Under this head we include the solitary cases observed by old writers, of rupture of the pregnant womb about the middle of pregnancy, caused by a deficiency in the substance of the uterus bicornis; the more frequent rupture of the uterus at its superior portion, in consequence of excessive labor-pains, caused by insuperable obstacles to birth on the part of the mother or the child, and accompanied by hemorrhage and escape of the contents into the cavity of the abdomen; and the still more common rupture of the uterus at its lower segment during parturition, in consequence of various difficulties.

The latter generally extends from the cervix to the vagina; it may also affect the parietes of neighboring hollow viscera, especially of the bladder; the blood may be effused into the pelvic adipose and cellular tissue, in the vicinity of the bladder and the rectum, and between the broad ligaments; it may pass downwards into the labia, or upwards under the peritoneum into the iliac and lumbar region; or the effusion may be accompanied by rupture of the peritoneum or the bladder, and take place into their cavities. These ruptures affect the entire thickness of the uterine or vaginal parietes, or are limited to an internal layer, or they are lacerations of the vaginal portion of the uterus. They generally have a vertical direction, transverse lacerations being very rare.

In cases of difficult labor the uterus may be subjected to contusions of more or less intensity, which sometimes involve the entire thickness of the organ. The parts adjoining the promontory, or the symphysis pubis and the horizontal rami of the pubes are most liable to suffer. The contusions may affect a circular spot and have a various extent, or they may be chiefly in a transverse direction.

In rare cases the uterus suffers a severe contusion immediately above the vaginal segment, and throughout its circumference, amounting even to laceration; thus the vaginal segment of the uterus may at once, or by a subsequent process of suppuration, become detached, and in the case of eversion of the uterus after parturition, the separation of the entire uterus from the vagina has been observed (Cook).

Finally, we have to allude to ulcerative affections of the uterus caused by or resulting from malignant puerperal disease, and in various other ways.