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 hwmorrhage that usually ensues, may be mistaken for a polypus or a hwmatoid grow th.
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 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 of thc 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 somethnes 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 hy 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 inore spongy, and redder than usual ; but in those forms of inflammatory action which rapidly pass into the puriform stage, the subjacent tissues become infiltrated and softened , so that they may be easily scraped away in the form of a discoloured flocculent pulp. This con dition, in its highest degree, where the tissues appear macerated and deeply penetrated by the dirty-coloured fluids already described, at the surface, constitutes uterine putrescence.
In addition to these products and results of inflammation, there may be found attached to the uterine surface fragments of an imper fectly detached placenta, or blood clots and shreds of the deciduous lining., lying free within its cavity. These, by their decomposition within the uterus, whose cavity, from the moment of parturition, has ceased to be com pletely closed against atmospheric contact, play an important part in the production of those septic and other infections of the blood which appear to form an essential part of all or nearly all puerperal inflammatory pro cesses.