TRANSPLANTATION OF BONE FOR THE RELIEF OF SADDLE-NOSE.WITH REPORT OF ONE CASE.
Authors: CULLEN F. WELTY
Journal: JAMA (1905)

tion of those already there; and this product may be recog- nized by an almost superficial inspection if it has not been absorbed.But we look in vain, after death, for any evidence of metritis or endometritis, or for ulcération of the cervix, as it is termed, for neither of the conditions so-called is inflam- matory.On the contrary, in the conditions in which these are supposed to exist, the tissues are blanched, the blood from the capillaries having passed into the larger vessels as the heart failed to keep up the supply; and there is to be detected neither loss of tissue on the surface of the mucous membrane beyond the epithelium, if even to that extent, nor any hyperplasia in the organ itself.Inflammation, strictly speaking, can exist only in an acute form, although its products may remain for an indefinite period.Therefore, the term chronic inflammation applied to the uterus is a misnomer, and only serves to give erroneous impressions of the pathology and treatment of uterine diseases.Inflammation of the uterine body never occurs except after parturition, and those condi- tions which are commonly held to be the direct results of in- llammation are due wholly to obstructed circulation in the organ, caused by pathologic processes in the cervix and neighboring parts.In this way the formation of flexures, many displacements, and the so-called uterine hyperplasias, with their attendant leucorrhea, are to be accounted for.We shall have made a great advance in solving the problem as to the true pathology of many supposed uterine diseases when we seek for the cause outside the uterine limits.In the second place, I will quote from a more modern author and at the same time one who is as well known, Dr.Howard Kelly:Acute endometritis is generally found in acute septic proc- esses involving the entire genital tract, but on account of the predominating symptoms of the other organs it is usually overlooked.Under any circumstances it is a rare affection.Chronic endometritis is also rather rare.The prevailing habit of describing all scrapings, particularly because of their abundance in some cases, as examples of endometritis, is greatly to be deplored.It interferes with our getting any satisfactory idea as to the frequency of the real affection and tends to encourage unnecessary operating.The so-called "fungoid endometritis" is not a pathologic entity at all, and the name ought to be expunged from gynecologic works.Chronic endometritis is oftenest associated with old cases of pyosalpinx; it is rarely ever found in the ordinary scrap- ings.The slight liability of the uterine mucosa to this affec- tion may be ascribed to two factors: In the first place, the tendency of pus-containing tubes is to complete closure at the uterine end, and so shutting off one avenue of infection, and, in the second place, the form and position of the uterine canal is such as to afford good drainage.After quoting two such eminent authorities on this subject, it leaves but little for me to say; but I can not help but add that a true endometritis can only exist as the result of a direct irritant to that structure, be it in the form of a microbic invasion or otherwise, conditions that rarely occur.The endometrium, owing to its inti- mate relations with the uterus, already alluded to, nat- urally will partake of any of its circulatory disturb- ances.