588 MANAGEMENT OF LYING-IN WOMEN. 



at which the menses reappear for the first time; the womb indeed 

 always remains a little larger than it was before the woman became 

 pregnant, and, in general, the more so, as gestation is more fre- 

 quently repeated. During this period an insensible process goes 

 on, by means of which the uterine parietes are disengorged of the 

 substances they had imbibed. These fluids are directed more espe- 

 cially towards the cavity, because in that direction the tissue is less 

 dense, and they find a freer issue. As long as the great uterine ves- 

 sels are not emptied, blood only flows; at a later period it is serum 

 combined with the detritus of the ovum and the raucous secretions of 

 the organ. But a real suppurative irritation is soon established, the 

 product of which, analogous in some sort to the non-contagious dis- 

 charges from the urethra, by mixing with the serosity and mucus 

 furnished by the womb, constitute the white lochia. 



The lochia require only cleanliness; upon the access of the milk 

 fever they sometimes cease to flow, or at least sensibly diminish in 

 quantity; nevertheless it is not uncommon to see these two pheno- 

 mena proceeding together without interfering with each other. 

 When they stop either before or after the milk comes, it appears to 

 me to be generally useful to add, to the means employed to recall 

 them, the injection of emollient or slightly detergent fluids into the 

 uterine cavity. 



1248. The uterine colics or after-pains commence soon after 

 the labor is over, and generally cease upon the appearance of the 

 milk-fever, and rarely last longer than the serous lochia: they are 

 more frequent and sharper in proportion as tlie labor has been 

 more rapid and easy, and are sometimes strong enough to fatigue 

 the woman considerably; being produced by the efforts of the 

 womb to contract, it is quite natural that they should be stronger 

 and more frequent in women who have had several children, than 

 in those who are in their first child bed. In effect, the womb, too 

 rapidly emptied in the first named case, does not contract soon 

 enough to prevent the formation of clots in its cavity, is obliged to 

 contract for their expulsion as often as they are reproduced, and 

 each one of these contractions gives rise to a pain. In the second, 

 having reacted for a long time upon the ovum, it is too much irri- 

 tated at the close not to resume rapidly its natural size, and not permit 

 the blood to accumulate within its cavity, and then there will be no 

 clots, no contractions, and no after-pains ; thus the presence of 

 clots determines the contractions, and as was the case during the 

 labor the contractions occasion the after-pains. I ought, how- 

 ever, to remark, that these pains must also vary in respect to their 

 intensity, the constitution of the patient, and the circumstances; 



