PARENCHYMATOUS METRITIS. 133 



are compressed by the neoplastic connective tissue, the more diffi- 

 cult menstruation becomes and the scantier the flow. Finally, the 

 menses are often absent for months or years, while the regularly 

 recurring molimina seem to indicate that the ripening and throwing 

 off of the egg takes place at normal periods. In this form of me- 

 tritis also which, moreover, is always accompanied by the catarrhal 

 form the nutritive state of the patient usually suffers after a time, 

 and the hyperaesthesia and other disturbances of innervation, men- 

 tioned in a previous chapter, usually develop. On physical exami- 

 nation we may often feel the enlarged uterus through the abdominal 

 walls above the symphysis pubis, particularly if we push it up a lit- 

 tle with the finger introduced into the vagina. On vaginal exam- 

 ination, we also discover that the vaginal portion is enlarged, indu- 

 rated, and more or less painful. On introducing the uterine sound 

 (which should not be employed unless the practitioner is skilled and 

 experienced in its use), the increase in the long diameter may be 

 ascertained. Although not dangerous, the disease is very obstinate 

 and tedious. Even in its advanced stages it cannot be regarded as 

 absolutely incurable ; the decrease after confinement of the uterus, 

 which had been greatly enlarged during pregnancy, renders it not 

 improbable that there may also be a retrocession of the pathologi- 

 cally increased tissues of the uterus. Occasionally improvement 

 and cure of infarction of the uterus have been seen directly after 

 pregnancy, and in such cases it seemed as if, with the involution of 

 the uterus after confinement, there had been at the same time a 

 diminution of the physiologically and pathologically increased tissue. 



TEE ATMENT. According to the variety of the exciting cause, 

 the causal indications are fulfilled by the different rules prescribed 

 in the preceding chapters. In many cases the continued use of 

 slight laxatives is very beneficial, particularly the laxative waters 

 of Marienbad, Franzenbad, Kissingen, etc. 



The indications from the disease are best answered by the repeated 

 application of leeches (four to six) to the portio vaginalis. Although 

 I have seen a most favorable effect from this treatment, in my own 

 practice and in that of others, where the disease was recent, it has 

 seemed of little use in protracted cases. Theoretically, also, we may 

 expect better results from abstraction of blood while the connective- 

 tissue formation is still new, and the catamenia are plentiful and con- 

 tinued, than when the capillaries have been compressed, the uterus 

 deprived of blood, and the menses have ceased. Before convincing 

 ourselves by personal observation of the brilliant results of abstraction 

 of blood in the first stages of parenchymatous metritis, and finding 

 how well the patients bear the loss, it is usually difficult to make up 



