INJURIES OF THE UTERUS, VAGINA AND VULVA 307 



The swelling diminishes in four to five days, a stinking 

 fluid flowing from the vulva. Examination reveals that the 

 leather-like mucous membrane has become detached here and 

 there, granulation tissue being visible underneath the crusts. 

 In about ten days the necrotic mucosa is expelled and the 

 internal wall of the vagina shows a granulating surface covered 

 with a small amount of creamy pus. The membranes are to be 

 cut off or removed with the fingers, and warm antiseptic solu- 

 tions should be injected, such as 2 per cent, carbolic acid or 

 creolin solutions, followed later by a 2 per cent, alum solution. 



In consequence of the retraction of the granulation tissue, 

 the lumen of the vagina is decreased and the elasticity of the 

 vaginal walls lessened, so that such a spot often forms an 

 obstacle to future birth. 



INJURIES OF THE VULVA. 



In dystokia, excoriations of the vulva are frequently met 

 with. They are the result of the tension to which the labia? 

 are exposed during passage of the calf. The subcutis, the 

 muscular layer and the mucous membrane are more elastic 

 than the skin. 



A vulva which is too narrow is often ruptured, the superior 

 commissure being mainly involved in primipara3. Wounds on 

 the lateral surfaces of the labia are caused by rough manipula- 

 tion, by instruments aud projecting bones after embryotomy. 



Although the wounds of the vulva are less important than 

 those of the vagina and uterus, the danger of infection is never- 

 theless present. During the puerperal state quantities of 

 pathogenic low organism and their media are discharged, thus 

 offering ample opportunity for septic infection. This danger 

 is partly lessened after the wound once granulates. 



The superior commissure may rupture to such an extent 

 that the perineum is torn in a vertical direction ; in such a 

 case the fseces drop into the vestibule — a serious complication 

 unless quickly attended to. 



Treatment. — Any injury of the vulva, no matter how insig- 

 nificant, demands attention. The labia3 are cleansed with 



