Sometimes endometritis appears in old women. Bleeding from the uterus, purulent discharge, and pain may be present. The condition is due to the atrophic changes of senility occurring in the endometrium--changes that resemble those that take place in the mucous membrane of the vagina and the external genitals. Though such symptoms may be indicative merely of a benign condition, yet, as they are also characteristic of the early stages of malignant disease, they demand immediate thorough examination and careful watching. =Treatment.=--As chronic endometritis is usually secondary to some disease of the cervix or body of the uterus, the treatment should be directed toward the cure of this primary condition. The operation of trachelorrhaphy will cure the subinvolution of the uterus and the resulting endometritis. Forcible dilatation of the cervix, in the case of an old anteflexion, will relieve the inflammation of the endometrium. Correction of a retroversion will likewise relieve the resulting endometritis. Therefore, though in every case the cure may be hastened by treatment applied directly to the endometrium, yet causative or complicating conditions must always also be treated if we wish the cure to be lasting. Many cases of mild endometritis may be relieved or cured by attention to the general hygiene and habits of the woman and by applications made only to the vaginal aspect of the uterus. The dresses should be worn loose about the waist and supported from the shoulders. Prolonged standing and slow walking should be avoided. Mild purgation with salines should be maintained. Regulated exercise or general massage should be prescribed. In addition, the vaginal douche, iodine applications, and the use of the glycerin tampon, with depletion from puncture of the cervix, should be used, as has already been prescribed for the subinvolution accompanying laceration of the cervix. If these methods fail after careful trial, direct treatment must be applied to the endometrium. The present method of treating chronic corporeal endometritis directly is by the uterine curette. Time is wasted by the use of applications to the interior of the uterus, and a great deal of harm has resulted from such applications carelessly made. The best curette is the Sims sharp curette (Fig. 120). The Martin curette (Fig. 121) is useful to remove the endometrium from the fundus. The operation had best be performed in the menstrual interval, though it may safely be performed during the menstrual period. An anesthetic should always be administered. The woman should be placed in the dorso-sacral position, with the feet in the supports. The vulva, vagina, vaginal cervix, and buttocks should be thoroughly sterilized. [Illustration: FIG. 120.--Sims’s sharp curette.]