692 PROLAPSE OF THE UTERUS. 



To prevent rupture and to assist replacement, the manipulations 

 are made when the animal is not straining. 



After reduction, by stretching out the fingers within the uterus, 

 the folds may be completely got rid of — the same object is served 

 by injecting lukewarm water. Instruments should be avoided. 

 They may cause perforation when the animal strains. 



Becker uses Giinther's parturition crutch. With the half-closed 

 hand, he thrusts the lowest portions of the uterus as far as possible 

 into the vagina, then introduces the previously well-oiled rounded 

 end of the crutch along the arm as far as the hand, and, whilst returning 

 the crutch with the other hand, withdraws the arm from the vagina. 

 An assistant holds the crutch firmly, without thrusting it further 

 forward, while the operator, by using both hands, passes any portion 

 of the uterus still in view into the vagina, reintroduces the right 

 arm, removes the crutch, and endeavours to place the uterus into 

 its proper position. The assistant then passes his left arm into the 

 vagina or uterus alongside the operator's right, closes his hand, and 

 whilst the operator removes his arm, the assistant keeps his in 

 position for an hour. The cow is watched for the next ten to twelve 

 hours to prevent straining, in which case the hand should be pressed 

 against the vulva. If possible, the animal should, after reposition, 

 be kept standing. Operation is facilitated by previously giving a 

 couple of ounces of chloral dissolved in a pint of water. 



In order to ensure retention, some operators recommend keeping 

 the arm for some time in the womb, and only withdrawing it when 

 contraction occurs or straining stops. Others, thinking this 

 encourages straining, replace the uterus, give an anodyne, and apply 

 a vulval clamp or rope truss, or insert hip-sutures. By introducing 

 small pieces of ice or very cold water into the rectum, contraction 

 of the uterus is excited, and recurrence prevented. The measures 

 recommended in prolapse of the vagina may be tried, but complete 

 reposition, and the return of the entire uterus and its horns to their 

 proper position, is much more likely to be successful. Closure of 

 the vulva is only of value in preventing injury to the prolapsed parts, 

 and is most easily and securely effected by using West's clamp or 

 tape sutures. Two or three sutures are sufficient. Pessaries — as an 

 inflated pig's bladder or rubber bag, or tampons of cotton wool and 

 gauzes— are sometimes passed into the vagina before the clamp 

 or truss is applied. Unfortunately there is no external appliance 

 that will prevent invagination of the uterine horn, and therefore 

 careful reposition of the womb is of prime importance. 



In cases where the violence of the expulsive efforts renders 



