554 Diseases of the Genital Organs 



ous infection present with a neutral fluid and then, if possi- 

 ble, to deposit in the organ some long-enduring substance, 

 like iodoform and bismuth, which, without irritating the 

 tissues, may tend to inhibit in some degree bacterial activity. 

 The final eff'ectual disinfection must be a physiologic act 

 upon the part of the organ itself. When the disease ad- 

 vances to constitute septic metritis or pyometra, or retreats 

 to become the endometritis of the post-puerperal period, the 

 clinical phenomena change, the indications for handling 

 shift, and the continuing disease is most profitably discussed 

 under other headings. 



C. Septic Metritis 



The term "septic metritis" is used here to designate a type 

 of uterine infection in which the invading organisms break 

 down the barriers formed by the body of the host, involve 

 the uterine tissues generally, and gain the blood stream, 

 where they cause marked sepsis with great peril to the life 

 of the patient. 



Uterine gangrene occurring during pregnancy, associated 

 with emphysematous decomposition of the fetus, has al- 

 ready been described and it has been stated that severe sep- 

 tic metritis or uterine gangrene not infrequently reveals 

 itself at the time for parturition and serves to delay or pre- 

 vent the expulsion of the fetus. Most cases of septic metri- 

 tis occur during the puerperal period and are clinically rec- 

 ognizable as a rule from two to seven days post partum. 



The gangrenous or septic metritis of pregnancy is funda- 

 mentally identical with the puerperal disease, but is modified 

 by the presence of the decomposing fetus. Septic metritis 

 is not ordinarily an initial or basic disease, but rather a 

 critical phase of metritis growing out of a less virulent 

 phase of infection. Puerperal septic metritis is not ordi- 

 narily the result of an invasion during the puerperal period, 

 but an inheritance from pregnancy, proceeding from sources 

 identical with those of the uterine gangrene in the preg- 

 nant cow. After parturition there may be important new 

 invasions added to the existing infection. These admittedly 



