538 Diseases of the Genital Organs 



but dependent upon the presence of the same infection. The 

 handling of such infections is discussed in the appropriate 

 places. 



4. Puerperal Diseases of the Uterus 



When pregnancy terminates, those infections which have 

 been present in the utero-chorionic space of the gravid 

 uterus meet with abrupt changes in environment which may 

 profoundly alter their activity. New forms of bacteria may 

 also quite readily invade the uterus at this period. If a calf 

 is born or a fetal cadaver is expelled and the fetal mem- 

 branes follow promptly, the entire placental area of the 

 uterus is denuded of its epithelium and the tissues laid open 

 to attack. The infections present in the utero-chorionic 

 space have already invaded the placental tissues about the 

 cotyledonal periphery and are ready to advance rapidly 

 when epithelial denudation becomes general. If, instead of 

 being expelled, the fetus dies and macerates, the fetal cada- 

 ver acts as a vast nutrient reservoir for bacteria which mul- 

 tiply in it and profoundly involve the contiguous uterus. If 

 a calf is born or a fetal cadaver is expelled, and the fetal 

 membranes are retained, the latter are necrotic and, like 

 the retained fetal cadaver, serve as a great nutrient supply 

 for infections present. The dilation of the cervical canal, 

 vagina, and vulva permits a greater supply of air in the 

 uterine cavity, which may modify favorably or unfavorably 

 the activities of the bacteria. 



It was long believed, and quite generally taught, that the 

 infections imperilling the life or health of the puerperal fe- 

 male regularly invade the uterus after the close of preg- 

 nancy. In an important measure that is true, but by far 

 the most important infections, measured by their frequency 

 and economic bearing, are those which are resident within 

 the pregnant uterus and acquire increased intensity when 

 pregnancy terminates. The infections of the puerperal 

 uterus are consequently divisible into two great groups — 

 the intrinsic or intra-uterine infections continuing from 

 pregnancy, and the extrinsic organisms invading the uterus 

 from without after pregnancy has terminated. 



