The introduction of the hysterometer into the uterine cavity was only painful in a single instance. But, in a number of other instances, at the moment when the instrument passed the internal os, we saw appear at the external os, and out of the uterine cavity, a little blood mixed with mucus, as if the instrument, in opening the uterine cavity, had per mitted it to empty itself of contained fluid. The color of the mucus proved that it had been retained for a certain time in the cavity. The uterus once emptied, the hysterometer passed to the fundus without giv ing rutin. The woman simply knew when the point of the instrument touched the fundus, rather on account of a feeling of pressure than of one of pain. When the instrument had reached the fundus, the guard was pushed down to the cervix, the instrument withdrawn, and the number registered on the blade gave us the measurement of the uterine cavity.
In a number of instances, in primiparte, and in particular where there existed a granular condition of the cervix, the withdrawal of the hyster ometer has been followed by a slight bloody discharge; but this discharge has always been little, and has ceased in a few minutes, except in three or four cases where it lasted three or four hours. But even in these cases the examination in no wise injured the woman, for all those measured left the bed in a few hours without either pain or hemorrhage. Sinclair and Milsom never met with any accident following the use of the hysterometer.
[The experiments of Milsom in the same direction are tabulated here, but, since they agree in the main with those of Sinclair and of Charpen tier, we omit them.—Ed.] Finally, Milsom has studied the influence of the duration of labor, of miscarriage, and of premature delivery, and he admits that the duration of labor does not appear to have much influence on the progress of invo lution. It is established, however, that where labor has lasted less than twelve hours, involution is slightly quicker than where the act of labor has been longer; the daily diminution being 0.5 in the first instance, and 0.42 to 0.46 in the second.
As to the influence of premature labor at seven or eight months, it does not seem to be considerable. Involution, nevertheless, is a trifle retarded and it does not progress with such regularity.
As to the duration of involution, it is longer than is generally stated, and the experiments of Sinclair, of Milsom, and of ourselves, justify the statement that in women who do not nurse it requires a mean interval of seven to eight weeks, and from ten to twelve in those who do. We are speaking, of course, of cases where this involution has not been retarded by any pathological factor.
Involution is not accomplished after a similar fashion in primiparte and in multiparal While in prim iparie it proceeds, as it were, insensibly, in multipara3 it is accompanied during the first few days by painful uter ine contractions which are called after-pains. We cannot accept the opin ion of Bouchacourt, who considers these pains absolutely independent of uterine retractility. Retractility and contractility, although they are special and independent properties of the uterus, are nevertheless con joined, at least during the first twenty-four hours after delivery, and although the retractile property predominates, contractility still re mains a factor during this period, and even longer in certain cases; and, while these contractions are painless in primiparte, they are always the reverse in multiparre, so painful that some women bear them less patiently than they do the pains of labor. They are, notwithstanding, of a similar
nature—they are due to uterine contraction. They are painful, intermit tent, accompanied by change of form and of consistency of the uterus, manifested by a hardening of this organ, and are excited by abdominal palpation, by lactation, etc. At first very intense, these pains assume a longer interval, diminishing in intensity, and cease, usually, at the end of twenty-four to thirty-six hours, although they may persist beyond this time. They should always be a source of solicitude to the physician, for although during the first thirty-six hours, their only importance is that of depriving the patient of rest, their existence beyond this period is often followed by pathological symptoms, (fever. metritis, pelvic peritonitis or cellulitis), and may, therefore, call for active treatment. They always yield to opium, either by the mouth, sprinkled on an abdominal poultice or by enema, twenty to thirty drops of the tincture, repeated in three to four hours.
[Since opium constipates, and not infrequently upsets the digestion, wo much prefer, what is just as effective, chloral hydrate, by the mouth, fif teen grains repeated in one half hour, or by the rectum, in double the dose.—Ed.] Now these after-pains being obviously due to uterine contractions, why aro they painless in primiparre, and the reverse in multiparfe ? Depaul, who does not consider them as simply a continuation of the rythmical uterine contractions of labor, has noted that they are more intense in cases where labor has been easy than where it has been tedious, and that, dur ing their presence, a slight amount of blood appears externally. In our opinion, after-pains are the result of nature's precautionary efforts to in sure firm uterine contractions. If they exist to a less degree in the primi pam, this is because in her retractility is perfect, present in all its inten sity, and therefore contractility is not called for. On the other hand, they are present in the multipara, because the tone of the uterus has been enfeebled by a previous labor, and, retractility hence being less perfect, small clots can form in the uterine cavity, and these, being foreign bodies, excite the uterine muscular fibres, and determine contractions which are destined to expel such clots, and are so much the more painful, because the muscular walls having become thicker, the strength of the contractions is limited within narrower bounds. After-pains, then, are useless to the primipara,and she scarcely feels them; they are necessary to the welfare of the multipara, because the uterine fibre has been weakened by previ ous labor; uterine retractility is less perfect. .