METRITIS - TYPES, CAUSES AND SYMPTOMS OF THEM

By Metritis is generally understood inflammation of the entire 
uterus, both of the body and of the neck, in the puerperal as

well as in the non-puerperal state.

It is not, however, my intention to enter into the consideration of puerperal metritis — the form of acute inflammation which immediately follows parturition. I shall not either, as I have stated in the preceding chapter, include in the same description the history of inflammation of the body and of the neck of the uterus, confining myself for the present to the study of the disease in the former region.
Thus limited, inflammation may occupy the substance of the unim-
pregnated uterus, and be either acute or chronic ; or it may attack
the mucous membrane lining the cavity of the uterus, constituting
internal metritis. We will successively examine each of these forms
of uterine inflammation.

ACUTE METRITIS.
Acute inflammation of the non-impregnated, non-developed uterus, is a rare disease. This is a fact which is generally admitted by ute-
rine pathologists. I believe, however, that acute metritis will be
found of even less frequent occurence than it is supposed to be when it is no longer confounded with inflammation of the lateral ligaments — a mistake at present frequently made, even by experienced practitioners.

The rarity of acute metritis is the natural result of the peculiar
dense, fibro-muscular, non-cellular structure of the body of the
uterus. Tissues of this nature being but slightly susceptible to inflamation as a necessary consequence of their peculiar structure, if the
uterine system is exposed to the causes of inflammation, its peri-
phery the mucous surfaces, the cervix, or lateral ligaments,which are so much more highly vitalized, are generally the regions attacked.

Acute metritis is always accompanied by considerable febrile reaction. The skin is hot, the pulse quick, but not small and thready, as when the peritoneum is compromised. The tongue is covered with a white fur, and continued nausea is nearly invariably experienced, but it is seldom carried so far as to produce vomiting, as in metro-peritonitis. Thirst, headache, and want of rest are also present, as in all febrile diseases ; and the bowels are constipated. The breasts are often sympathetically affected, one or both becoming swollen and painful.

CHRONIC METRITIS
In describing chronic metritis, I shall likewise confine myself to the consideration of the disease in the body of the uterus. Although the distinction is not made by writers on uterine diseases, it is of extreme practical importance. It is in a great measure because it has not been adopted, that there is not to be found a correct description of this form of uterine inflammation. Some of the leading symptoms of chronic metritis are erroneously attributed by many uterine pathologists to the displacements of the uterus which it occasions ; and this has likewise much contributed to obscure its history, especially of late years.
Causes.Chronic metritis sometimes occurs as the termination of acute metritis, whether puerperal or non-puerperal ; but it is, generally speaking, as I have just stated, the result of the gradual extension of chronic inflammation of the neck to the body of the uterus, and the product of years of uterine disease.

Symptoms. Chronic metritis is a malady, the symptoms of whicvary considerably in intensity, according as the patient is examineduring the quiescent state of the uterus — that is, in the interval of
menstruation — or during the presence of the menstrual flux, and
for a few days before and after. Although a most distressing and
wearing affection, it is not altogether incompatible with what a
superficial observer might consider tolerable health, especially
during the interval of menstruation. At that time, indeed, there is
scarcely ever any febrile reaction, and the local uterine symptoms
are much mitigated. The general symptoms are then not unfre-
quently confined to functional derangement of the stomach, of the
nervous system, and of the general nutrition ; the result of the
sympathetic reaction of the diseased uterus on the economy at
large.
A very different state of things, however, is observed when
the molimen hemorrhagicum that precedes menstruation sets in.
The uterine inflammation, previously latent, again becomes evident ,both the local and general indications of its existence reappearing
with renewed intensity.