39 Op. cit., p. 195.
Ergot, hydrastis canadensis, potassium iodide, ammonium chloride, strychnia, are among the remedial agents which are supposed to have some direct effect upon the condition of the uterine parenchyma. Ergot may be exhibited by the mouth or hypodermatically. Squibb's fluid extract, while an active and tolerably agreeable preparation, is not as effective as the decoction employed on an extensive scale in many of the German hospitals, and the formula of which we append:
| Rx. | Secalis cornuti recent. pulver., | 15.0 |
| Alcohol., | 5.0 | |
| Acidi sulphurici, | 2.0 | |
| Aquæ, | 500.0 | |
| Coque ad | 200.0 | |
| Ne cola. | ||
| Adde Syr. cinnamom., | 30.0 |
Dose: Two to three teaspoonfuls, pro re nata. This unfiltered decoction is extremely distasteful, and its continued use is not without effect upon the gastric mucous membrane. It is, however, physiologically very active. Subcutaneous injections of Squibb's aqueous extract of ergot may be occasionally employed with benefit to keep up the impression of the remedy when exhibition per os is interrupted. Schatz speaks in high terms of the fluid extract of hydrastis canadensis in doses of fifteen to twenty drops two or three times daily.
All European writers ascribe an important influence to the numerous watering-places and baths of the Continent in the treatment of chronic uterine infarct. The rigid observance of hygienic rules, the imbibition of enormous quantities of water more or less impregnated with salines and carbonic acid, the frequent bathings, exercise, and recreation, undoubtedly effect amelioration of symptoms in many desperate cases.
Acute Endometritis.
ETIOLOGY.—An acute inflammation of the mucous membrane of the uterus is a rare affection before puberty. The acute infectious diseases play an important rôle in the production of the condition. The acute exanthems—smallpox, measles, scarlet fever, cholera, typhus, typhoid, and relapsing fever, certain forms of malarial fever—deserve mention in this connection. Probably owing to some change in the constitution of the blood, these diseases predispose to the hemorrhagic form of acute endometritis. The rapid cooling off of extensive areas of the skin surface during menstruation frequently leads to an acute inflammation of the endometrium, with suppression of the flow as one of the first symptoms. Gonorrhoeal infection and sepsis are most important causative factors. Ill-advised therapeutic procedures, as in the case of acute metritis, must be included in the list of causative agencies. Finally, acute endometritis may be caused by various poisons. Among toxic agents which may give origin to the condition under discussion phosphorus is especially noteworthy.40
40 Hausmann, Berl. Beitr. z. Geb. u. Gyn., Bd. i. S. 265.
PATHOLOGICAL ANATOMY.—The entire lining membrane of the uterine cavity may be involved in the inflammatory process; usually, the mucosa of the body and fundus is affected, the mucosa of the cervical canal remaining normal. The mucous membrane is of a dark-red color, swollen, softened, and presents a velvety appearance. Its connection with the muscularis is loosened, so that it can frequently be stripped off with the handle of a scalpel. Minute extravasations of blood are visible in the superficial layers and on the surface. The interglandular connective tissue is the seat of the inflammatory process. The glands are involved secondarily. The ciliated epithelium is destroyed and cast off at an early stage. The bloody discharge from the uterine cavity becomes serous, and finally purulent, during the progress of the condition. The cervical secretion becomes thin, turbid, and profuse.
The inflammatory process is seldom limited to the endometrium. It involves, as a rule, the tubal mucous membrane, the uterine parenchyma, and the perimetrium.