PERIMETRITIS AND PARAMETRITIS. 135 



further, and the mucous membrane of the cervical canal becomes 

 everted and chafes against the vaginal walls. Through the irritation 

 thus set up, the angle of the laceration becomes the seat of an ero- 

 sion, which may spread over the everted surfaces. Such an ulcer 

 heals with great difficulty, and only by granulation and by the for- 

 mation of a dense cicatrix. The womb usually suffers subinvolution 

 with all its consequences, and the cicatrices are a fruitful source of 

 neuralgia and other forms of uterine irritability. As long as the 

 fissure remains open, the ulceration is most refractory to all treat- 

 ment. It is necessary to close the laceration by a surgical opera- 

 tion. This in judicious hands is neither difficult of accomplish- 

 ment nor dangerous, and yields most satisfactory results.] 



CHAPTER III. 



PEEIMETEITIS AND PAEAMETEITIS. 



INFLAMMATIONS of the parts about the uterus occur very fre- 

 quently just after confinement, and not unfrequently at other times. 

 In the latter case they usually depend on disturbance of the menses. 

 If the inflammation starts from the serous coat of the uterus and its 

 appendages, and the case is one of partial peritonitis, the disease is 

 called perimetritis / if, on the contrary, the inflammation is in the 

 subperitoneal connective tissue, it is called phlegmon periuterina, 

 or, according to Virchow, parametritis. 



Perimetritis leads to more or less copious exudation on the free 

 surface of the peritonaeum. Scanty fibrinous exudations cause adhe- 

 sions with the neighboring organs. Even large fluid exudations are 

 usually encapsulated by adhesions at their edges. After absorption 

 of the exudation, adhesions to the pelvic organs often remain. In 

 parametritis there is infiltration of the subperitoneal tissue, which 

 is firm from the first. The infiltration may be reabsorbed ; but a 

 firm induration often remains as the result of connective-tissue pro- 

 liferation. In other cases the inflammation goes on to suppuration, 

 and abscesses form, whose contents may perforate into the rectum, 

 vagina, bladder, or abdomen. 



It is often difficult to distinguish between perimetritis and para- 

 metritis during life ; they begin and run their course with more 

 or less severe subjective and objective symptons of fever. The 

 patients complain of pain deep in the pelvis, which is increased by 

 pressure on the lower part of the abdomen. Generally, also, there are 

 symptoms of compression of the pelvic organs, the bladder, rectum, 

 59 



