The uterus, especially in the woman, varies extraordinarily as it is fecundated or not, both in constitution and in the results of that constitution—I mean in position, size, form, colour, thickness, hardness, and density. In the girl, before the age of puberty, the breasts are no larger than those of the boy, and the uterus is a small, white, membranous organ, destitute of vessels, and not larger than the top of the thumb, or a large bean. In like manner in old women, as the breasts are collapsed, so is the uterus shrunken, flaccid, withered, pale, and void of vessels and blood. I attribute the suppression of the catamenia in elderly women to this cause; in them the menstruous fluid either escapes as hemorrhoidal flux, or is prematurely stopped, to the injury of the health. For when the uterus becomes cold and almost lifeless, and all its vessels are obliterated, the superfluous blood boils up, and either falls back and stagnates, or else is diverted into the neighbouring veins. On the contrary, in those pale virgins who labour under chronic maladies, and in whom the uterus is small and the catamenia stagnate, “by coition,” says Aristotle,[374] “the excrementitious menstrual fluid is drawn downwards, for the heated uterus attracts the humours, and the passages are opened.” In this way their maladies are greatly lessened, seeing that want of action on the part of the uterus exposes the body to various ills. For the uterus is a most important organ, and brings the whole body to sympathize with it. No one of the least experience can be ignorant what grievous symptoms arise when the uterus either rises up or falls down, or is in any way put out of place, or is seized with spasm—how dreadful, then, are the mental aberrations, the delirium, the melancholy, the paroxysms of frenzy, as if the affected person were under the dominion of spells, and all arising from unnatural states of the uterus. How many incurable diseases also are brought on by unhealthy menstrual discharges, or from over-abstinence from sexual intercourse where the passions are strong!
Nor are the changes which take place in the virgin less observable when the uterus first begins to enlarge and receive warmth; the complexion is improved, the breasts enlarge, the countenance glows with beauty, the eyes lighten, the voice becomes harmonious; the gait, gestures, discourse, all are graceful. Serious maladies, too, are cured either at this period or never.
I am acquainted with a noble lady who for more than ten years laboured under furor uterinus and melancholy. After all remedies had been employed without success, she became affected with prolapsus uteri. Contrary to the opinion of others, I predicted that this last accident would prove salutary, and I recommended her not to replace the uterus until its over-heat had been moderated by the contact of the external air. Circumstances turned out as I anticipated, and in a short time she became quite well; the uterus was returned to its proper situation, and she lives in good health to the present day.
I also saw another woman who suffered long with hysterical symptoms, which would yield to no remedies. After many years her health was restored on the uterus becoming prolapsed. In both cases, when the violence of the symptoms was abated, I returned the uterus, and the event proved favorable. For the uterus, when stimulated by any acrid matter, not only falls down, but like the rectum irritated by a tenesmus, thrusts itself outwards.
Various, then, is the constitution of the uterus, and not only in its diseased, but also in its natural state, that is, at the periods of fecundity and barrenness. In young girls, as I said, and in women past childbearing, it is without blood, and about the size of a bean. In the marriageable virgin it has the magnitude and form of a pear. In women who have borne children, and are still fruitful, it equals in bulk a small gourd or a goose’s egg; at the same time, together with the breasts, it swells and softens, becomes more fleshy, and its heat is increased; whilst, to use Virgil’s expression with reference to the fields,
“Superat tener omnibus humor,
Et genitalia semina poscunt.”
Wherefore women are most prone to conceive either just before or just subsequent to the menstrual flux, for at these periods there is a greater degree of heat and moisture, two conditions necessary to generation. In the same manner when other animals are in heat, the genital organs are moist and turgid.
Such is the state of the uterus as I have found it before birth. In pregnant women, as I have before stated, the uterus increases in proportion to the fœtus, and attains a great size. Immediately after birth, I have seen it as large as a man’s head, more than a thumb’s breadth in thickness, and loaded with vessels full of blood. It is, indeed, most wonderful, and, as Fabricius remarks, quite beyond human reason, how such a mass can diminish to so vast an extent in the space of fifteen or twenty days. It happens as follows: immediately on the expulsion of the fœtus and its membranes, the uterus gradually contracts, narrows its neck, and shrinks inwardly into itself; partly by a process of diaphoresis, partly by means of the lochia, its bulk insensibly lessens; and the neighbouring parts, bones, abdomen, and all the hypogastric region, at the same time diminish and recover their firmness. The lochial discharge at first resembles pure blood; it then becomes of a sanious character, like the washings of flesh, and is otherwise pale and serous. At this last stage, when no longer tinged with blood, the women call it “the coming of the milk,” for the reason probably that at that time the breasts are loaded with milk, and the lochia sensibly diminish; as if the nutritive matter was then transferred to the breasts from the uterus.
In other animals the process is shorter and simpler; in them the parts concerned recover their ordinary bulk and consistence in one or two days. In fact, some, as the hare and rabbit, admit the buck, and again become fecundated, an hour after kindling. In like manner, I have stated that the hen admits the cock immediately on laying. Women, as they alone have a menstruous, so have they alone a lochial discharge; added to which they are exposed to disorders and perils immediately after birth, either from the uterus, through feebleness, contracting too soon, or from the lochia becoming vitiated or suppressed. For it often happens, especially in delicate women, that foul and putrid lochia set up fevers and other violent 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.