594 Diseases of the Cienital Organs 



B. Pyometra. 



When pus in large volume is retained within the uterus, 

 the condition is designated pyometra. It passes by scarcely 

 discernible gradations on the one hand into endometritis, 

 and upon the other into sclerotic metritis. Pyometra is 

 used to designate not only the amount of pus formed within 

 the uterus but also the approximate degree of uterine atony 

 and hence the extent of retention of the pus within the uter- 

 ine cavity. There may be a considerable volume of pus 

 formed within the uterus, but the muscular coat retains its 

 function and almost immediately expels it into the vagina. 

 One frequently encounters several ounces of pus in the va- 

 gina, but upon douching the uterus finds but little within 

 that cavity. After making proper allowance for such pus 

 as may have been formed in the cervix or in the vagina 

 itself, the volume within the uterus compared with that in 

 the vagina expresses approximately the general tonicity of 

 the uterus and the extent of involvement of its various tis- 

 sues. If the pus lies almost entirely within the vagina, it 

 indicates that the disease is limited chiefly to the uterine 

 mucosa or endometrium and may therefore be designated 

 endometritis. If, however, there is comparatively little pus 

 encountered in the vagina, but most of it is retained within 

 the uterus, it is more appropriately designated pyometra. 



The chief symptom of pyometra is the presence of a puru- 

 lent discharge from the vulva. The discharge may be pro- 

 fuse or scant, and in exceptional cases may be absent. A 

 discharge issuing from the vulva may emanate, aside from 

 the uterus, from the cervix, vagina, urinary bladder (and 

 through the bladder, from the kidney), and from other 

 sources. The pus discharged may vary infinitely in charac- 

 ter. It is usually fetid, often extremely so. It is generally 

 yellowish-white and thick. The pus of pyometra, as the 

 term is commonly applied, is not ordinarily mixed with 

 recognizable mucus because suppuration has supplanted 

 the formation of mucus in the mucous glands of the uterus. 

 In endometritis the mucus-secreting power of the uterus is 

 deranged but not destroyed. In some old cases the heavier 



