THE NORMAL PUERPERIUM.
We say normal state, but only in a relative sense. We have already seen that the uterus, after the first confinement, remains a trifle larger than before conception. The end of the process of involu tion is not fixed, and although, in general, it may be said to be completed about the sixtieth or seventieth day after delivery, there are many women in whom much more time is requisite. There exists, hoirever, one sign, which, if it does not mark the end of involution, indicates at least the return of a prime function of woman, ani this is the reappearance of the menses, the external manifestation of renewed ovulation, in other words the sign which tells us that the ovary has resumed its r6le in the economy. We believe that this sign indicates the end of the puerperal state. It is during this period that the hypertrophy, characteristic of pregnancy, is replaced by the tendency to atrophy which predominates during the puer perium. This atrophy, this retrograde metamorphosis, concerns all the systems of the body, but, in particular, the genital organs, since they have suffered the greatest alteration by reason of pregnancy. Often this retrogression occurs in a physiological manner, so to speak, without in terfering with the health of the woman; in other instances, however, what are called puerperal accidents interfere with involution, and the woman's health is more or less compromised. Whence the two divisions, physiological puerperium, and pathological. In this chapter we are con cerned with the former, and we refer the reader to the end of this work for the study of the pathology of the puerperal state.
There are two kinds of phenomena: 1st. General phenomena. 2d. Local phenomena.
The first phenomenon following on delivery is a feeling of lassitude, of fatigue, which must be satisfied by the most complete rest. Peaceful, and smiling, the woman, happy in her safety, shows her joy by her actions and her words; or else, she seems tired out by her labors, resting perfect ly impassive; or else, finally, she is covered with perspiration, her skin is hot, and she is still excited by the last efforts of labor. Almost all primi
pare complain that their genital organs feel as though ruptured, and the coccygeal region contused. After the lapse of a few hours, these painful sensations, the result of the pressure exercised by the head on these organs, disappear, although, at times, the pain over the coccyx remains for a num ber of days. We have already referred to the chill following delivery. It is of no serious import, and all that is needed is extra bed-clothes, and a hot drink. Usually the woman goes to sleep, during which she per spires freely, and, on awakening, she is hungry, and naturally so, seeing that she has fasted during the hours of labor.
The abdomen is relaxed, not painful; the uterus, well contracted, is about the level of the umbilicus, spherical, and a trifle sensitive on pal pation. If, as should be the rule, the physician visits the newly-delivered woman in from five to six hours after labor, he will find that the uterus is higher, often greatly so, than the umbilicus, and yet the woman does not complain, nor is there danger of hemorrhage. This phenomenon, more frequent in primiparEe than in multiparEe, is due to the fact that the woman has not urinated, and that the uterus, therefore, is pushed up by the distended bladder. This organ emptied, the uterus will return to the proper position.
It has been pointed out by Naegele and Grenser, that owing to the vast quantity of blood which has flowed to the uterus, and which has only par tially escaped from the uterine sinuses, there exists a species of general plethora, for the disappearance of which derivation is necessary, and this takes place through the skin, the breasts, and the lochial flow. This, in especial, is the reason for the abundant perspiration, sour in smell, which occurs a number of times daily, in particular during sleep, and is accompanied, frequently, by miliary, scarlatiniform, eruptions. These emotions should not be confounded with true scarlatina, for they are in significant, and not at all of bad omen.