_Miliary tuberculosis_ of the uterus may be part of a general miliary tuberculosis. Typical miliary tubercles are found scattered throughout the endometrium, usually situated immediately beneath the epithelium (Fig. 136). _Chronic diffuse tuberculosis_ is the most frequent form. The uterine cavity is filled with cheesy material. The mucous membrane is the seat of irregularly shaped ulcers and tubercles in various stages of development. When the disease has extended to the muscular coat of the uterus, the whole organ becomes considerably enlarged. Degeneration and softening of the uterine wall may be so extensive as to cause rupture. The internal os may become closed, and a pyometra may be produced. [Illustration: FIG. 136.--Miliary tuberculosis of the endometrium and glandular endometritis (Beyea).] [Illustration: FIG. 137.--Advanced fibroid tuberculosis of the endometrium (Beyea).] _Chronic fibroid tuberculosis_ of the endometrium seems to be the rarest form of the disease. A microscopic section of this form of tuberculosis is shown in Fig. 137. The endometrial tissue was almost entirely destroyed, and was replaced by a mass of typical miliary tubercles. There were no traces of glandular tissue. The tubercles were separated from each other by a very extensive small round-cell infiltration and a small amount of remaining stroma tissue. To the naked eye the endometrium did not appear to be diseased. Tuberculosis of the uterus may occur at any period of life. It is most often found between the twentieth and fortieth years. The =symptoms= of tuberculosis of the uterus are not at all characteristic. In the early stages they resemble those of non-tubercular endometritis. There is sometimes a very profuse leucorrhea, which may contain the characteristic cheesy material. The body of the uterus may be considerably hypertrophied. If the condition follows tuberculosis elsewhere, or if any form of genital tuberculosis exists in the husband, the physician would be led to suspect tuberculosis of the uterus. The =diagnosis= can be made only by thorough curetting of the uterine cavity and the microscopic examination of the tissue removed. The tubercle bacillus has not often been found, but the other microscopic appearances are frequently characteristic. In the case from which the section shown in Fig. 137 was taken the diagnosis of tuberculosis of the endometrium was made by such curetting and examination. The =treatment= of tuberculosis of the uterus is hysterectomy. The operation is indicated in every case except those in which there is present in some other part of the body an incurable tubercular lesion. CHAPTER XXIII. INVERSION OF THE UTERUS. In inversion of the uterus this organ is turned partly or completely inside out. The condition usually results from childbirth or from the growth of an interstitial or polypoid tumor.