670 THE REPRODUCTIVE ORGANS OF THE FEMALE. 



INFLAMMATION. (Metritis and Endometritis.) 



I. INFLAMMATION OF THE UNIMPREGNATED UTERUS. 



Acute Catarrhal Endometritis. In this disease, which iu its lighter 

 grades may leave but little alteration after death, the mucous membrane 

 is swollen, hypersemic, and sometimes the seat of punctate haemorrhages. 

 The epithelium may be degenerated and may desquamate, and the mucosa 

 contain an undue quantity of small spheroidal cells. The surface is more 

 or less thickly covered with muco-purulent exudate. In severe cases 

 shreds of mucous membrane may be exfoliated. The lesion is usually 

 most marked in the mucous membrane of the body, but may involve the 

 cervix at the same time, or the cervix alone. The body of the uterus 

 may be swollen and hypersemic. 



In Endometritis exfoliativa (membranous dysmenorrhoBa) there may be 

 an expulsion, with more or less blood, of membranous masses consisting 

 of fibrin mingled with blood and pus cells, or consisting of exfoliated 

 superficial layers of epithelium. This exfoliated epithelium is frequently 

 much flattened so as considerably to resemble the vaginal epithelium. 

 When the shreds are large the openings of the uterine glands may be seen 

 as perforations. ' 



Acute catarrhal inflammation of the uterus maybe due to injury, ex- 

 posure during menstruation, gonorrhoeal infection, local infection with 

 other bacteria, 2 or it may accompany the general acute infectious diseases. 



Chronic Endometritis. This may be a continuation of an acute inflam- 

 mation or begin as a chronic process. In some of the lesser degrees of 

 inflammation but slight changes are found after death. The mucous 

 membrane, on the other hand, may be swollen, hyperaemic, and covered 

 with muco-purulent exudation. In other cases there is more or less well- 

 marked thickening of the mucous membrane, which may present a smooth 

 or a rough papillary surface or polypoid outgrowths. 



The thickened mucous membrane may show on microscopical examina- 

 tion considerable hyperplasia of the uterine glands. These may be fairly 

 normal and regular in type ; or the epithelial cells may be much increased 

 and irregularly massed within the tubules (Fig. 423) ; the hyperplastic 

 glands are often contorted, forming irregular spirals (Fig. 424). The 

 interglandular stroma of the mucosa may be little changed or much 

 thickened ; it may be dense or very loose in texture and formed largely 

 of small fusiform and spheroidal cells. It is often extremely vascular 

 and may be the seat of interstitial haemorrhage. If there be considerable 

 growth of new gland structure the condition is called "glandular hyper- 

 plasia " of the mucous membrane. It is often difficult in the microscopical 

 examinations of small portions removed from the uterine mucous meni- 



1 See DeWitt, Am. Jour, of Obstetrics, vol. xlii., 1900, bibliography. 



2 For an account with bibliography of the bacteria of the vagina see Williams, Am. 

 Jour, of Obstetrics, vol. xxxviii.. No. 4, 1898; for bacteria of non-pregnant uterus see 

 Miller, Johns Hopkins Hosp. Bulletin, vol. x., p. 29, 1899, bibliography ; also reference 

 to Wadsworth, p. 675. 



