Although we shall, as much as possible, distinguish between the mucous membrane and the uterus itself in examining this subject, we must confess that, as may be expected from the close anatomical connection of the two, the diseases which we shall have to consider, very readily pass from the one to the other. Yet we must also affirm that generally the lining membrane of the uterus is affected primarily, and that this is scarcely ever the case with the uterine tissue, as far as can be demonstrated by the pathological anatomist, with the exception of the reaction following traumatic influences, especially of the vaginal portion. We shall not at this place devote any attention to peritoneal inflammation, but discuss the inflammatory affections of the unimpreg-nated uterus, and the participation of the uterine parenchyma in them. The uterine inflammations occurring after childbirth, with their sequelae, we shall consider in a separate appendix on puerperal diseases of the uterus.

A. Catarrhal Inflammation (Endometritis Catarrhalis)

This is an acute affection; it occurs in combination with inflammation of the adjacent uterine tissues, extending to a greater or less depth and of various intensity, and even complicated with peritonitis; it is frequently met with in the sick-room, but rarely in the dead-house: it is here only occasionally observed in a protracted blennorrhoic stage.

The uterine mucous membrane is much more commonly discovered in a state of chronic catarrh and inveterate blennorrhcea, which is either the residue of acute catarrh, or the result of a similar affection of the vagina; it may occur as a sequela of parturition, or as a complication of those morbid growths that bear a near relation to the uterine mucous membrane. The mucous membrane offers a pallid appearance, or there is evidence of previous stasis and inflammation, and it then presents, with the adjoining uterine tissue, a brownish-red or slaty color; the membrane is tumefied, relaxed, plicated, and secretes a grayish-white viscid mucus, which during temporary exacerbations, or an enduring state of more intense inflammation, appears streaked with blood, creamy, yellow, and puriform.

Here, too, we find hypertrophy of the mucous membrane resulting from chronic catarrh, in the shape of mucous or cellular polypi. They consist of club-headed elongations of the mucous membrane, in which we find a group of closed follicles, or a lobulated tissue containing a gelatinous mucus, which is discharged from time to time in consequence of a dehiscence of the follicles. These excrescences occur chiefly at the fundus uteri, in the neighborhood of the insertions of the Fallopian tubes and in the channel of the cervix - a point at which, in the normal condition, large follicles (ovuli Nabothi) are found, which occasionally undergo considerable enlargement.

We find that the uterine parenchyma becomes more or less hypertro-phied during catarrh, in the same manner as other muscular layers which are subjacent to mucous membranes.

Inveterate uterine catarrhs not unfrequently give rise to the above-mentioned strictures and atresiae; and if the blennorrhcea persists, the dilatations of the uterine and cervical cavities previously discussed, result. During the progress of dilatation occurring under these circumstances, the same changes that we have already repeatedly met with under similar circumstances, in dropsy of mucous cavities and canals, are sometimes found to occur in the uterus. As a dilatation from the accumulated secretion increases, the uterine mucous membrane is converted into a thin serous membrane, which secretes a colorless, serous, albuminous fluid, resembling synovia. The uterus appears in the shape of a round, slightly-thickened, hydropic capsule, of the size of a hen's or duck's egg or a fist. This condition is the only one that really deserves the name of hydrometra, of which several remarkable instances are related, especially by older writers. The contained fluid may always, or for a long time, remain such as above described; but it generally undergoes some alterations from the admixture of various products of slight inflammatory attacks, and especially of hemorrhagic exudations of the uterine lining, which give it a chocolate-colored, rusty, or black tinge.

Occasionally temporary discharges of these fluids occur by the vagina during life, after which fresh accumulations take place. They are to be distinguished from similar discharges from the hydropic Fallopian tube.

Uterine catarrh generally suffices to produce sterility; but it often extends to the Fallopian tubes, and there also gives rise to changes that are of extreme importance in this respect.

B. Exudative Processes (Endometritis Exudativa)

Croupy or plastic fibrinous exudation, whether or not accompanied by a similar process in the vaginal or Fallopian mucous membrane, very rarely occurs on the inner surface of the uterus, except after confinement. It is, at all times, rather a secondary than a primary process. Exudative affections of the uterus and their varieties, occurring after parturition in the shape of puerperal diseases, are all the more frequent and the more numerous.