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II. The placenta is a pulmonary organ like the gills of fish. Oxygenation of the blood from air, from water, by lungs, by gills, by the placenta; necessity of this oxygenation to quadrupeds, to fish, to the foetus in utero. Placental vessels inserted into the arteries of the mother. Use of cotyledons in cows. Why quadrupeds have not sanguiferous lochia.
A faint but characteristic odor to the lochia proves very disagreeable to some patients, and on that account it was formerly customary to give them a daily douche throughout the lying-in period. This was before the characteristics of the puerperal uterus and the nature of infection were thoroughly understood.
After-pains are caused by the same physiologic process that causes labor pains namely, by the contractions of the uterus. After the first confinement the after-pains are, as a rule, not severe; attention to the regular emptying of the bladder and bowels also lessens the severity of the after-pains; these pains seldom last after the second day. The Lochia.
Baudeloque speaks of a case of superfetation observed by Desgranges in Lyons in 1780. After the birth of the first infant the lochia failed to flow, no milk appeared in the breasts, and the belly remained large. In about three weeks after the accouchement she had connection with her husband, and in a few days felt fetal movements.
Somewhat later the lochia consists almost entirely of mucus, being only streaked with blood; but there will be an increase in the bleeding when the patient gets up; and injudicious activity may cause flooding. A slight bloody discharge may be expected to continue until five or six weeks after the child was born.
On the twelfth of March, 1878, Dr. Hervieux was good enough to admit me to his service in the Maternity to visit a woman delivered some days before and seriously ill with puerperal fever. The lochia were extremely fetid. I found them full of micro-organisms of many kinds. The culture remained sterile during the following days.
The seventeenth of May, 1879, a woman, three days past confinement, was ill, as well as the child she was nursing. The lochia were full of the pyogenic vibrio and of the organism of furuncles, although there was but a small proportion of the latter. The milk and the lochia were sowed. The milk gave the organism in long chains of granules, and the lochia only the pus organism.
Formerly much larger amounts were considered normal, and, therefore, it is probable that modern aseptic treatment of child-birth has lessened the subsequent loss of blood. Toward the end of a week the lochia changes from a bright red to a brownish color, because the discharge now includes certain products of disintegration.
A second child was born at term, sixty-eight days after the first; and in 1782 both children were living. A woman of Arles was delivered on November 11, 1796, of a child at term; she had connection with her husband four days after; the lochia stopped, and the milk did not flow after this intercourse.
Bourdon mentions milk from the thigh, labia, and vulva. Klein speaks of the metastasis of the milk to the lochia. Gardane speaks of metastasis to the lungs, and there is another case on record in which this phenomenon caused asphyxia. Schenck describes excretion of milk from the bladder and uterus.
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