From the side of the abdomen and the genital organs there is nothing specially noteworthy. The uterus only exceptionally is slightly sensitive on pressure, but its involution, although retarded, is not arrested, and we may follow its gradual decrease in size, until it has sunk into the pelvis.
To the touch there is nothing peculiar. The uterus is scarcely at all sensitive, the vaginal culs-de-sac are free, the cervix is often patulous, es pecially when the uterus contains a foreign body in a state of decomposi tion. Then the uterus is large, and a reddish fcetid discharge flows from the os. At times the discharge is profuse, containing dark clots, and the finger introduced into the cervix withdraws black stinking debris. Where the retained body is large and the discharge profuse, the internal os is open and the finger may reach this body.
If the uterus contains nothing, the cervix is shut, the organ involutes, and there exists simply a more or less bloody discharge slightly fcetid.
[It is well to bear in mind that flexion of the uterus may cause partial or total retention of the lochia, and thence putrid infection. On exami nation the os may be closed, the organ not specially sensitive, and yet the lochial discharge is fcetid, although not from retained placenta or secun dines. The patient may none the less be infected, however, and on straightening out the flexion bi-manually, the cause of the infection will be evident when more or less stinking lochia escape.—Ed.] To this continued fever, fcetid lochia, and repeated chills, are joined a peculiar general condition, and a facies markedly characteristic.
The face has not that appearance of suffering which it presents in grave metritis, and in peritonitis, but it has a tired worn-out look. The skin
has a dirty green tinge, it is moist, although the perspiration is not pro fuse; the patients complain of feeling tired, and of vague aches and pains; they object to the injections and the odors around them; they are thirsty, lose their appetite; the tongue is roughened and a trifle dry. Rarely vomiting, usually only slight nausea is present. There exists persistent and foetid diarrhoea. The abdomen is neither sensitive nor tympanitic. What predominates, as we have said, is the general state without special local manifestation. Each recurrence in rise of temperature is accom panied by more or less perspiration If the patient resists the infection, and progresses towards recovery, either, the foreign body having been expelled en masse, the natural order of things returns, and in a few days she is convalescing; or else, the foreign body passing away in shreds, the lochia little by little lose their odor, the pulse lowers, the temperature diminishes, and recovery ensues more slowly.
Where, on the other hand, the woman is deeply infected and is going to die, she grows weaker and weaker. The diarrhoea cannot be checked, the perspiration becomes abundant, the temperature rises, the pulse ex ceeds 120, the face becomes pale and ashy, and in the final twenty-four hours, there is slight delirium, the coma passing insensibly, without much suffering, into death.
Although exceptionally putrid infection progresses rapidly, even as in gangrenous metritis, ordinarily the phenomena last from fifteen to thirty days and over. In a personal case of miscarriage at 34- months the rem nant of placenta was only expelled spontaneously at the end of thirty seven days.