CHRONIC UTERINE CATARRH 125 



The discharge also generally becomes less copious about this tune, 01 

 a little later ; it loses its purulent appearance, and finally disappears 

 entirely. In otlier cases these symptoms of acute catarrh are followed 

 by those of chronic catarrh of the uterus. 



The latter cases, where chronic uterine catarrh is developed from the 

 acute form, are far rarer than those where only the symptoms peculiar 

 to the former were developed at first. In these cases the commence- 

 ment of the disease can rarely be recognized with certainty. As long 

 as it is not abundant, the patients do not usually attach much importance 

 to the discharge, which is the most prominent, and for a long time the 

 only, symptom of their disease. If asked how long they have had it, 

 they are almost always unable to tell exactly. The daily amount of 

 the discharge varies : sometimes it is slight ; in other cases the patient 

 must change the underclothes daily, and must even lay folded napkins 

 under her at night. The dependence of the discharge on catarrh of 

 the uterus may be inferred whop glairy plugs are evacuated from time 

 to time, br if we find in the underclothes the gray, stiff spots that this 

 form of secretion leaves. It is uncertain whether a discharge that 

 leaves yellow spots comes from the uterus or vagina. The more readily 

 it chafes the inner surface of the. thighs, the more probable that part of 

 it at least is vaginal secretion. Later in the disease it not unfrequently 

 happens that the secretion from the uterine cavity is retained there by 

 swelling of the mucous membrane, and by tough plugs of mucus that 

 obstruct the canal. The retained secretion collects in large quantities, 

 and distends the uterus. Under these circumstances, there are occa- 

 sionally pains like labor-pains, very painful contractions of the uterus, 

 that are usually called uterine colic. The longer the catarrh lasts, and 

 the more change it has caused in the mucous membranej the more fre- 

 quently we see abnormal symptoms accompanying the physiological 

 congestions of the uterine mucous membrane that occur during men- 

 struation. Among these, the most frequent are severe molimina before 

 the occurrence of menstruation, and pain while it lasts, dysmenorrhoea. 

 In other cases there is too much blood lost, or, on the contrary, too 

 little or none at all. Conception is not always prevented ; the fact, 

 that occasionally women with very obstinate and excessive catarrh of 

 the uterus conceive, appears to indicate that it is not the uterine 

 catarrh, but the extension of the disease to the oviducts and their 

 closure by the secretion of the mucous membrane that lie at the root 

 of the sterility wnich is so common in the disease. When women with 

 chronic catarrh of the uterus do conceive they abort easily, and are in- 

 clined to placenta. praevia. Veit believes that both the deep seat of 

 the placenta in the uterus and the sterility common in this disease are 

 due to the circumstance that it is difficult for the ovum to become en> 



