Endometritis 589 



non-gravid uterus is infinite. Any organism competent to 

 cause wound infection may injuriously attack the uterus. 

 A long list of bacteria has been described as the causes of 

 various uterine diseases. Perhaps the Streptococcus viri- 

 dans is the most common and most destructive, but colon- 

 like bacilli, B. pyogenes, staphylococci, and micrococci are 

 common. The B. abortus is apparently a common resident 

 of the uterus during the puerperal period but, according to 

 most bacteriologists, disappears early after the close of preg- 

 nancy. In the follovi^ing discussion of the uterine infections 

 of this period, explicit reference to the biology will not be 

 attempted because the present knowledge of the subject does 

 not warrant it. The classification is arbitrary and merely 

 intended to aid in arriving at reliable diagnoses and prog- 

 noses. The classes merge by imperceptible gradations one 

 into another. 



A. Endometritis 



The typically healthy uterus passes imperceptibly into the 

 simplest type of metritis. The imperceptible line of demar- 

 cation between health and disease is as impossible to fix in 

 the non-gravid as in the gravid uterus. As previously 

 stated, there is almost always sufficient infection present in 

 the apices of the uterine horns to cause a definite necrosis of 

 the contiguous tips of the embryonic sac. It may be of suf- 

 ficient virulence to cause necrosis of the entire non-gravid 

 horn of the fetal sac. But it may not cause disease so far 

 as any marked peril to the embryo is concerned. 



Clinically the non-gravid uterus physiologically runs such 

 a gamut that it is sometimes perplexing. For some days 

 prior to estrum the uterus becomes increasingly engorged, 

 until finally, when estrum is fully developed, the healthy 

 uterus is enlarged to approximately double its size when at 

 rest. After the ovisac ruptures, the engorgement slowly 

 subsides and the uterus regains its typical character of the 

 inter-estraal pause. The secretions change also. With the 

 advent of estrual engorgement there is an increased secre- 

 tion of mucus, but not notable. Most of the mucus of estrum 



