LOCAL PHENOMENA-INVOLUTION OF THE GENITAL ORGANS-THE Loc HIA-LACTATION.
With the diminution in size of the abdomen which follows delivery, the abdominal walls relax to such an extent, that it is possible to press the fingers deeply into the abdominal cavity, and to palpate readily, not only the fundus, and the posterior wall of the uterus, but also the spinal column, the aorta, the bladder, and the rectum. Only at the end of a few weeks, at times many months, do the abdominal walls regain their con tractility and normal thickness, but the linea alba, and the umbilical ring, remain so much enlarged, that, in certain women, hernia results. The skin may remain loose, and hang like a .bag over the pubes; at times, on the other hand, the abdomen remains larger from development of fat in the omentum and in the abdominal walls. These last phenomena are most likely in lymphatic blondes, who already had a tendency to embonpoint. To the despair of these women, the physician cannot assist them. Ab dominal bandages alone aid them, by concealing, rather than by causing, the disappearance of this fat.
Modifications of the Genital Organs.—More time is requisite than is usually believed for the return of the vulva, perineum, and the vagina, to the normal. If the perineum be intact, the fourchette alone ruptured, cicatrization rapidly sets in, and without leaving much trace. In case of rupture of the perineum, two things, as we will see, may occur. It is however, particularly the vulvo-vaginal lesions which are of frequent oc currence in primiparw, and which require a long time for cicatrization. Frequently, for a few days, oedema of one or another labium minus is pre sent. If, in such event, we separate the vulvar cleft, we find in addition to fissures and erosions a species of necrotic patch, of greater or less ex tent, situated to the side of the swelling, a patch which separates at the end of a few days, and gives place to an open wound, which requires from twelve to fifteen days to cicatrize. The same thing happens to those in cisions which we may have been obliged to make in order to avoid lacera tion of the perineum. (See, in this connection, chapter on " Laceration of the Perineum.") These lesions of the vaginal orifice have been studied by many authors, amongst whom we mention Thiaudiere and Budin. " At the first labor,
the odium vaginse is always torn. The lacerations are generally multiple —one in the mid-line posteriorly, and one or more to the left and to the right. The posterior and median laceration, during the expulsion of the head, may extend into the mucous membrane of the vagina, at the navicu lar fosse, and be the starting point of perineal laceration; but this median and posterior tear is not constant. After labor, the appearance of the vaginal orifice is completely altered; the hymen has been more or less destroyed; the vulvar cleft is continuous with the vaginal canal; the earuncuhe myrtiformes are present, being the remains of the anterior ex tremity of the vagina. These lesions of the orifice may extend into the mucous membrane of the vagina. When cicatrization occurs, the tissues which surround the vaginal orifice retract." The vagina is frequently, at its upper part, dilated, and presents, according to Bouchacourt, the form of a pouch, and this he considers characterisic of recent delivery.
The broad ligaments return to their normal shape. The two divisions of these ligaments come together again, and the tubes and the ovaries resume their natural position in the pelvis, in case they have not, as the result of an inflammatory process, formed adhesions to the neighboring organs.
Involution of the e have seen that, during pregnancy, the uterus undergoes modifications in form, volume, consistency, situation, direction, and structure. These phenomena must retrograde, during the puerperium, in order that the uterus may return to the normal. Whence a series of modifications which we will pass successively in review. These modifications concern both the cervix and the body, but they are far more difficult to follow in the body, since, at the end of a few days, it returns to the pelvic cavity, and escapes, so to speak, our investigations. Still to a degree, as will be seen, we may follow the changes in the body of the uterus. This organ tends to resume its origi nal shape and situation, but it does this slowly and progressively. Schroe der, Winckel, Veit, Horwitz, Martin, and Bidder, have, in particular, studied this question.