Volume 4

A system of gynecology and obstetrics / by American authors ; edited by Matthew D. Man and Barton Cooke Hirst.

Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: A system of gynecology and obstetrics / by American authors ; edited by Matthew D. Man and Barton Cooke Hirst. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    finement, would certainly seem to indicate that fatty degeneration plays a most important part in the reduction of the large muscle-cells charac- teristic of pregnancy to the much smaller muscular fibres of the unim- pregnated womb. My own belief is that the redundant material within each cell is destroyed by some degenerative process (chiefly fatty), but that the cell is not destroyed in toto. Recent measurements made by Sano-er1 show very plainly that the reduction of the uterus after labor is effected bv a diminution in the size of the individual fibres, and not by their destruction.2 There is a greater unanimity of opinion in regard to the involution of the serous covering, connective tissue, blood-vessels, and mucous membrane of the puerperal uterus. Mayor3 found in the peritoneal covering of the uterus after delivery a number of folds in the membrane : at the bottom of these folds the endothelial cells seemed to be transformed into a spherical shape. Kilian4 found the cells in this region infiltrated with fat-globules. Bernstein,5 in a study of involution in the rabbit’s uterus, paid especial attention to the behavior of the connective tissue: he found that the reduction of this tissue in the puerperal uterus was effected by a fatty degeneration of the connective-tissue cells, and by a drying out, as it were, of the connective-tissue fibres; these, deprived of the excessive blood-supply of pregnancy, dry up and shrink. Bernstein incidentally mentions the fatty degeneration of the peritoneal endothelium, and expresses the opinion that the muscle-cells, while they do undergo a fatty degeneration, are not completely destroyed. The chief changes in the blood-vessels seem to be shrinkage, the obliteration of many large vessels by a connective-tissue growth in the intima, associated with fatty degeneration of the media,6 and the devel- opment of new elastic fibres in the adventitia of the vessels not oblit- erated (Mayor). The involution ot the endometrium is now, thanks to the investiga- tions, first of Friedlander,7 then of Knud rat.,8 Engel man n,9 Langhans,10 Leopold, and others, clearly understood. When the ovum is cast oft’ 1 Loc. cit. 2 Fibre-length in pregnant uterus 208.7« “ “ in first few hours p.-p ] 58.3y “ “ until the 4th day of the puerperium 117.4.U “ “ in first half of 2d week p.-p 82.7/z “ “ in beginning of 3d week 32.7,u “ “ at end of 5th week 24.4/r 3 Loc. cit. 4 jr oc 5 Kin Beitrag zur Lehre. vnn der puerperalen Involution des Uterus, D. i., Dorpat, 1885. Balin: Ueber das \ erhalten der Blutgefiisse ini Uterus nach stattgehabter Geburt,” Arch./. Gynak., Bd. xv. 1 Physiol .-Anatom. Untersuch. fiber den Uterus,” Leip., 1S70, Arch. f. Gyn., Bd. ix. 8 Wien. med. .lahrbiicher, 1873. 9 Ibid. 10 Arch. f. Gynak., Bd. viii. n Ibid. Bd. xii. Von. II.—30