UTERUS, DISEASES OF THE. The causes of uterine disease may be divided into those which are operative before marriage, those which arise during married life, and those which depend upon child-bearing or its sequels. These causes thus embrace neglect of out-of-door life and physical development; improper dress; imprudence dur ing menstruation; excessive mental strain; the prevention of conception and the production of abortion; the neglect of precautions after child birth or the failure to repair lacerations occur ring during delivery; disease communicated dur ing sexual intercourse; and habitual constipa tion. Utter disregard of weather o• temperature during menstruation and a continuance of the nervous tension of study during this period are grave and undermining agencies. Tno great ac tivity after parturition in women heretofore un accustomed to physical labor interferes with the normal degeneration of the enlarged uterus. a process requiring six weeks for its accomplish ment. Tight bandaging, 'to preserve the figure,' results in bending the large uterus hack into the hollow of the sacrmn and fixing it in a displaced position. which is the reason for subsequent pain, weariness. constipation, and much discomfort. The modern obstetrician is prepared to close lacerations immediately after delivery, to corn plete the surgical repairs necessary, and to pre vent infection through bleeding surfaces. A very fruitful source of uterine disorder lies in the prevention of conception and the procurement of abortion. The resort to drugs locally applied has resulted often in chronic endometritis, and abortions leave a patulous uterine mouth inviting infection, even if hemorrhage has not proved de bilitating, or peritonitis has not supervened, or retained shreds of fatal or placental tissue have not started a fatal septica•mia. Gonorrhtea (q.v.) is a frequent and dangerous cause of uterine disease. Constipation, so often a result of sheer neglect in young women, contributes to displacement of the uterus by the mass of fcecal matter retained in the rectum with resulting dysmenorrlicea, sterility, and endometritis.
Endomctritis is an inflammatory affection of. the mucous lining of the uterus, and may be confined to either the neck or the body of the viseus, or may affect both. It is caused by ex posure during menstruation, direct injury, in fection from the vagina (notably gonorrhceal), excessive sexual intercourse, or suppressed men struation. its symptoms are pain, weight, and oppression in the pelvic cavity and in the back, frequent griping in the urinary bladder and rec tum, burning in the vagina, and a leucorrhcpal discharge of an irritating and suppurating char acter. It may be complicated by similar disease in adjoining structures. It may last but a few weeks or continue for years.
Chronic metritis, or hyperplasia, gives rise to similar symptoms, with dyspepsia, headache, and languor added, besides nausea and vomiting in some cases. The pathological condition present is an enlargement of the uterus through increase of its connective tissue.
Laceration of the cervix of the uterus consists of a tearing in the wall of the neck of .the organ during labor. It gives rise to all the symptoms noted under endometritis, and also to neuralgic pains in the uterus and discomfort in walking. It may be unavoidable during delivery, and most frequently occurs as a result of precipitate labor, or manual or instrumental delivery. It is a frequent cause of lifelong suffering and distress, which operative interference, in the vase majority of cases, relieves at once.
Fistula' are common affections of the uterus, which give great discomfort. A fistula may be an unnatural opening from the bladder into the uterus, front the bladder into the vagina, from the bladder into the rectum, or from the uterus into the rectum. In each case the passage of urine or focal matter through an improper chan nel is a symptom, as well as pain, pruritus, erup tions, and excessive irritation. The operation devised and improVed by James Sims (q.v.), after unsuccessful suggestions had been made in France, England, and Germany, has revolution ized the topic and rendered these distressing con ditions susceptible to cure.