symptoms. Because the uterus, torn and injured by the separation of the placenta, especially if any violence has been used, resembles a vast internal ulcer, and is cleansed and purified by the free discharge of the lochia. Therefore do we conclude as to the favorable or unfavorable state of the puerperal woman from the character of these excretions. For if any part of the placenta adhere to the uterus, the lochial discharges become fetid, green, and putrid; and sometimes the powers of the uterus are so reduced that gangrene is the result, and the woman is destroyed.
If clots of blood, or any other foreign matter, remain in the uterine cavity after delivery, the uterus does not retract nor close its orifice; but the cervix is found soft and open. This I ascertained in a woman, who, when laboring under a malignant fever, with great prostration of strength, miscarried of a fœtus exhibiting no marks of decomposition, and who afterwards lay in an apparently dying state, with a pulse scarcely to be counted, and cold sweats. Finding the uterine orifice soft and open, and the lochia very offensive, I suspected that something was undergoing decomposition within; whereupon I introduced the fingers and brought away a "mole" of the size of a goose's egg, of a hard, fleshy, and almost cartilaginous consistence, and pierced with holes, which discharged a thick and fetid matter. The woman was immediately freed from her symptoms, and in a short time recovered.
When the neck of the uterus contracts in a moderate degree after birth, and certain pains, called by the midwives "after pains," ensue, in consequence of the difficulty with which the clots are expelled, the case is considered a favorable one, and is so in fact; for it indicates vigour on the part of the uterus, and that it is inclined readily to contract to its usual bulk; the result of which is that the lochia are duly expelled, and health restored to the woman.
But I have observed in some women the uterine orifice so closed immediately after parturition, that the blood has been retained in the uterus, and then, becoming putrid, has induced the most dangerous symptoms; and when art did not avail to promote its exit, the woman has presently died.
A noble lady in childbed being attacked with fever for want of the ordinary lochial discharge, had the pudenda swollen and
