Inflammation of the Womb.—Two forms of this affection may be distinguished : the acute and the chronic. The acute form (acute metrilis or endometrilis) is brought about by the entrance of bacteria into wounds caused during delivery or by a surgical operation. It is frequently occasioned by a gonorrhoeal infection of the mucous membrane of the uterus, the inflammation thence spreading to the muscular wall of the womb. The condition may terminate in death if the inflammation involves the peritoneal covering of the uterus. Fatal results, however, may he prevented by early professional treatment.
In many instances an acute metritis develops into a chronic form of the disease. Chronic inflammation of the body of the uterus may develop from the same causes as the acute form, if the infections are less virulent. It may be due also to incomplete involution, to displacements of the womb after childbirths, to constant over-filling of the bladder and rectum, to sexual irregularities and excesses, and to diseases of the heart and lungs. Inflam mation of the womb leads to proliferation of the connective tissue and, thereby, to enlargement of the organ.
Acute metritis begins with violent pains in the region of the lower abdomen, and with fever and purulent discharge ; it is sometimes accompanied also with distention of the abdomen and with vomiting. In the chronic form the abdominal pains are less severe, or they may be entirely absent ; whereas pains in the small of the back, a sensation of heaviness in the pelvis, and increased menstruation usually accompany this condition.
The treatment of acute metritis requires absolute rest in bed, cold applica tions (ice-bags or compresses) to the abdomen, and careful local treatment by a qualified physician. In the chronic form it is of great importance to obviate the exciting causes of the affection as much as possible. In case of displacement of the womb, the condition should be corrected ; and prompt treatment should be given in cases of catarrh of the uterus, constipation, or diseases of the heart or lungs. When necessary, the physician may prescribe hydrotherapeutic measures, such as irrigations or baths. If that part of the uterus which projects into the vagina is greatly enlarged on account of inflammatory tissue-proliferations, and covered with severely inflamed mucous membrane, it may he necessary to remove part of the vagina] portion. This results in a diminution in the size of the womb, and in retrogression of the organ.
Tumours of the Womb. --- In addition to cancer (which see), the womb may become the seat of other dangerous forms of tumours. Stoppage of the mouth of the womb (which opens into the vagina) may occur from the time of birth, and may remain unnoticed until the time of puberty, when it prevents the discharge of the menses. This causes an accumulation of
menstrual blood in the uterus, which gradually distends that organ as well as the Fallopian tubes, and gives rise to violent pain. Unless relieved, this blood-tumour may attain a size of several inches in diameter, until it finally ruptures, causing a fatal inflammation of the peritoneum. Severe abdominal affections may, therefore, occur in virgins. This fact should he remembered, since the popular idea is that female disorders can occur only after sexual intercourse has taken place. See also HYMEN.
Fibrous tumours of the womb are composed of the same kind of tissue as the uterus itself—namely, of connective tissue and smooth muscle-fibres. This form of tumour usually develops in Nvomen between forty and fifty years of age ; and fibromata, growing more or less rapidly, may finally occupy the entire abdominal cavity. In addition to the symptoms characterising ovarian tumours (see OVARIES, DISEASES OF), fibroid tumours of the uterus generally cause profuse hemorrhages from the womb. Even small pedunculate fibromata (polypi) of the womb may induce such hemorrhages, and cause an extreme degree of anaemia which necessitates the immediate removal of the tumours, or, at times, even of the womb itself. On the other hand, fibrous tumours of the size of a man's head may exist without causing any marked disturbances—neither liemorrhages, nor pains, nor symptoms of pressure. In such cases the patients may quietly await developments, as these tumours often cease to grow for years. In fact, they may even shrink spontaneously during the change of life. It must, however, be remembered that even these benign tumours may develop into cancerous. growths ; and this fact must be borne in mind when the tumour suddenly begins to grow rapidly, giving rise to severe pain, loss of strength, hmmorrhages, and discharges from the womb.
The removal of the womb is an operation which at the present time can be performed with little danger. The uterus may be removed either through the vagina or through the abdominal wall. Fibroid tumours may be removed in the same manner. In young women, who wish to bear children, it is often possible to preserve the uterus by extirpation of the tumour nodes. This operation, however, may at times be attended with greater danger than the removal of the entire womb, including the tumours. Besides, small nodules may be overlooked at the time of the examination, and their growth may necessitate a new operation after the lapse of several years.