Tuesday, January 29, 2013

Dropsy of the Uterus

Roger Mitnick  /  at  1:10 PM  /  No comments

By dropsy of the uterus we understand an accumulation of 
serous or mucous fluid within its cavity. It is generally the 
immediate consequence of stricture or atresia of the orifices, 
and occurs in its true form only after the cessation of menstru- 
ation. 
 
If tlie efflux of uterine mucus secreted in considerable quan- 
tity, be impeded by the above-mentioned causes, it accumulates 
in the cavity of the body of the uterus when the impediment is 
situated at the internal orifice, and in the cavity of the cervix, 
when it exists at the external orifice. In rare cases also of 
stricture of both orifices, accumulation of fluid takes place in 
the cavity of the body as well as in that of the cervix. 

In stricture of the internal orifice the cavity of the body of 
the uterus dilates in such a manner as to become globe shaped ; 
its walls are uniformly distended, and in general are found in 
a state of eccentric hypertrophy. If the distention attains a 
higher degree the uterus is finally transformed into a thin- 
walled sac with inelastic walls. Investigations, especially of 
cases of considerable hydrometra in aged females, show that 
the elements of connective tissue predominate considerably 
over those of muscular tissue and we must assume that the 
latter are chiefiy destroyed by the distension, and that the 
hyperplasia accompanying nearly every case of hydrometra, 
chiefly aflfects the connective tissue. 

When the cavity of the body of the uterus is considerably 
distended, its mucous membrane becomes thin and degener- 
ates, and its external soft velvet-like appearance is lost, its sur- 
face assuming the smooth, glossy appearance of serous mem- 
branes. If the uterus be further distended it becomes net- 
like in appearance, and is Anally changed into a soft layer of 
connective tissue covered with a single layer of frequently 
degenerated cyhndrical epithelial cells. The latter generally, 
and in the higher degrees of hydrometra, always loose their 
cihas, and appear shorter and thicker, resembling the so- 
called transitory epithelium. I have been unable, even in the 
highest degree of hydrometra, to discover the pavement epithe- 
lial cell, which is found in analogous conditions of the gaU 
bladder. The glands of the uterine mucous membrane in the 
commencement of hydrometra, are generally affected with a 
fatty degeneration of their epithelium, and are finally destroyed, 

leaving indurations in the mucous membrane. Sometimes also 
tlie utricular glands degenerate into small cysts. 

The fluids contained in the cavity of the uterus are at first a 
viscid mucus, sometimes clear or serous, sometimes slightly 
turbid and yellowish or brown in color. In many cases of 
atresia after menstruation has made its appearance for a short 
time only, or several times and then ceased, a hsematometra 
formed at first, may turn into hydrometra, and the hsematine 
being changed into brown pigment, may give a peculiar color 
to the fluid. Upon closer investigation we find varying quan- 
tities of cast-off epithehum and colloid bodies suspended in a 
mucus fluid. After a longer continuance of hydrometra how- 
ever, we generally find the contents strongly alkaline, very 
fluid and nearly or perfectly clear. The mucous substance 
contained in the secreted fluid may have been dissolved by its 
alkalescence.* 

In stricture of the external orifice the cervical canal is dis- 
tended Hke a pouch, and we may mention that the cavity of 
the uterus participates only slightly in the enlargement. Fre- 
quently enough I have observed pouch-hke distention of the 
cervical canal without dilatation of the uterine cavity. In every 
such case there was stricture only at the external orifice. Ob- 
struction of the cervical canal being the chief cause of disten- 
tion of the cavity of the uterus, we are led to assume that in 
such cases there is no hypersecretion of the uterine mucous 
membrane, consequently that the cervical mucous membrane 
alone is diseased, or, which seems possible, that although the 
cervical catarrh may be most severe, a slight catarrh of the 
uterine mucous membrane may co-exist, but that a temporary 
emptying of the cervical canal occm's from time to time and 
the uterus distended by accumulated fluid, contracts and tem- 
porarily assumes its former size, whilst the less muscular cervix 
is distended to its utmost at an earlier period and remains 
 

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