VII.
FORMS OF PARAMETRITIS.
Parametritis, or inflammation of the cellular tissue around or in connection with the womb, is one of the most important subjects in gynaecology. I can only, in accordance with the cases that I have to consider, go over a very small part of this great subject. Parametritis may begin and end during pregnancy, and give rise to great difficulties in diagnosis when it is pelvic. Of this I have seen an example. But in pregnancy it is very rare. It is characteristically a disease of the puerperal and of the unimpregnated states. There is a kind of parametritis which I do not consider at all, and which is observed in cases of septicaemia or pyaemia, or what are ordinarily called cases of puerperal fever. This parametritis is erysipelatous in its nature; it is diffuse and it is not in its general characters like ordinary inflammation. There are pathologists of eminence who regard all kinds of parametritis as essentially the same, differing only in degree. In the meantime, at least, I do not hold that view.
The kinds of parametritis are phlegmon, abscess, gangrene; and these again may occur in different forms. You may have a chronic parametritis, a chronic phlegmon, ending in the production of indurations, which, when cut into, present a hard, dense, fibrous structure, the interstices of the fibrous tissue being filled up with fat. These chronic, hard masses are most frequently observed at one or both sides of the uterus. They sometimes atrophy, like fibrous tissue, the
