The symptoms of tuberculosis of the uterus are not at all characteristic. In the early stages they resemble those of non-tubercular endometritis. There is sometimes a very profuse leucorrhea, which may contain the characteristic cheesy material. The body of the uterus may be considerably hypertrophied. If the condition follows tuberculosis elsewhere, or if any form of genital tuberculosis exists in the husband, the physician would be led to suspect tuberculosis of the uterus.
The diagnosis can be made only by thorough curetting of the uterine cavity and the microscopic examination of the tissue removed. The tubercle bacillus has not often been found, but the other microscopic appearances are frequently characteristic. In the case from which the section shown in [Fig. 137] was taken the diagnosis of tuberculosis of the endometrium was made by such curetting and examination.
The treatment of tuberculosis of the uterus is hysterectomy. The operation is indicated in every case except those in which there is present in some other part of the body an incurable tubercular lesion.
CHAPTER XXIII.
INVERSION OF THE UTERUS.
In inversion of the uterus this organ is turned partly or completely inside out. The condition usually results from childbirth or from the growth of an interstitial or polypoid tumor.
There seem to be two factors that result in the production of inversion: a degeneration or atrophy of part of the uterine wall, and traction, as from the drag of a uterine polyp or of the umbilical cord. These causes may act together or independently.
If a portion of the uterine wall has lost its strength or tonicity, it may be depressed toward the uterine cavity. The depression is increased by the traction of a tumor or of the umbilical cord. The inversion having been started in this way, may be rapidly increased by uterine contractions. Emmet says that inversion usually takes place between the birth of the child and the delivery of the placenta. A consideration of the subject of acute inversion following labor belongs to obstetrics. It is very important that reduction should be accomplished immediately. The delay of a few hours greatly increases the difficulty of replacement. Emmet says: “The uterus is generally well contracted in twelve hours, and with many cases it would be then quite as difficult to effect a reduction as if a year had elapsed.”
If the placenta is still attached to the inverted uterus, it should be removed before reduction is attempted. Inversion of the uterus when seen by the gynecologist is usually of the chronic form. It has existed for a few weeks or for several years.