THE LOCHIA.
During the above process of regeneration, there are excreted from the uterus a number of products, which together constitute what are called the lochia. The lochia, composed almost entirely of pure blood, have been called, according to the predominance of blood corpuscles or len cocytes, bloody, serous, sero-purulent, milky. Robin has shown that this latter term is erroneous, for the lochial discharge never contains true pus, but only a of a stale odor, and alkaline reaction. This dis charge is only truly bloody during the first three days. It becomes serous from the third to the fifth day. There are variations, however, in differ ent women.
Almost exclusively made up of blood during the first hours, from the second to the fifth day, according to Wertheimer, the discharge is com posed of a serous liquid, containing larger or smaller masses of vaginal mucus, which, mingling in the vagina with blood corpuscles, forms a sediment. Under the microscope are found: 1. Blood corpuscles. 2. Elliptical and polygonal epithelium, nucleated. 3. Mucous corpuscles. 4. Sometimes remnants of placenta or of membranes. Chemical analy sis reveals albumin, the albuminate of soda, mucus, fat, chlorides, alka line phosphates, iron, lime, salts. The solids vary in amount from 267.6 to 86.2 parts per 1000. From the fifth day the blood corpuscles dimin ish greatly. They are altered in contour, modified in form, and we find in the lochia pus corpuscles according to Wertheimer, leucocytes accord ing to Robin, an epithelium which has changed from elliptical and poly gonal to round, nucleated cells, free nuclei and fat globules.
Schroeder has found in the lochia the trichomonas vaginalis, and Scherer, who has studied the lochia since Wertheimer. finds: " During the first few days, the predominating elements are the constituents of the blood, albumin and globules, in the shape usually of molecular granu lations. There is no fibrin; uterine and vaginal epithelium is found, as well as shreds of placenta. After a few days, the epithelium almost en tirely disappears, the blood corpuscles are less abundant, the discharge becomes of a dirty red color, and many mucous corpuscles are found (abor tive epithelial cells). Little by little, the discharge becomes more viscid,
and at the same time more perfect epithelium is found. Mucin appears, instead of trae albumin." (Naegele and Grenser.) According to Gassner, the amount of the lochia is 21 pounds during the first four days, (red lochia), of a pound from the fourth to the sixth day, (serous lochia), and up to the ninth day, pound (white or green lochia). The total during the first eight days is about 3+ pounds. This quantity is doubled in women who do not nurse.
The duration of the lochial discharge is variable. Usually the discharge continues until the re-appearance of the menses, that is to say, till the sixth week, in women who do not nurse. In those who do nurse the duration is somewhat less, but there is no absolute rule. It is not unu sual for the lochia to diminish notably for a few hours, and then to reap pear more abundantly, even as when they have become serous they may return to the red for a day or two, again to change to greyish-white. Lactation seems to greatly modify them; often, at the onset of the func tion, they diminish markedly, sometimes to complete suppression, to reappear as abundant as usual when the function is established. Depaul agrees with Gassner in the opinion in regard to the increase of lochia in women who nurse.
The odor of the lochia is stale, not normally very pronounced, and fetor is always a grave indication, since it always points to deep lesions of the genital tract, or to more alarming puerperal accidents. The same re mark applies to acute suppression, or too rapid disappearance of the lochia. If, indeed, we consider the lochia as the external manifestation of the phenomena occurring within the genital organs, of the process of involu tion in other words, this suppression always coincides with a temporary arrest of involution; and since the first phenomenon which accompanies puerperal pathology is the arrest of involution, the importanoe is at once apparent of the regular and normal flow of this discharge.