If there exists in the genital tract any obstruction that prevents the escape of menstrual blood, the uterus will become distended and the condition of _hematometra_ will be present. If the retained fluid consists chiefly of the mucous secretion of the utricular glands, the condition is described as _hydrometra_; or if suppuration has taken place, so that the uterus becomes distended with pus, the condition is called _pyometra_. [Illustration: FIG. 135.--Hematometra.] The uterine walls may be very much attenuated by the distention, or the muscular coat may hypertrophy as the accumulation progresses. The cause of these conditions may be congenital or acquired atresia of any part of the genital tract. The symptoms usually appear after puberty. The menstrual period is accompanied by intense bearing-down pain in the region of the uterus. There is no appearance of menstrual blood. A round tumor may be felt in the hypogastrium. Examination will reveal the obstruction in the cervical canal. Sometimes the chief accumulation and distention occur in the cervix; in other cases the body of the uterus is chiefly affected. Distention of the Fallopian tubes, with the formation of hematosalpinx, hydrosalpinx, or pyosalpinx, often accompanies old cases of hematometra. The =treatment= consists in relieving the obstruction and in maintaining the patulous condition of the genital tract. If the cervix is the seat of the obstruction, it should be punctured with a trocar and thoroughly dilated. It may be necessary to practise repeated dilatation in order to keep the canal open. The accompanying disease of the Fallopian tubes may persist after drainage of the uterus, and salpingo-oöphorectomy or hysterectomy may be ultimately required. CHAPTER XXII. TUBERCULOSIS OF THE UTERUS. Tuberculosis of the uterus is not a very rare disease. In this respect it differs from tuberculosis of the cervix, which, as has already been said, is a most unusual site for the appearance of tuberculosis. Even in advanced cases of tuberculosis of the body of the uterus it is very rare that the condition extends below the internal os. Tuberculosis of the uterus is often found post-mortem in women who have died of phthisis or other form of tubercular disease. It has also been recognized during life, and operation has been performed for its relief. Tuberculosis of the uterus seems most frequently to be secondary to a tubercular lesion in some other part of the body. It often begins in the Fallopian tubes, and extends thence to the endometrium; or it may be primary in the endometrium, caused by infection through the genital tract. The disease first attacks the endometrium, and in the late stages extends to the muscular coat. Tuberculosis of the endometrium may occur in three forms--miliary tuberculosis, chronic diffuse tuberculosis (caseous endometritis), and chronic fibroid tuberculosis.