THE FEMALE GENERATIVE ORGANS 547 



upwards, and slight loss may continue until the water is drawn 

 ofE. As soon as the uterus is allowed to nestle down into its 

 normal position the bleeding stops." ^ 



The puerperal vaginal discharge is known technically as the 

 lochia. It varies considerably in amount in different individuals, 

 and changes in character as the puerperium proceeds, ceasing 

 altogether about the middle of the third week. For the first few 

 days it consists almost entirely of blood, which makes its way 

 from the raw surface of the uterus and from lacerations caused 

 during dehvery. This is the lochia rubra. After three or four 

 days it becomes paler, owing to the dilution of the sanguineous 

 discharge by mucous secretion. This is called the lochia serosa. 

 During the next three days the normal colour of the lochia is 

 brown. This change (from pale pink to brown) is due to the 

 fact that the normal acidity of the vaginal secretion has by this 

 time become re-estabhshed. Longridge suggests that the 

 brown colour is probably the result of the formation of some 

 such compound as acid hsematin. After about the tenth day 

 the lochia assumes a whitish or yellowish- white colour, owing 

 to the admixture of leucocytes and the cessation of the blood 

 flow. It is then known as the lochia alba. In many cases, 

 however, traces of blood may be observed for weeks, but the 

 lochia alba consists mainly of secretions from the vagina and 

 cervix, together with leucocytes, a few epithehal cells, fragments 

 of decidual tissue, and crystals of cholesterin. Micro-organisms 

 are also present in the discharge, but recent investigations have 

 shown that the lochia obtained directly from the uterine cavity 

 does not contain bacteria, excepting in cases where the uterus 

 is the seat of infectious processes.' 



The average quantity of the discharge has been computed by 

 Gassner ' at 1485 cubic centimetres, or about 50 ounces. Giles * 

 estimated it as 10| ounces (or considerably less than Gassner's 



' Brook (Practitioner, January 1908) has recently expressed the opinion 

 that puerperal bleeding is ohieily venous, pointing out that the discharge is 

 usually very dark in colour. 



^ Kronig, Bakteriologie des Genitalkanales, &o., Leipzig, 1907. 



^ Gassner, ' ' Ueber die Veranderungeu des Korpergewichtes bei Sohwang- 

 eren, Gebarenden, und Wochnerinnen," Monataschr. f. Oeburtskunde, voi. xv., 

 1862. 



■* Giles, " On the Lochia," Trans. Obstet. Soc, vol. xxxv., 1897. 



