UTERUS (ABNORMAL ANATOMY). 



703 



of a discoloured flocculent pulp. This con- 

 dition, in its highest degree, where the tissues 

 appear macerated and deeply penetrated by 

 the dirty-coloured fluids already described, at 

 the surface, constitutes uterine putrescence. 



In addition to these products and results 

 of inflammation, there may be found attached 

 to the uterine surface fragments of an imper- 

 fectly detached placenta, or blood clots and 

 shreds of the deciduous lining, lying free within 

 its cavity. These, by their decomposition 

 within the uterus, whose cavity, from the 

 moment of parturition, has ceased to be com- 

 pletely closed against atmospheric contact, 

 play an important part in the production of 

 those septic and other infections of the blood 

 which appear to form an essential part of all 

 or nearly all puerperal inflammatory pro- 

 cesses. 



Puerperal metrophlebitis. Inflammation of 

 the veins of the uterus occurs most frequently 

 in combination with, and is, to a certain 

 extent, secondary to, the conditions last de- 

 scribed ; but it may occur also as a primary 

 affection, and continue for a time the chief or 

 only morbid state of the organ. The inflam- 

 mation is seldom confined throughout to the 

 veins of the uterus. It appears to commence 

 in some of the orifices of the venous sinuses, 

 which, after labour, terminate open mouthed 

 upon the inner surface of the uterus, over the 

 placental place, and thence spreading through 

 those sinuses which occupy the uterine walls, 

 it may extend to the spermatic and hypogas- 

 tric veins and their tributaries, either upon 

 one or both sides, and ultimately involve more 

 distant vessels. 



The condition of the veins in uterine phle- 

 bitis varies according to the intensity and 

 duration of the inflammation. The inner 

 coat may be pale or stained with the colour- 

 ing matter of the blood. It may have lost its 

 polish, or have become adherent to the con- 

 tents of the vessel, where these are of a solid 

 nature. The coats of the vessels affected 

 may be thickened and opake, and the sur- 

 rounding tissues infiltered by various co- 

 louring fluids, or softened and in a state of 

 putrescence. 



Regarding the contents of the vessels, these 

 consist sometimes of firm plugs of fibrine 

 coagulated from the blood, but more often of 

 these in a softened grumous state, intermixed 

 with portions of a yellow grey or whitish 

 colour. The interior of such coagula may 

 consist of a fluid not easily distinguishable 

 from pus, but resulting from metamorphic 

 changes in the fibrine, subsequent to its co- 

 agulation within the vessels. Or the veins 

 may be distended by a brownish sanies, or a 

 yellow or greenish yellow viscid pus, so that 

 upon section of the uterine walls numerous 

 collections of the latter, resembling separate 

 abscesses, are displayed. 



In the more severe cases of metrophlebitis 

 the proper tissue of the uterus is deeply in- 

 volved, being discoloured and in a state of 

 disorganisation and putrescence throughout 

 its entire thickness ; or exhibiting at different 



points smaller or larger abscesses, the con- 

 tents of which may have been discharged into 

 the general cavity, or form ramified sinuses or 

 fistulae in the uterine substance. Such ab- 

 scesses most probably arise from the suppu- 

 rative inflammation extending beyond the 

 coats of the veins, and involving the surround- 

 ing parenchyma. 



Uterine phlebitis is often associated with 

 inflammation of the uterine lymphatics 

 (Lymphangioitis). These vessels, like the 

 veins, become distended and varicose, and 

 filled with a yellow or greenish puriform 

 fluid, so that their course, together with that 

 of the Fallopian tubes and ovaries, which are 

 generally conjointly affected, may be easily 

 traced into the corresponding hypogastric 

 and lumbar lymphatic plexuses and glands. 



Puerperal metro-peritonitis, or inflammation 

 of the peritoneal coat of the uterus, is asso- 

 ciated with either or both of the foregoing 

 affections, or it occurs as the primary local 

 disease, and sometimes constitutes through- 

 out the sole apparent morbid condition of the 

 uterus. The inflammation may be limited to 

 the peritoneal covering of the uterus and its 

 appendages, or it may involve that of the en- 

 tire pelvic and abdominal regions. The mem- 

 brane itself, which often exhibits little vas- 

 cular congestion, may have retained its polish, 

 or may be covered by exudative products of 

 very various characters. These may be only 

 small in amount, and partially distributed, or 

 abundant and copious. They consist of firm 

 fibrinous concretions, or softer and more 

 pulpy yellow or greenish exudations, consist- 

 ing of coagulable lymph loosened by serous or 

 purulent infiltration, or thick purulent fluid, 

 or semi-fluid matter, or lastly serous or sa- 

 nious fluids, the latter being often discoloured 

 and rendered turbid by intermixture with the 

 before-mentioned products, especially with 

 fibrinous flocculi and puriform and sangui- 

 neous effusions. 



These several pathological conditions of 

 the uterus, which appear to be incompatible 

 with the progress of those normal changes in 

 the condition of the organ that constitute the 

 process of involution (see p. 658.), are ac- 

 companied almost invariably by a marked in- 

 terference with those processes, so that the 

 act of retrogression is either altogether ar- 

 rested, or is in a high degree retarded. 



The foregoing puerperal affections of the 

 uterus exhibit numerous points of great pa- 

 thological interest. These, even in their 

 milder forms, cannot be generally regarded as 

 purely topical affections, for they commonly, 

 in their progress, become associated with like 

 conditions of other and often distant organs, 

 whose connection with the original, or at 

 least principal, seat of disease, can only be 

 explained upon the hypothesis of a general 

 dyscrasis of the blood. It is probable that 

 in some cases, of those, for example, whose 

 commencement is apparently dependent upon 

 miasmatic influences, inoculation with cada- 

 veric matter and the like, a primary infection 

 of the blood precedes the development of the 



