Symptoms. The external signs are very few, and must be carefully studied, in order that wrong conclusions may be avoided.
Certain of these external signs suggest general disturbance such as one finds in all acute visceral inflammations, viz., loss of appetite, progressive wasting, irregular slight fever, diminution or cessation of the secretion of milk, dulness, etc.
The others are purely local. The discharge from the vagina is mucoid, muco-purulent, sanguinolent or fœtid, according to circumstances. It is small in quantity, and occurs only when the animal lies down or makes expulsive efforts. Examination with the speculum reveals the existence of slight secondary vaginitis and more intense inflammation of the neck of the uterus, which remains half open. Rectal examination shows that the uterus is abnormally large and more difficult than usual to displace. If acute metritis has existed for some weeks, the uterus is painful to the touch, and sometimes fixed in position in consequence of the development of parametritis and of slight pelvi-peritonitis, the occurrence of which is always indicated by temporary tympanites.
Cases of acute metritis may recover spontaneously, but they rarely do so. The condition usually tends to become chronic or to be complicated with peri-uterine diseases which may prove fatal.
Diagnosis. The diagnosis can be established without difficulty by rectal examination and direct examination with a speculum.
Prognosis. The prognosis is grave, because the patients are temporarily or permanently incapable of becoming pregnant, and because acute metritis may be complicated with pelvi-peritonitis, phlebitis of the intra-pelvic veins, etc.
Treatment. The uterus, and particularly the uterine mucous membrane, being affected, all our efforts should be concentrated on that organ. A careful study of the lesions shows that the glandular follicles are infected, and with them the entire thickness of the mucous membrane. The object to be attained, therefore, is the perfect disinfection of this tissue. The parts should repeatedly be washed out with warm water at blood-heat, followed by antiseptic injections containing 4 drachms of chloral per pint; a 1 in 2,000 iodine solution or 20 per cent. to 25 per cent. hydroxyl solution, etc. Despite such injections, the inflammation disappears slowly and with difficulty, and when the neck is sufficiently open it might perhaps be possible, as in human medicine, slightly to curette the mucous membrane of the uterus and plug the cavity with iodoform gauze.
Where, however, the neck of the uterus is so far contracted as no longer to admit a sound or canula for irrigation, the difficulties are very great. Nothing effectual can be done until the neck of the uterus is dilated, an exceedingly troublesome operation.
In the forms termed “post-partum traumatic metritis” antiseptic injections must not be made with any considerable pressure, because of the danger of rupture; plugging the cavity with antiseptic gauze is preferable.