Volume 1

Cyclopaedia of obstetrics and gynecology ... / [edited] by Egbert H. Grandin.

Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Cyclopaedia of obstetrics and gynecology ... / [edited] by Egbert H. Grandin. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    509/540 (page 487)
    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-fonr 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, we 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 utei'ine contractions, why are they painless in primipara, and the reverse in multiparas ? 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- para, 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 oeing less perfect, small clots can form in the uterine cavity, and these, being foreign bodies, excite the utei'ine 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^he 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 hcen weakened by previ- ous labor; uterine retractility is less perfect. Retractility and contractility, however, would not suffice to cause dimi- nution in size of the uterus, if to these factors were not added the process of fatty degeneration which invades each anatomical element, and which causes the disappearance of certain of these elements, and their reproduc- tion by new elements, and further causes diminution in size, acquired during pregnancy, of other elements; in a word, the process which sub- stitutes normal conditions for the hypertrophic of gravidity. In one case, there is total destruction of old elements, and entire new formation; for