I have further found, in agreement with Autefage and Depaul, that in volution occurs more rapidly in primiparze than in multiparte, and I fur ther admit the manifest influence of ergot administered after delivery. I cannot express myself as positively in regard to the influence of lactation. It has seemed to me to interfere with involution, but my observations have been made in a hospital where each woman is obliged to nurse her infant. Nevertheless, comparative observations, but incomplete because made on private patients who will not submit to careful experiment, incline me to agree with those who believe that lactation interferes with involution. Pinard, my colleague, is of the contrary opinion, but my teacher, Depaul, agrees with me.
[In reference to this point, one would, a priori, be led to the belief that lactation assists uterine involution. It is a familiar fact that the applica tion of the infant to the breast causes uterine contractions, painful to the mother, and we can recall one case where this effect was constant for the first ten days after delivery. Contractions of the uterus not only empty it of clots, but also make the organ less congested, more bloodless. Fur ther, the sympathy between the uterus and mamma is so close, that it is allowable to think that congestion of the one, excessive function of the one, may have a derivative action on the other. The milk markedly diminishes where the lochia become profuse or last over long; while in our experience, other factors equal, the lochial flow is more natural in women who nurse, or have an abundance of milk, than in those who do not. We believe, therefore, that the proper performance of lactation assists involution through a species of derivative effect on the uterus. Careful comparative experiments are, however, necessary to settle this point.—Ed.] Whatever the precautions, external measurements cannot give us exact figures. During the year 1880, while substituting for Depaul at the Clinique d'Accouchemente, I endeavored to determine the exact dimen sions of the uterus, by Measuring the depth of the cavity of every woman before she left the hospital, about the fifteenth day after confinement. I thus examined 83 women. I believed I was the first to do this, when Budin called my attention to similar experiments made by Sinclair of Bos ton. My conclusions, as will be seen, are nearly similar to those of Sin clair. The only difference is that, having made his measurements on the seventeenth day, his figures are a trifle less than mine. My personal re searches are contained in the thesis of my pupil, Dr. Avrard, published in December, 1880.
In 1881, Milsom, without being aware of either my experiments, or those of Sinclair, followed the same method with the hysterometer, the measurements being made about the tenth day. He has further made measurements from the thirtieth to the fiftieth day after delivery, thus determining, in a measure, the duration of involution.
[Charpentier here inserts the elaborate tables drawn up by Sinclair of Boston. Since our readers have ample access to the original, in the Trans
actions of the American Gynecological Society, Vols. for 1879, 1881, and to the continuation of these tables by Richardson, of the same city, in the volume of the same series for 1882, we omit them here, giving simply the comparative tables of Sinclair's and Charpentier's experiments.—Ed.] The comparative length of the uterine cavity, in primiparse and in mul tiparw, as deduced from our own experiments and from Sinclair's, is: In the last four cases the puerperal state had been complicated by peri tonitis, metritis, albuminuria. The last had required forceps for extrac tion of a child weighing eleven pounds.
According to Sinclair, therefore, the mean depth of the uterine cav ity is 2.7 inches about the seventeenth day; for us, about 3.1 to 3.9 inches at the fourteenth day; we may hence conclude that, about the fourteenth day, the uterine depth is 3.5 inches, in at least half the women.
To resume the above figures: Sinclair. Charpentier.
107 women, mean depth 2.3 to 4.6 in. I 81 women, mean depth 2.3 to 4.6 in. One woman only 1.9 " 2.3 " I One woman 5.07 in.
Our measurements were made after the following fashion: The woman was placed across the bed, the feet resting on two chairs, and the nates at the very edge of the bed. The lochial discharge had never ceased in any case. In multiparre the genitals were more or less deeply colored, with out lesion. In primiparw, on the other hand, the vulva was nearly always eroded and the fouchette ruptured; in certain exceptional cases there were lacerations of the perineum; almost always there existed lesions of the mucous membrane and of the vaginal orifice, in a more or less advanced stage of cicatrization. And this was the case, as well in women who had been delivered spontaneously, as in those who had required instrumental interference. Cusco's speculum, introduced into the vagina, has always allowed us to examine the cervix carefully. In certain cases, above all in primiparie, the introduction of the speculum caused the appearance of a drop of blood at the external os. The appearance of the cervix was very different, according as we were dealing with a primipara or a multipara. In the multipara, the cervix has always seemed less large. Its color was bluish, except at the level of the os,where there was a reddish circle, formed by the mucous membrane. Its consistency was firmer. In the primipara, the cervix, larger, has always, or nearly always, seemed inflamed, because the surroundings of the external os were red,projecting,as though granular, the mucous membrane of the lips being swollen, and bleeding at the least touch; in a word, it resembled that of a woman affected with deep granu lar ulceration of the cervix, looking, as expressed by Nieberding of Wurtz burg, like an ectropion. From this cervix, ordinarily, there flowed a greater or less quantity of bloody mucus.