138 DISEASES OF THE UTERUS. 



without rendering it impossible. Moreover, they impede the escape 

 of the menstrual blood, and cause it to collect temporarily in the 

 uterus, and to be expelled by painful contractions (uterine colic). 

 I have frequently known women to menstruate without difficulty 

 after their first confinement, who, during their maidenhood and the 

 first years of married life, had severe uterine colic during menstrua- 

 tion. Great flexions and angular curvatures cause contraction of 

 the cavity of the uterus at the point of flexion, which also impedes 

 conception, and occasions uterine colic during menstruation. Final- 

 ly, neoplasia, which encroach on the calibre of the uterine cavity 

 and the cervical canal, have the same effect. Perfect closure, atre- 

 sia of the uterus, is very rare. It is sometimes congenital, some- 

 times the result of erosions and ulcers, which, in cicatrizing, have 

 caused adhesions. The seat of congenital closure of the uterus is 

 usually at the external orifice, that of the developed form at the 

 internal orifice. 



As long as the women continue to menstruate, the menstrual 

 blood collects behind the point of closure, causing hcemometra. If 

 the closure does not take place till the menses have ceased, the 

 catarrhal secretion from the mucous membrane occasionally collects 

 in the closed cavity, and distends the uterus. Sometimes this secre- 

 tion resembles serum or synovia, doubtless because the excessive ten- 

 sion destroys the secreting glands in the mucous membrane, and 

 the latter becomes like a serous membrane. The above state is 

 called hydrometra. 



In hcemometra, which, moreover, depends upon atresia of the 

 vagina oftener than upon atresia of the uterus, the uterus may 

 be gradually distended till it becomes as large as it does in the later 

 months of pregnancy, and the blood contained in it, which is usually 

 black and tarry, may amount to eight or ten pounds. According to 

 the observations of Scanzoni and Veit, when the distention takes 

 place rapidly, the walls of the uterus are thinned ; if it comes on 

 slowly, they are thickened by hypertrophy. In the early stages it 

 is difficult to diagnose haemometra. During childhood closure of 

 the uterus or vagina is hardly ever discovered. The first morbid 

 symptoms occur about the commencement of puberty. At intervals 

 of four weeks there is severe uterine colic, with a feeling of pressure 

 and weight in the pelvis, and signs of severe congestion of the other 

 pelvic organs, or of perimetritis. At first the patients feel well 

 again after these symptoms have continued a few days ; but after 

 four weeks there is a relapse. After a time the intervals are no 

 longer free from pain. The abdomen increases in size ; the uterus 

 rises above the symphysis pubis, and may rise as high as the navel. 



