule, it persists for a long time.
It can ordinarily be cured either by local treatment or operation.
Chronic corporeal endometritis of the septic variety is apt to get well if there is good drainage through the cervix. Without adequate drainage it becomes chronic and is liable to spread to the adnexa.
In the non-puerperal uterus the risk of the inflammation spreading to the tubes is little save when the cervical canal is obstructed or the infection gon orrhceal in nature. NV. P. Carr (Vir ginia :lied. Semimonthly, Jan. 8, '97).
The prognosis of fcetid endometritis is favorable, though recurrence may occur after curettement. Mansange (Arch. de Tocol. et d'Obstet.; Centralb. f.
No. 21, '97).
In cases of long standing the septic condition can be removed, but the endo metrium and myometrium can seldom be restored to a normal state.