MACERATION 129 



the first few clays, later purulent, mucopurulent and finally 

 mucous. 



2 —Maceration. 



Definition. — Maceration, same as mummification, is a 

 necrotic process. While mummification is somewhat of a drying 

 out process, maceration consists of a colliquation (liquefac- 

 tion). With it the development of low organisms go hand in 

 hand, causing at the same time a purulent metritis. 



Although the boundary line cannot be closely drawn 

 between mummification and maceration, there is nevertheless a 

 marked difference in the more pronounced cases of a mummified 

 and macerated fcetns. Mummification produces a firm mass, 

 maceration dissolves all soft parts, so that the bones of the 

 skeleton fall apart. In complete maceration even the epiphyses 

 and diaphyses separate ; the bones of the head become discon- 

 nected at their sutures ; the individual bones of the skeleton 

 rest in the uterine cavity amidst a muco-purulent mass. 



JEtiology. — Maceration usually occurs in the fourth to 

 sixth month of pregnancy, rarely later. Disturbances causing 

 death of the foetus, and at the same time interfering with 

 expulsion, may lead to maceration, provided air enters. Macer- 

 ation often follows when the foetal envelopes have ruptured 

 and the dead foetus is retained in the uterus. 



Course. — The dead foetus liquefies and falls to pieces. The 

 mucosa of the uterus develops a chronic inflammation, with a 

 muco-purulent exudate liquefying still further the already 

 softened foetus. This chronic inflammation not only attacks 

 the mucosa, but also the submucosa, muscularis, and serosa, 

 so that the uterine walls become thickened and may develop 

 purulent foci (Franck). 



Under favorable conditions the uterus behaves as the wall 

 of an abscess ; the changed mucosa and submucosa represent 

 the pyogenic membrane, protecting the body against further 

 infection. But it happens that by continuity a metro peritonitis 

 sets in, leading to adhesions between the uterus and adjoining 

 organs, as the rectum, bladder, intestines and abdominal walls. 



