Chronic metritis is often the termination of acute metritis, though inflammation of the uterine mucous membrane may assume the chronic form from the first. All post-partum infections with pathogenic microbes may give rise to chronic metritis, as may the various forms of cystitis, vaginitis, rupture of the vulva, etc. Tuberculosis also leads to chronic metritis, which is easily diagnosed by a simple bacteriogical examination of the discharge.
Symptoms. Chronic metritis is accompanied by bad general health and persistent local disturbance. The animals show a permanent muco-purulent discharge varying in amount, or simply an intermittent discharge, which is then more abundant and only lasts some hours or some days, but reappears after irregular intervals. On examination the neck of the uterus is found to be half open, slightly hypertrophied, sometimes sensitive, and covered with vegetations.
Examination through the rectum may show the organ to be considerably hypertrophied, sensitive, and comparatively immobile. Cases are numerous, however, in which the examination reveals nothing very striking.
In other cases, vaginal examination by means of the speculum reveals nothing, except that the neck of the uterus is completely closed, and yet on rectal examination the uterus is found to be of large size, tense, uniformly fluctuating, and in exactly the position to be expected were the animal pregnant. This clinical form was formerly termed “hydrometritis,” but it would be better named “pyo-metritis,” inasmuch as it depends on chronic metritis. The neck of the uterus remains contracted, and the morbid products accumulate in the body and uterine horns, which are gradually dilated. Then suddenly the uterus is seized with reflex contractions overcoming the resistance of the neck and expelling the contents in one jet. The discharge may continue for some days, after which the neck again closes and the disease enters on a new phase.
Lesions. The lesions affect the mucous membrane, more particularly the glandular tissue and the interstitial tissue. From the anatomical and pathological point of view different forms are recognised, some with glandular and mucous atrophy, others with marked hypertrophy, the mucous membrane being covered in some cases with vegetations and fungus-like growths.
Diagnosis. From a clinical standpoint, it is only necessary to distinguish the ordinary forms from tuberculous metritis, which latter is of no clinical importance on account of the impossibility of treatment.
Prognosis. The prognosis is grave, as in all chronic diseases. Furthermore the animals are, for the time being, sterile and difficult to fatten.
Treatment. One of the fundamental conditions of treatment is to attack the disease locally, and it is necessary, therefore, that the uterine neck should be dilated.
If the neck of the uterus is pervious, the parts must be washed out daily with antiseptic solutions, after having lightly curetted the mucous membrane with a blunt curette. Boiled water is first used, and is followed by solutions of chloral, iodine, hydroxyl, or permanganate of potash.
When the neck of the uterus is contracted, it must first of all be dilated. In practice such treatment is sometimes considered too costly, so that the animals are slaughtered or recovery is left to chance.