574 ACCIDENTS INCIDENTAL TO PARTURITION. 



while disintegration between the fcetal and maternal placentae has ad- 

 vanced sufficiently to permit the hand to complete the disunion without 

 need for violence. It sometimes happens, however, that extraction can 

 be effected so late as the fifth or eighth day after delivery ; but then the 

 membranes are extremely friable, and will scarcely withstand any degree 

 of traction. Besides, the operator himself incurs great risk of infection, 

 either Iccal or general, from the absorption of the putrid matters in the 

 uterus by the skin of the hand and arm, which have been engaged in that 

 cavity. 



An assistant holds the tail of the animal to one side, and the hand and 

 arm, being well oiled, are passed into the vagina ; if a portion of the 

 membranes is in this canal, then the operation is not so difficult, as the os 

 will probably be more or less relaxed, and this portion lying towards the 

 palm of the hand — the back of which is upwards — serves as a guide ; 

 while the left hand pulls at it gently, as occasion requires. When, how- 

 ever, nothing of the envelopes is to be found outside the os, and that 

 opening is firmly closed — as happens four or six days after birth — then it 

 may be very difficult to reach the interior of the uterus. One finger must 

 be at first introduced, then two, and three, and so on, until the hand, in 

 the form of a cone, and by a semi-rotatory motion, can be passed through. 

 This operation is often long, troublesome, and fatiguing, and requires to 

 be carefully managed, so as not to bruise, irritate, or wound the organ. 



When the hand reaches the interior of the uterus, it is pressed forward 

 between the mucous membrane of the latter and the chorion — the palm 

 towards the latter — separating them as it advances until it meets with the 

 cotyledons. Some of these — the maternal — may be detached from the 

 membranes, while others are still imbedded in them, as it were, through 

 their fcetal cotyledons. These last have to be enucleated ; and to effect 

 this, the cotyledon is gently pressed at its base between the thumb and 

 index finger, and, if necessary, the fingers are moved over each other as 

 if removing a buttoi-Afrom its button-hole. Other practitioners make pres 

 sure on the summit of the cotyledon by the three first fingers, and thus 

 destroy the adhesion. In this manner the hand passes from one coty- 

 ledon to another, effecting disunion as rapidly, yet carefullv, as possible. 

 At times a cotyledon will be met with which adheres so very firmly that 

 it cannot be detached in the way just mentioned. Then the nail of the 

 thumb or other finger must be gently insinuated at the border, so as to 

 gradually raise it, and pass the finger over its entire surface. 



The tediousness of the operation will be inferred, when it is known that 

 the number of adherent cotyledons may sometimes amount to more than 

 a hundred ; and the fatigue is often so great that the right and left hand 

 have to be employed alternately — a circumstance which has advantages 

 otherwise. 



When a certain number of cotyledons are detached, the portion of en- 

 velopes so released is carried into the vagina, and beyond the vulva, where 

 the other hand, or an assistant, seizes it, and pulls gently on it. As the 

 bulk of this increases by the detachment of more cotyledons, the pulling 

 must cease, and the mass will require to be supported so as to prevent 

 tearing of the membranes, or painful dragging on the fundus of the uterus. 



As the hand reaches the cornua, the cotyledons increase, and it be- 

 comes difficult to reach them — particularly the cornu in which the hind- 

 limbs of the calf were lodged — because o^ the insufficient length of the 

 arm. Moderate traction, however, on the part just detached will bring 



