124: 



DISEASES OF THE UTERUS. 



projects from the gaping os uteri, particularly when a large speculum 

 is introduced (Hoser's ectropion of the os uteri). 



The ovula Ndbothi are very frequently found. These are round 

 translucent nodules, from the size of a millet-seed to that of a pea, and 

 filled with liquid, which are seated in the cervical canal and about the 

 os uteri. They are the distended follicles of the portio vaginalis, 

 whose excretory duct is closed, but whose secretion continues. 



Both forms of catarrhal ulcers that come on other mucous membranes 

 also occur very frequently in catarrh of the uterus, and are very readily 

 observed, as they occur chiefly at the os uteri. Diffuse catarrhal ulcer 

 or catarrhal erosion is most frequently found at the posterior lip of the 

 uterus ; it may thence spread to the anterior one. The loss of sub- 

 stance is very superficial, irregular in shape, has a dark-red base, and is 

 usually covered with puriform secretion. Follicular ulcers, which re- 

 sult from the suppuration or rupture of obstructed follicles, form small 

 round losses of substance, which show no inclination to spread laterally. 

 Granulating ulcers of the os uteri are almost as frequent accompani- 

 ments of uterine catarrh as are the ovules of Ndboih^ simple erosions, 

 or follicular ulcers, and are more important than these. They are dis- 

 tinguished from simple erosions, from which they appear to proceed, 

 by their irregular, granular, readily-bleeding surface. The softness 

 of the granulations prevents our mistaking them for simple erosions oc- 

 curring over a thi3k group of ovules of Naboth, which have a nodulated 

 granular appearance. 



SYMPTOMS AND COURSE. If we except the virulent form, of which 

 we shall hereafter speak, severe catarrh of the uterus running an acute 

 course is rare. The disease usually begins with symptoms of severe 

 congestion of the pelvic organs, with pains in the sacral and inguinal 

 regions, with a feeling of fulness and weight in the pelvis, often also 

 with dysuria and tenesmus. Pressure on the lower part of the abdo- 

 men gives the patient pain, although we cannot feel the uterus. When 

 the disease is mild, these symptoms usually appear without fever; 

 when it is more severe, especially in irritable subjects, they are not 

 unfrequently accompanied by fever. After three or four days, the 

 patients notice a discharge from the genitals ; this is at first transparent 

 and somewhat glutinous ; it leaves gray spots on the underclothes ; 

 subsequently it becomes cloudy, more or less purulent, and leaves yel- 

 low spots on the clothes. If we introduce the speculum (a measure 

 which causes great pain if the vagina participate in the disease), we 

 find the portio vaginalis swollen, dark red, and the secretion above 

 described is escaping from the os uteri. While the reaction of the 

 paginal secretion is acid, this is alkaline. In most cases the pain 

 and any accompanying fever disappear in from eight to fourteen da vs. 



