132 DISEASES OF THE UTERUS. 



mia which is at first present subsequently disappears, as the vessels 

 are compressed by the neoplastic shrinking connective tissue. Then 

 the substance appears very pale and dry, and becomes denser and 

 harder, often to such an extent that it creaks under the knife. In 

 rare cases we find hypersemic spots and veins that have become 

 dilated as a result of the obstructed flow of blood. If the vaginal 

 portion be chiefly affected, the os uteri is greatly swollen, and occa- 

 sionally elongated like a snout. The mucous membrane almost in- 

 variably shows the changes described in the previous chapter. On 

 the peritoneal surface we often find firm adhesions to neighboring 

 organs. 



SYMPTOMS AND COUESE. Acute parenchymatous metritis begins 

 with a chill more frequently than the catarrhal form does, and is 

 more apt to be accompanied by symptoms of fever in its subsequent 

 course. The pain in the sacral and inguinal regions, the feeling of 

 pressure in the pelvis, the sensitiveness of the lower part of the ab- 

 domen, the dysuria and tenesmus, are present in the former as well 

 as in the latter, and almost always attain a higher grade than they 

 do in the simple catarrh. The uterus can rarely be felt above the 

 symphysis pubis, but through the vagina we may usually detect en- 

 largement and tenderness of the inferior segment, and a moderate 

 shortening and thickening of the portio vaginalis. There are also 

 anomalies of menstruation. If, as is commonly the case, the dis- 

 ease begins during menstruation, the bleeding usually ceases sud- 

 denly ; if the time for menstruation occurs during the progress of 

 the disease, we either have metrorrhagia (metritis haemorrhagica), 

 or, as more frequently occurs, there is no bleeding. Except during 

 the period of menstruation, the discharge characteristic of uterine 

 catarrh (the constant companion of parenchymatous metritis) is 

 present. In favorable cases the disease runs its course in from 

 eight to fourteen days, the symptoms subside gradually, and the 

 disease ends in perfect recovery ; in unfavorable cases, chronic in- 

 farction remains. There have been some very rare instances where 

 an abscess formed and perforated into the abdomen, and the dis- 

 ease thus terminated fatally. 



Except at the menstrual periods, the symptons of chronic in- 

 farction of the uterus are often not very prominent. Frequently 

 the patient complains only of a feeling of weight in the pelvis and 

 a sensation of "bearing down." The pressure of the enlarged 

 uterus on the rectum and bladder usually causes constipation, as 

 well as a frequent and annoying inclination to go to stool and to 

 urinate. At the commencement of the disease, menstruation is 

 often free and prolonged ; but the more the vessels of the uterus 



