674 THE REPRODUCTIVE ORGANS OF THE FEMALE. 



uterine wall ; these may perforate into the peritoneal cavity or into the 

 rectum. 



Chronic Metritis may follow acute metritis or accompanies acute or 

 chronic endometritis, and is dependent upon similar conditions : subin- 

 volution, displacements, tumors, active irritants, etc. The uterus is en- 

 larged, the wall congested, thickened, and soft, or, owing to the new 

 formation of connective tissue, hard and dense. The lesion may be most 

 marked in the body or in the cervical portion. 



Perimetritis. The peritoneal coat of the uterus may be inflamed, with 

 the production of membranous adhesions or of pus. The adhesions may 

 be small or very extensive, and, owing to their contractions, may cause 

 various distortions and displacements of the pelvic organs. The inflam- 

 mation is usually an accompaniment of chronic metritis and endometritis. 

 In prostitutes such adhesions are of very common occurrence. 



Parametritis. The connective tissue about the uterus, between that 

 organ and the reflexions of the peritoneum, may be the seat of suppura- 

 tive inflammation. It most frequently ends in death, but may result in 

 the formation of dense connective tissue about the uterus. 



II. INFLAMMATION OF THE PREGNANT UTERUS. 



The forms of inflammation which have just been described may also 

 occur in the pregnant uterus. Catarrhal endometritis may lead to effusion 

 of serum, extravasations of blood, and abortions. Metritis may lead to 

 softening of the uterine wall, so that rupture takes place during labor. 

 Perimetritis and parametritis produce adhesions and abscesses about the 

 uterus. 



Infectious Inflammation (Puerperal Fever). For a week or more after 

 delivery the inner surface of the still dilated uterus is rough, especially 

 at the insertion of the placenta, and covered with dark shreds of blood, 

 mucous membrane, and placenta. This condition should not, as is some- 

 times the case, be mistaken for inflammation or gangrene. 



As a result of injury to the uterus or vagina during or after delivery, 

 and the action of bacteria which may gain access to the tissues, in this 

 vulnerable state, the puerperal uterus is liable to become the seat of a 

 series of severe and often destructive inflammatory and necrotic changes. 

 These may be confined to the uterus ; they may induce serious alterations 

 in surrounding parts ; they may lead to an involvement of the peritoneum 

 or to septicaemia or pyaemia and its accompanying lesions in the most 

 distant parts of the body. In some cases a more or less extensive gan- 

 grenous inflammation of the mucous membrane and the underlying parts 

 may lead to the casting-off of larger and smaller shreds of necrotic tissue 

 and the formation of deep and spreading ulcers, which may be accom- 

 panied by severe parametritis and fatal peritonitis. In other cases the 

 inflammation is croupous, and may affect the vagina leading to necrosis, 

 gangrene, ulceration, or peritonitis. 



In connection with either of the above forms of inflammation, or 



