Femina, A Work for Every Woman

by John A. Miller

Acute endometritis is the most common form; it has also been described under the names of acute uterine leucorrhœa, acute uterine catarrh, and acute internal metritis. It usually runs a rapid course, ending in recovery or in the chronic form. It undoubtedly passes unrecognized in many instances, and in this way many cases of painful menstruation or suppressed menstruation are explainable.

It can be said that at each and every menstrual period there is a physiological catarrh, which belongs to the natural process of the menstrual function. During each menstruation there is a hyperæmia, or congestion of the mucous membrane, so that the turgent blood vessels rupture, and this constitutes the menstrual flow. Before this congestion reaches the point of bursting the capillaries, and about the time that the sanguineous flow ceases, there is an increased and altered mucous secretion of the mucous membrane. If this secretion is prolonged beyond the normal period that constitutes healthy menstruation, or if it continues to be present at any time between the menstrual periods, it constitutes a disease or a catarrh. Now when we consider the close relation that the normal functions of the womb have to those that are abnormal, and that the one may be the stepping-stone to the other, we need not be surprised that endometritis, or catarrh of the womb, is one of the most common affections to which women are liable.

Chronic endometritis is where the disease has lasted for a long time; some authorities consider it a rare affection, but this is a great error. Any disease so frequent as acute endometritis must, in the very nature of inflammatory processes, become chronic, in a large proportion of cases.

Endometritis of the body of the womb, in contra-distinction to a partial inflammation, located and confined to the mucous membrane of the neck or cervix of the womb, forms another or third variety of this affection. This disease has been described under the names of chronic corporeal endometritis, uterine catarrh, uterine leucorrhœa, and internal metritis, and the seat of it is confined to the lining membrane of the cavity of the womb, without complicating the cavity of the cervix; but there is no doubt that when either the one or the other is the seat of a stubborn catarrh, the remaining portion of the uterus must become sooner or later more or less compromised in the diseased process.

Chronic cervical endometritis is where the inflammation affects the membrane of the neck; this has been described under the names of cervical catarrh, cervical leucorrhœa, and endocervicitis. These terms are all derived in composition from the Latin word cervix, neck.

The uterus is really divided into two cavities that run into each other; one of these is the cavity of the body, while the other is the cavity of the cervix, a fusiform canal, measuring about one inch and a quarter in length. The cervix partly projects into the vagina, and, as a result, is liable to injury and irritation, to which the other portion of the organ is not exposed. Friction and other influences aggravate the inflammatory process, so that erosions, granular and cystic degenerations, follicular ulcers and chronic enlargements, become complications of the catarrhal inflammation of the cervix.

To return again to a consideration of the general aspect of catarrh of the womb, for it is one and the same pathological process that underlies the different forms. There is a simplicity in the relation of cause and effect, that will strike the casual student as one of the most instructive lessons that it is possible to learn, because it also suggests the simplicity of the measures of which persons can avail themselves for the prevention or cure of this affection.

From the physiological reasons that were mentioned as a cause of endometritis, it follows, as a natural consequence, that the predisposition to catarrh of the womb, varies greatly with the age of persons, so that before the age of puberty, at a time when there are no periodical congestions of the womb from the menses, it occurs very rarely, while from the period of pubescence, and during the functional activity of the pelvic organs, it is very prevalent, but at the approach of the menopause and sexual decadence the predisposition is again lost.

As far as the character and nature of uterine catarrh is concerned, that which in technical language is termed the pathological anatomy is no different from what it is in catarrhal inflammations in other organs, so that the remarks that were made on similar affections of other organs, apply with equal correctness to catarrh of the uterus.

There is, however, one exception of which I desire to remind the reader, and that is a hemorrhagic or granular variety of inflammation. In this form of the disease the mucous glands, and the blood vessels that are distributed between these glandular tubules, increase or multiply enormously, so that I have seen the mucous membrane in some places a quarter of an inch in thickness. This is the most obstinate variety to yield to ordinary remedies, and as it occasions excessive and at times dangerous hemorrhage from the womb, it should not be treated as conservatively as the other varieties of which I have spoken.