Page:Clinical Lectures on the Diseases of Women.djvu/15

 not more than half as bulky as it was. Fourteen days after the operation the uterus measured two inches and a half, and the cervix was reduced to natural dimensions.

This woman was very ill ; her case was recognised as probably dependent upon miscarriage, although the mis- carriage was the enormous distance backwards of eight months. I see no reason to think that, if this woman had not been properly treated, she could have escaped death from continuance of discharge ; for the placental mass was alive, and had firm adhesion to the uterus ; and when separa- tion would have taken place I do not know. I think it would not have taken place, but have led to the woman's being drained of blood, and dying. The case was supposed to be connected with a recent miscarriage, because there was no evidence of fibrous tumour nor of anything else that would account for the bleedings and the great size of the uterus. Had this woman's uterus been enlarged by a fibrous tumour so big as to make the cavity measure five inches, the tumour would have been easily felt ; but no tumour was felt. The uterus, instead of being enlarged as it would have been by a fibrous tumour, was a flattened mass which could not be distinctly felt through the anterior wall of this woman's abdomen. I call your attention to the great size of the uterus. There was no need of this size to include such a small thing as the bit of placenta which we took away, and the removal of which was followed by the complete cure of the woman, and the diminution of the uterus to its natural size. The case, then, is a very remarkable illustration of the power of a persistently attached piece of living pla- centa in maintaining the development of the organ, or, in other words, preventing its involution. In this it contrasts with the comparatively small size of the uterus in the next case — that of missed abortion. The case is quite clear. The woman had decidual endometritis affecting a part of her placenta, and making it adherent. The placental deci-