PARENCHYMATOUS METRITIS. 131 



severe uterine colic, but in many instances has induced a fatal 

 metritis or peritonitis. Hence the operation demands the utmost 

 precaution. A ready escape for the liquid injected must be secured 

 by dilating the cervix by means of sponge-tent, and the quantity of 

 liquid used must be very small. When the womb is tender to the 

 touch, and when we suspect that there is a parenchymatous metri- 

 tis or other complication, intrauterine injection must not be at- 

 tempted.] 



CHAPTER II. 



PARENCHYMATOUS METRITIS ACUTE AND CHRONIC INFARCTION OF 



THE UTERUS. 



ETIOLOGY. The changes of the substance of the uterus in acute 

 and chronic parenchymatous inflammation rarely go beyond exces- 

 sive hyperaemia, inflammatory oedema, and proliferation of its con- 

 nective-tissue elements, in which the muscular elements usually par- 

 ticipate but little or not at all. There is rarely suppuration or for- 

 mation of abscesses. We do not include the puerperal form here. 



For the etiology of parenchymatous metritis we may refer to 

 that of the catarrhal form. The injurious influences there men- 

 tioned sometimes cause inflammation of the substance of the uterus ; 

 at others, of its mucous membrane ; but most frequently of both. 

 These influences also cause parenchymatous metritis more readily if 

 they act while the uterus is in a state of physiological congestion. 

 Lastly, the parenchymatous metritis of an unimpregnated uterus 

 must often be regarded as the continuation of a puerperal metritis ; 

 or at least a large number of cases date from the period of a con- 

 finement or of an abortion. 



ANATOMICAL APPEARANCES. In acute parenchymatous metritis, 

 we find the uterus increased in size, particularly in thickness. It 

 may attain the volume of a hen's egg or larger. The over-filling 

 of the blood-vessels causes its substance to appear more or less 

 dark, and usually irregularly reddened. These changes are most 

 marked in the layers lying next the mucous membrane. Occasion- 

 ally there are effusions of blood into the parenchyma. The mu- 

 cous membrane almost always shows the signs of acute catarrh. 

 The serous coat also often participates in the inflammation, and is 

 covered with deposits of fibrin. 



In chronic infarction, the uterus is often enlarged to three or 

 four times its normal size ; its cavity increases, particularly in the 

 long diameter ; its walls may become an inch thick. The hyperaB- 



