466 Diseases of the Genital Organs 



many, probably in most cases, cervical endometritis is the 

 result of an extension of infection from the cervical mucosa 

 forward. In the most outstanding cases, the infection evi- 

 dently extends from the cervical canal, as illustrated in Fig. 

 174, in which the cervical seal has failed to form and a me- 

 tritis has served to destroy the placental relations about the 

 os uteri internum, so that portions of the chorion, some of 

 which are necrotic, protrude through the cervical canal into 

 the vagina. At the same time the embryo may be living 

 and not visibly involved, but ultimately the fetus must par- 

 ticipate in the infection and abortion follow. 



Cervical endometritis is not always clinically recognizable, 

 but in many cases it is very evident. Frequently the uterine 

 seal is imperfect, is wanting in resistance or density, or 

 may be discolored. In some cases, like Fig. 174, portions of 

 the fetal sac protrude into the vagina. The protruding 

 parts are usually necrotic, but moderate traction ordinarily 

 brings living vascular membranes into view. Such cases 

 are well advanced on the road to abortion. 



Cervical endometritis is sometimes diagnosable by means 

 of rectal palpation, owing to the atony of the pregnant 

 uterus. Physiologically the gravid uterus is tonic to the 

 sense of touch, but in some cases of disease the organ is 

 clearly atonic, soft, paretic, and flabby. 



So far as known, the infection of cervical endometritis 

 exists within the cervical end of the uterus or in the contin- 

 uous cervical canal at the time of conception. The infection 

 may exist at the time of coitus or may be transmitted by 

 coitus as a seminal contamination. 



In studying the bacteriology of cervical endometritis, 

 most investigators have searched for the B. abortus only, 

 and when they have not recovered that organism have re- 

 ported the findings as negative. A few investigators have 

 reported the finding of paracolon or paratyphus bacilli, B. 

 pyogenes, streptococci, etc. The B. abortus, according to 

 recorded observations, is frequently present and apparently 

 plays an important part in the metritis, but just what part 

 is not precisely known, because the other organisms present 



