Menstrual Subinvolution.
Symptoms and Diagnosis. — Menor rha,?ia exists in many cases. Dysmenor rhcea is common and, although it may be connected with uterine cramps in case there be stenosis, usually persists during and after the period as an aching pain or sorenes.s in the pelvis or sacrum, in creased by being on the feet. Headache and hysteria are, if present, worse at such times.
In chronic cases the menses may be ecme scanty, and the patient often claims that she feels badly in proportion to the scantiness, and is apt to demand em menagogues.
The symptoms between the menstrual periods are similar to those of endoine tritis.
Examination usually reveals a sym metrically enlarged uterus_ The cervix is large and dark red or purple in color, and in the advanced stages is hard. The uterine cavity is from three to three and one-ball inches long. The ovaries are usually enlarged and more or less tender.
The uterus may hang low in the pelvis, or it may be held high up by rigid sacro uterine ligaments or by adhesions.
causes include those of endometritis.
Causes which act either in conjunc tion with endometritis or distinct from it, interfering with the normal post menstrual involution or retrogression, are as follow:— 1. Mechanical, — such as displace ments, tumors, stenosis of the cervix, pelvic exudates, etc.
2. Active inflammation in the pelvis, —such as endometritis, aphoritis, sal pingitis, etc.
3. Traumatism and disturbances of the circulation acting during the men strual congestion,—such as blows and strains, catching cold, excessive coitus, onanism, and fatiguing or long-con tinued labor.
Eathology.—In many cases the uterine walls become progressively thicker and the uterus larger, while those in the endometrium do not keep pace with them, or become less and less pro nounced. The blood-vessels are enlarged and the tissues infiltrated with serum and migratory cells. The muscular fibres may at first be enlarged, but soon become separated from one another by embryonic cells, which also surround the blood vessels in large quantities. In time, adult connective tissue forms, which com presses and causes atrophy of the mus.cu
lar fibres, and diminishes the caliber of the blood-vessels until the uterus may be come hardened and purplish in color and finally pale and anomie.
Displacements of the uterus or inflam mation of the surrounding tissues are not uncommon.
At the time of menstruation the con gestion is intense and the retrograde changes do not take place normally and completely, and some enlargement or menstrual subinvolution remains. At each period the enlargement or ment is greater, and, the retrogression or involution being imperfect, the uterus becomes permanently and progressively larger, until the formation of adult con nective tissue or the menopause prevents the process, and sclerosis supervenes.
Metritis of the cervix and cancer. In doubtful changes of the cervix, no pre cise diagnostic criterion is possible with out an accurate microscopical examina tion of the tissues removed from the sus pected locality. This is also of material assistance in establishing a diagnosis be tween cancroid of the cervix and other forms of carcinoma. In incipient can eroid amputation of the cervix is suffi cient, and there is no likelihood of return of the new growth, less so than after total hysterectomy, even when cancerous infiltration has already in vaded the cervical mucosa, or when the malignant process has passed beyond the cervical boundaries. Amico Roscas (Ar chili° di Ostet. e Ginec., Aug., '99).
Analysis of metritis desiceans in 29 cases reported in literature, showing a mortality of 18 per cent. Symptoms of infection were present in all; either a fragment of the uterus was expelled or else it was found atter death loose in the uterine cavity. It consists of slough ing of portions of the uterus from obliter ation of its vessels by bacteria. In 6 un published cases, 2 were examined bac teriologically; in both the mucosa and adjacent muscular tissue, detached in the course of the disease, were found obliter ated by colonies of streptoeocci. Dachxe vich (Vratch, No. 6, '99).