WHAT IS PARTURITION & HOW DOES IT RELATE WITH INFLAMMATION AND ULCERATION OF CERVIXParturition is a very frequent cause of inflammation and ulceration of the cervix, as might be presumed a priori.Not only is parturition frequently followed by inflamation of the uterus involving the cervix, which may perpetuate itself in the latter region even when it has beesubdued in the body of the organ, but it often occasions inflammation of the cervix alone, other parts of the uterine system not being simultaneously affected. This is owing to the cervix being the part of the uterus the most exposed to laceration and contusion during parturition.The cervix may be lacerated more or less extensively during the most natural labour. In a rapid confinement, a strong contraction, or a succession of strong contractions propelling the child with great force against the imperfectly dilated os, will, as I have repeatedly witnessed, thus lacerate the cervix, under circumstances otherwise the most favourable.Morever, this dilatation of the os uteri is very slight until parturition actually commences, and is not consequently calculated to interferewith the integrity of the mucuous membrane with which the cervical canal is lined. As soon, however, as the pains which precede and ac- company the expulsion of the foetus commence, the dilatation of the os uteri progresses rapidly, and in the course of a few hours is carried to such an extent as to admit of the passage of the foetus.A necessary consequence of this rapid dilatation of a canal lined by a mucous membrane in an entire state is, that it must, in many cases, be accompanied by contusion, erosion, and laceration of the membrane.
The peritoneal folds themselves are seldom compromised in non-
puerperal inflammation of the uterine appendages. When inflam- mation occurs in ' this region after parturition, there is a great tendency in the peritoneal membrane to take on the inflammatory action, as is the case when the uterus itself is the seat of inflamma- tion. In the unimpregnated non-puerperal condition, on the contrary,
There is very little tendency to inflammation in the peritoneum, and the organs contained between its folds mav remain inflamed during months or years without its being much affected. This is a singular pathological fact, but one which is equally true when applied to inflammatory affections external to the peritoneum in other points of the pelvic cavity. Even when peritonitis does complicate the attack in the non-puerperal state, it seems to have a greater tendency to localize than to extend its action — the contrary of what obtains in the puerperal condition.
In the form of the disease which I am now more especially describing, that which is unconnected with this condition, the pus escaping internally and the abdominal walls not being involved, the secondary symptoms are not very severe, except during exacerbations and relapses. The patient is able to get about, and to follow more or less her usual avocations. She is merely in delicate or bad health, has unusual pelvic pains and sensations, and menstruation is disturbed and laborious ; the real cause of this condition being nearly always a mystery both to herself and her medical attendant.
WHAT HAPPENS IN PARTURITION
In parturition,in which very extensive pelvic suppurations take place, giving rise to external perforations. In this form of the disease, death occasionally occurs ; but even under such circumstances it is rare, unless inflammation assume an extreme and exceptional degree of intensity.