702 



UTERUS AND ITS APPENDAGES. 



the latter being discharged through the uterine 

 cavity. 



Pathological conditions of the Uterus after 

 Parturition. 



Irregular contraction. After tedious and 

 exhausting labours, or those in which the 

 uterus has been rapidly emptied, or under 

 other circumstances which tend to the 

 production of a general or partial atony of 

 the organ, its post-partum contractions are 

 often imperfect. The whole uterus may re- 

 main relaxed and undiminished in size, or a 

 portion only of the walls may contract while 

 the rest remain inactive. From the latter 

 combination result the hour-glass and other 

 irregular forms of the organ when the cavity 

 of the uterus is partitioned into two chambers, 

 in the upper of which a part or the whole of 

 the placenta may be imprisoned. The seat 

 of constriction being either near the fundus, 

 or the centre of the uterus, or the neigh- 

 bourhood of the cervix. This condition is 

 often attended by haemorrhage from the un- 

 contracted portions of the uterine walls. 



In explanation of these irregular contrac- 

 tions, it has been usually assumed that the 

 contracted portions consist of the fibres that 

 have retained their vigour, and the relaxed 

 parts of those that have been exhausted. 

 Numerous observations, however, have satis- 

 fied me that this is but an imperfect and, in 

 some respects, an errdneous interpretation of 

 this phenomenon. It appears to depend rather 

 upon arrested peristaltic action, which may 

 indeed be, and probably is, the result of ex- 

 haustion ; not, however, of a particular set of 

 fibres, but of the ganglionic nerves which 

 especially govern this movement of the organ. 

 So that the peristaltic contraction in travelling 

 along the uterus from os to fundus, is stopped 

 in some part of its course. This explanation 

 is consistent with the fact that these constric- 

 tions are not confined to any special region, 

 but may occur at any point between the cer- 

 vix and the fundus, and particularly with the 

 circumstance that in some cases the con- 

 stricted part may change its seat, the contrac- 

 tion being sometimes felt to travel onwards 

 towards the fundus, while the hand is em- 

 ployed within the uterus in removing the pla- 

 centa. See p. 673. 



Rokitansky describes a remarkable result 

 of partial contraction, with relaxation of the 

 rest of the uterine fibre. When this occurs 

 at the placental region, the part that gave at- 

 tachment to the placenta being relaxed is 

 forced into the cavity of the uterus by the 

 superior tonicity of the surrounding tissues, 

 and there constitutes a kind of tumour which, 

 on account of its form and the protracted 

 haemorrhage that usually ensues, may be 

 mistaken for a polypus or a haematoid 

 growth. 



Retarded and incomplete involution consists 

 in an arrest of those metamorphic processes 

 by which the uterus after parturition is re- 

 stored to its ordinary condition. All inflam- 

 matory puerperal processes are attended by 

 this condition in a greater or less degree. 



But involution may be arrested without in- 

 flammatory action, so that the uterus remains 

 undiminished in bulk, its fibre uncontracted, 

 and its tissues unrenovated for several weeks 

 or months after labour. The soft flabby organ 

 is easily distinguished above the pubes, reach- 

 ing sometimes as high as the umbilicus ; while 

 its cavity, tested by the uterine sound, may 

 measure several inches in depth. 



Puerperal inflammations. The puerperal or 

 post-partum inflammatory affections of the 

 uterus may be noticed according as they in- 

 volve the peritoneum, the proper tissue to- 

 gether with the blood-vessels and absorbents, 

 or the lining membrane of the organ. 



Puerperal endometritis. Inflammation of the 

 internal surface of the uterus occurs, as a pri- 

 mary affection of that organ, shortly (within 

 a few hours or days) after labour. It takes 

 the form usually of plastic inflammation, whose 

 first seat is either the surface which has been 

 exposed by the separation of the placenta, or 

 certain portions that have suffered injury, such 

 as lacerations and contusions, occurring dur- 

 ing forced or spontaneous delivery. From 

 these points, the inflammatory action may 

 spread over the entire inner superficies of the 

 organ, or it may involve more or less deeply 

 the uterine parenchyma, and ultimately extend 

 by contiguity to the peritoneum itself. The 

 form of inflammation, and the nature of the 

 exudative products, exhibit great variations in 

 different instances, variations which are espe- 

 cially observable in respect of individual and 

 epidemic influences, and are directly connected 

 with corresponding conditions of the blood to 

 be hereafter noticed. Endometrial inflamma- 

 tions have been accordingly distinguished by 

 some pathologists, as croupy, dysenteric, ca- 

 tarrhal, and the like. 



The exudations of the fibrinous or croupous 

 kind, which are found upon the inner surface 

 of the inflamed uterus, exhibit sometimes great 

 plasticity. These may occur in the form of 

 isolated patches, or of more extensive invest- 

 ments of a dense yellowish or greenish lymph, 

 either firmly agglutinated to, or lying loosely 

 upon, the sublying tissues. In inflammations 

 of a less sthenic type, the exudation is softer 

 and more gelatinous, and is often intermixed 

 with serous and purulent fluids. Or the fibri- 

 nous matter may be wholly wanting ; the in- 

 flammatory products consisting then entirely 

 of purulent discoloured and sanious exuda- 

 tions, which, in cases that have been distin- 

 guished as putrescence of the uterus, assume 

 usually a greenish or dirty-brown coffee-co- 

 loured aspect. 



The condition of the tissues, which are 

 brought into view by removing or wiping away 

 the above-mentioned products, exhibits corre- 

 sponding variations. Beneath the coating of 

 firm lymph, characteristic of uterine croup, 

 the uterine tissue is merely softer and more 

 spongy, and redder than usual; but in those 

 forms of inflammatory action which rapidly 

 pass into the purifbrm stage, the subjacent 

 tissues become infiltrated and softened, so that 

 they may be easily scraped away in the form 



