These figures seem to us very excessive when compared with those ob tained, about the twelfth and the fourteenth day, from measurements of the uterine cavity. The hysterometer, indeed, gives the dimensions of the uterus, body and cervix together, and it is difficult to make correct allowance for each. Finally, the figures obtained by Milsom for the body of the uterus, and those given further on, from our own and Sinclair's researches, cannot be accepted with those given above for the cervix.
As for the body of the uterus, the modifications are more difficult to appreciate, and, notwithstanding every care, we can do so only approxi mately. The weight of the uterus is given by Simpson as 23.56 ounces, by Naegel6 23.5 to 24 ounces, by Heschl and Playfair, 20.3 to 20.4 ounces, by Spiegelberg 31.24 ounces, and this diminishes rapidly after labor. According to the last authority, the weight is only 23.5 ounces two days after labor, about 16 ounces at the end of the first week, 12 ounces at the end of the second, and at the end of the sixth the uterus has returned nearly to the normal; for the uterus which has borne one child remains ever a little heavier, a little larger, with more spacious cav ity than in the virginal state. This is readily apparent from the figures given in the anatomical part of this work.
The dimensions of the uterus suffer the same reduction. At the end of pregnancy the organ has a mean vertical diameter of 12 to 14 inches, antero-posterior diameter of 8 to 9, transverse of 9 to 10, and, after labor, these diameters diminish slowly to the normal. This diminution is not due alone to the retreat of the organ, but to involution, a complete trans formation of all its constituent elements.
Endeavors have been made to follow this work which takes place in the uterus, and while some have measured the organ, others, envisaging the subject more closely, have studied with the microscope the phenom ena of involution. Wieland was the first to measure directly the progress of involution, but the figures he obtained are far below those of others. He gives the vertical dimensions of the uterus as 5 to 5.4 inches, and the transverse as 3.5 to 3.9, immediately after the expulsion of clots and of placenta. But his measurements concern only that portion of the uterus which is above the pubes, and consequently, differ widely from the true dimensions of the organ. Bouchacourt, and his pupils, Philipotaux, Mar
dual and Morin, conclude, from 100 observations, that: " At the end of the first, or the commencement of the second day after labor, the fundus of the uterus rises about .7 inches, to descend .39 to .7 inches daily, with slight re-ascent on the fifth day, a stationary period on the seventh day." The descent of the uterus, therefore, is more or less regular, at the rate of .39 to .7 inches daily.
Autefage, whose experiments were conducted and controlled by ourselves and by Depaul, used Baudelocque's pelvimeter, modified by Depaul. One branch was introduced into the vagina, and held by the finger against the at the level of the external os, the other was applied at the fundus of the uterus. Thus the vertical diameter was obtained. The transverse di ameter was taken through the abdominal wall, at the largest part of the uterus. The following are the figures he obtained, and they were con trolled by myself: 42 women, six hours after delivery: vertical diameter 6.2 inches (mean); from pubes to fundus uteri 4.3 inches (mean); transverse diameter 4.7 inches (mean.) 16 women, six to twelve hours after delivery: vertical diameter 6.4 inches (mean); from pubes to fundus uteri 4.8 inches (mean); trans verse diameter 4.8 inches (mean.) 7 women, from twelve to eighteen hours after: vertical diameter 6.4 inches (mean); from pubes to fundus uteri 5.4 inches (mean); transverse diameter 5 inches (mean.) 19 women, from eighteen to twenty-four hours after: vertical diameter 6.3 inches (mean); from pubes to fundus uteri 4.5 inches (mean); trans verse diameter (mean.) The measurements taken thereafter daily, the rectum and the bladder having first been emptied, have given the figures in the annexed table. These figures are exact, and my personal researches have confirmed them. The regularity is not as complete, however, as may be thought from a study of the table, for I have frequently found, and without pathological cause, that involution might cease for a day, the uterus even increasing a trifle in size, to decrease again, finally sinking into the pelvis about the tenth or twelfth day.