Prognosis. — The prognosis without treatment is not good, for the disease runs a very chronic course and the uterus remains enlarged. If treated early and vigorously, a cure may be effected, al though sometimes not without a sacrifice of the ovaries.
Treatment. —Mechanical causes—such as displacements, tumors, stenosis, etc.— should be removed. Inflammations about the uterus must be treated in order that their unfavorable influence upon menstruation shall cease.
In the ascending type of metritis—not that which begins at the cervix, but the variety which proceeds from a pyosal pinx—removal of the tubes alone will not cure the patient, but the uterus itself should be removed. Pilliet (Progres Med., May 8, '97).
The uterus should be curetted, unless co-existing exudates or inflammations contra-indicate such an operation.
Curettage for hmmorrhagic rnetritis in the virgin successfully employed in three cases. In the first two cases-16 and 15 years, respectively—the curette brought away large masses of whitish fungosities, of a firmer consistence than is usually met with in the scrapings of Inemor rhagic metritis in married women; the uterus was afterward packed with iodo form gauze. In the third patient, a girl of 14 years, the curette removed grayish white fungositics, of a softer consistence than in the foregoing cases. Blanc (Loire Med., No. 12, Dec. 15, '96).
Chloride of zinc in chronic metritis preferred to curette. It never gives rise to aggravation of inflammation of the appendages which may complicate me tritis as the curette often does. The lat ter requires aniesthesia and confinement to bed; chloride of zinc permits the patient to go about directly after the in jection with impunity. In 62 eases treated the solution of chloride of zinc varied in strength from 30 to 40 per cent. A drachm is injected into the uterine cavity and the borax-saturated solution injected immediately after. The danger of forcing the fluid into the peri toneal cavity should be borne in mind, and due care to avoid this accident slionld be taken.
The injections are painful at first, and transient .syncope may ocenr, but uo per manent ill effects were noted. The best results were obtained in linemorrhagic endometritis, of 20 eases, 22 being cured. In glandular endometritis 8 cures were obtained in 15 cases. When the adnexa were diseased only half of the eases were permanently benefited. Delbert (An n.iles de Gynee. et d'Obstet., Jan., '99).
The application twice monthly of a so lution of zinc chloride not only benefits the endometritis, but tends to stimulate the uterus to contraction, and thus favors involution and diminishes the menor rhagin. It may be used as a primary
method of treatment, or to follow up a curettage. Before each application the cavix should be slightly dilated with a round dilator. As this treatment is apt to cause some pain for a few bours after 11S.e, it should be followed by rest dur ing the remainder of the day. A slight cauterization is produced by each appli cation, and, if sufficient time be not al lowed to pass between them, the patient will complain of more backache or pelvic discomfort than previously. In such cases the intervals must be lengthened or the treatment suspended for a few weeks.
Jequirity highly recommended in chronic granular metritis. The strength of the solution employed is 1 per cent. Horde (Archives of Gynwe., Sept., '91).
The following is useful in hemorrhagic metritis:— R FL extract of ergot, 1 ounce.
Fl. extract of hamamelis, Tr. einnamorn., of each, 1/, ounce.
M. Sig.: A teaspoonful every two hours. Chase (Med. News, June 19, '97).
Bipolar faradism or mild galvanism of the endometrium will sometimes reduce the uterus in size.
Intra-uterine electrolysis recommended as a treatment of rnetritis, a silver elec trode being employed. Boisseau du Pocher (La Presse Med., June 29, '95).
Tonics, laxatives, a midday rest in the recumbent position, etc., are indicated the same as for endoinetritis.
Deep scarification through the specu lum relieves the engorged vessels and may abort or palliate the attack. Should pain be intolerable, a suppository of aqueous extract of opium, 1 grain, and extract of belladonna, '/, grain, may be used. Curettage, if indicated at all, should be thorough. The steps of the operation are as follow:— 1. Anfesthesia.
2. Preparation of the vagina and ex ternal genitalia.
3. Dilatation of tbe uterus, unless it is already sufficiently open.
4. Removal of the infected endo metrium by means of the sharp curette.
5. Thorough irrigation of the endo metrium with cotton wound- on dress ing- forceps and dipped in saturated so lution of iodine crystals with pure car bolic acid.
Dilatation, curettage, and drainage of the endometrium in acute infection should be limited in its application. The only cases in which it should be per formed are those which will otherwise result in dangerous spreading of the in fection.
Curettage is contra-indicated in cases in which the infection has passed to the parametria. E. C. Dudley (Albert Lea Med. Jour., Dec., '98).
Acute gonorrlicea is an absolute con tra-indication to washing out of the uterus; otherwise this measure iu suit able cases has been largely adopted with success of late years. Gesna (These de Paris, '99; La Gynec., Dec. 15, '99).