660 



UTERUS AND ITS APPENDAGES. 



the circumference of a dollar. Finally, how- 

 ever, these coagula are removed, and, together 

 with the veins, disappear, while the place sinks 

 to the level of the surrounding parts ; and, 

 after becoming smooth and receiving an in- 

 vestment of mucous membrane, is generally 

 no longer discernible. The restoration of 

 the placental space to its former condition 

 does not, however, always proceed normally. 

 Sometimes, in consequence of excessive acti- 

 vity in the process of reconstruction, hyper- 

 trophic growths of the new material take 

 place ; so that, several months after labour, a 

 tumour of more or less considerable size, 

 formed at the expense of the uterine tissues, 

 is found to occupy the original seat of the 

 placenta. I have satisfied myself by several 

 microscopic examinations of the correctness 

 of Heschl's opinion, that in this way are 

 formed some of those anomalous-looking 

 fleshy substances which are occasionally dis- 

 charged from the uterus, and are regarded as 

 moles. 



The hittological changes, which take place 

 after labour in the tissues lying internally to 

 the muscular coat, up to the complete resto- 

 ration of the mucous membrane, have been 

 examined by many observers, not always, 

 however, with corresponding results. It ap- 

 pears certain that a portion at least of that 

 layer of decidua which is still left attached to 

 the uterine walls, is removed by fatty trans- 

 formation, and that many of the products are 

 discharged by the lochia. Schroeder van der 

 Kolk has traced this process as it occurs in 

 the nuclear cells and fibres, which form so 

 large a portion of the decidua. Those very 

 broad fibre cells, which are visible in it up to 

 the ninth month of pregnancy, are no longer 

 to be found four or five days after labour, 

 when they appear to be transformed into long 

 cells, through an abundant fatty transforma- 

 tion which progressively continues, until, by 

 the increasing development of the oil granules 

 and the corresponding diminution of the cells 

 and fibres, the situation of the latter can ulti- 

 mately only be discovered by the still existing 

 longitudinal direction of the fat nuclei, while 

 all traces of a cell wall have entirely disap- 

 peared. 



Without the aid of the microscope, how- 

 ever, it may be seen that, a few days after 

 labour, the entire inner surface of the uterus 

 is covered by a more or less red soft pulpy 

 substance, which has the same anatomical 

 composition as the decidua. This, which is 

 considered by some physiologists as identical 

 with the layer of decidua already described, 

 as formed, according to Kilian, Robin, and 

 others, as early as the fourth or fifth month 

 of gestation, is not discharged after labour, 

 but becomes the seat of that reparatory pro- 

 cess, by which the restoration of the mucous 

 membrane upon the uterine body is effected. 

 Between the twentieth and thirtieth day, this 

 layer begins to resume the character of a mu- 

 cous membrane. It is at first more pulpy, and 

 softer, and thicker than mucous membrane in 

 a normal state. The vessels become distinct 



in it about the third week, and sometimes still 

 later. Previous to this, the blood appears to 

 be contained in simple channels between the 

 elongating cells. 



The epithelium is as yet hardly formed. 

 By scraping the inner surface of the uterus 

 twenty days after labour, Schrceder found still 

 only the remains of half decomposed cells. 

 But no new cells with cilia could be yet with 

 certainty discovered. 



The utricular glands make their appearance 

 last of all. In several cases, Heschl found 

 them completely formed at the end of the 

 second month ; but previous to this, their de- 

 velopment could not be traced.* 



Finally, it may be said that the restoration 

 of the mucous membrane, with all its peculiar 

 structures, is completed about the sixtieth or 

 seventieth day after delivery, i. e. by the time 

 that the uterus is reduced to its normal bulk. 



Thus it appears, that the act of involution 

 consists in two processes, which are concur- 

 rently performed, yet with opposite purposes. 

 For the act of reconstruction being com- 

 menced long before the retrograde metamor- 

 phosis is complete, the result of both is, that 

 a restitution or reconstruction of certain tis- 

 sues of the uterus, more or less complete, 

 takes place. 



With regard to the muscular coat, it is 

 perhaps not any overstatement of the fact to 

 say that each ovum is provided with its own 

 series of fibres for the purpose of effecting its 

 expulsion, and that these, after parturition, 

 entirely disappear, or at least can no longer 

 be recognised, while a new series of embryo- 

 nic or undeveloped forms appears in their 

 place. The same may also be said of the 

 decidua, though with certain differences as to 

 the time and mode of its destruction and re- 

 novation. Regarding the fibrous tissue of the 

 uterus, little has been determined with accu- 

 racy ; but enough has been observed to ren- 

 der it probable that this also, to a certain 

 extent, becomes subject to fatty transforma- 

 tion. The blood-vessels appear to be likewise 

 partly involved in a similar process, although 

 their principal trunks probably suffer but little 

 change beyond a material diminution of size. 

 The peritoneum is that tissue which undergoes 

 the least apparent alteration. It preserves, 

 however, a thickness proportionate to the 

 reduced bulk of the organ, and consequently 

 it must suffer a corresponding involution. 



Regarding the puerperal alterations in the 

 nervous system of the human uterus, but little 

 is known. Kilian-}-, after examining a spe- 

 cimen at eight, and another at twelve days 

 after labour, as well as the uterus of many 

 animals at different periods, arrived at no de- 

 finite conclusions. He thinks it in the highest 

 degree doubtful, that, in the puerperal state, 

 the nerve fibres undergo the same involution 

 process as the other tissues ; viz. that the 

 old fibres are entirely destroyed, and become 

 replaced by a new, younger, or embryonal 



* By Kilian they are said to be formed during 

 pregnancy, 

 f Loc. cit. 



