ON PARTURITION. 545 



symptoms. Because the uterus, torn and injured by the sepa- 

 ration of the placenta, especially if any violence has been used, 

 resembles a vast internal ulcer, and is cleansed and purified by 

 the free discharge of the lochia. Therefore do we conclude as to 

 the favorable or unfavorable state of the puerperal woman from 

 the character of these excretions. For if any part of the placenta 

 adhere to the uterus, the lochial discharges become fetid, green, 

 and putrid ; and sometimes the powers of the uterus are so 

 reduced that gangrene is the result, and the woman is de- 

 stroyed. 



If clots of blood, or any other foreign matter, remain in the 

 uterine cavity after delivery, the uterus does not retract nor 

 close its orifice ; but the cervix is found soft and open. This 

 I ascertained in a woman, who, Avhen laboring under a malignant 

 fever, with great prostration of strength, miscarried of a foetus 

 exhibiting no marks of decomposition, and who afterwards lay in 

 an apparently dying state, with a pulse scarcely to be counted, 

 and cold sweats. Finding the uterine orifice soft and open, and 

 the lochia very offensive, I suspected that something was under- 

 going decomposition within ; whereupon I introduced the fin- 

 gers and brought away a "mole" of the size of a goose's egg, 

 of a hard, fleshy, and almost cartilaginous consistence, and 

 pierced with holes, which discharged a thick and fetid matter. 

 The woman was immediately freed from her symptoms, and in 

 a short time recovered. 



When the neck of the uterus contracts in a moderate degree 

 after birth, and certain pains, called by the midwives " after 

 pains," ensue, in consequence of the difficulty with which the 

 clots are expelled, the case is considered a favorable one, and 

 is so in fact ; for it indicates vigour on the part of the uterus, 

 and that it is inclined readily to contract to its usual bulk ; the 

 result of which is that the lochia are duly expelled, and 

 health restored to the woman. 



But I have observed in some women the uterine orifice so 

 closed immediately after parturition, that the blood has been 

 retained in the uterus, and then, becoming putrid, has induced 

 the most dangerous symptoms ; and when art did not avail to 

 promote its exit, the woman has presently died. 



A noble lady in childbed being attacked with fever for want 

 of the ordinary lochial discharge, had the pudenda swollen and 



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