Both, but especially phlebitis, are important puerperal diseases.

Uterine phlebitis is generally a primary affection, originating in the open mouths of the veins at the insertion of the placenta, and caused as well by their laceration as by contact with the external atmosphere, with the traumatic secretion of the part, and with the product of exudation on the internal surface of the uterus. It is either confined to a small portion of the veins, or it spreads over the greater part of the veins of the uterus belonging to the spermatic or uterine system of vessels. In the latter case, a secondary inflammation of the trunk of the spermatic vein, brought on by coagulation of the blood, may on the one hand extend through the vena cava to the right auricle, or on the other along the iliac and the crural veins, to the cutaneous veins of the lower extremity; in this case the symptoms of phlegmasia alba dolens are induced.

The resulting products differ very much. There is no doubt that coagulable lymph is frequently secreted, which causes the venous parietes to become agglutinated to one another, or to a contracting plug of coagulum; but in most cases pus is formed, which is variously discolored, presents a dirty geenish, or brownish, or chocolate-colored hue, with a fetid odor, varies in density, and is more or less sanious (septic phlebitis). In consequence of exacerbations, the same portions, or, if the disease extends, consecutive sections of the uterine venous system, may present various exudations at the same time or in succession.

Metrophlebitis undoubtedly sometimes occurs as the sole and primary disease, but in the vast majority of cases it is complicated with exudative processes on the internal surface of the uterus. This combination commonly takes place from the commencement, or the phlebitis supervenes upon and is induced by the exudative process; or, lastly, phlebitis may exist for a short period in an isolated form as the primary disease, and give rise to a single or to repeated exudative processes.

We thus find that the combined processes are closely related to one another, in reference to their essential characters and the nature of their product; this and other points will become more apparent from the description of the chief anatomical symptoms which we are about to give.

If incisions be made in various directions from the point of insertion of the placenta, to the lateral parietes of the uterus and the adjoining broad ligaments, a large number of veins become apparent, which are dilated and varicose, and filled with yellow or greenish-yellow viscid pus, or even with chocolate-colored sanies. Their orifices at the placental portion of the uterus, are either closed up by loose pale coagula, or they are covered over with an exudation which attaches itself to the spongy tissue of the raw surface, or, lastly, they are exposed so that their contents exude on the application of a slight pressure. The coats of the veins are relaxed and pale, the lining membrane is opaque, and discolored by the contents of the vessels, and after a protracted duration of the disease, it appears tumefied, thickened, partially gangrenous and ichorous. The tissue surrounding the veins, and especially the cellular tissue at the lateral portions of the uterus, is infiltrated with a yellow gelatinous or purulent matter, which is much discolored if the contents of the veins are ichorous; the tissue is relaxed, soft, friable, and lacerable. At different points there are abscesses of greater or less dimensions, which not unfrequently burst internally, and discharge their contents into the uterus.

The internal surface of the uterus presents purulent and ichorous exudations, the products of primary or secondary processes, or of both. The tissues throughout are in a state of disorganization or putrescence, becoming dissolved in a manner analogous to the exuded product, and being attacked from the various foci of destruction within the parietes of the uterus themselves. The discoloration advances as far as the peritoneum, and the affection may, therefore, be recognized by the external appearance, as well as by the general habit of the organ. The fusion occasionally predominates at one portion of the placental segment of the uterus, involves the entire thickness of the parietes, and causes the portion to be detached, and to pass into the uterine cavity in the shape of a pulpy, discolored, semifluid plug.

Uterine phlebitis often runs a rapid course, with intense typhoid symptoms, proving fatal by uterine paralysis; or it proceeds more slowly under circumstances preventing a general infection of the blood, even when the product is of a putrid character, and then proves fatal by the secondary destruction set up.

Inflammation of the uterine lymphatics is, on the whole, less frequent than phlebitis, and is generally complicated with the latter. When it occurs, the lymphatics, and particularly those of the lateral and posterior portions of the uterus, of the ovary, and the Fallopian tubes, become dilated and varicose, their coats pale and opaque, the lining membrane dull and furred, and they contain a yellow, yellowish-green, purulent fluid. By these characters they may be traced into the neighboring hypogastric and lumbar plexuses, and into the associated glands, of the lymphatic system.

Inflammation of the veins and lymphatics of the uterus is generally the source of secondary occurrences, the so-called metastases, or lobular foci of inflammation (lobulare Entziindungsheerde), in the most various tissues and organs, as well as of exudative processes occurring in serous and mucous membranes during the later stages of puerperal disease.