RETENTION OF THE AFTERBIRTH 329 



retained on account of the excessive dilatation of the uterus 

 and its insufficient contractility. 



4. Tetanus, which is very rare, may follow retention of the 

 secundines (Giovanoli, Koder.) 



Prognosis. — It is pretty favorable, when proper assistance 

 is rendered in time, but unfavorable when symptoms of puer- 

 peral infection are already present before assistance is 

 requested. 



Therapeutics. — Treatment must be preceded by an internal 

 examination. The point here is not so much what may we do 

 in retentio secundiuarum, but what are its causes and how may 

 we remove them. 



The treatment depends on the causes, as they decide upon 

 either a medicamentous or manual treatment. Some practi- 

 tioners prefer the former, others the latter. Either one may 

 yield good results. It is best to first conduct a thorough 

 examination, letting the treatment depend on the cause 

 detected. 



It is not exactly an agreeable business to examine a cow 

 with a decomposing afterbirth. The stench is often unbear- 

 able and hardly to be removed from the arm. Nevertheless it 

 must be done. When somewhat careful we need not soil our- 

 selves particularly. Of course it is understood that no good 

 clothing is worn for this work. It is also a matter of course 

 that any small wouuds are well covered and that hands and 

 arms are thoroughly oiled. Any negligence along this line 

 exposes the operator to infection. 



The purpose of the exploration is to detect: Atony of 

 the uterus, firm adhesions between the fcetal and maternal 

 placentae, whether caught in the empty horn (cornu) or closed 

 cervical canal. Possibly a portion of the afterbirth passed 

 through a perforating uterine wound into the abdominal cavity. 

 All these are not difficult to recognize. When the uterus has 

 not contracted sufficiently one feels during the examination 

 only a few cotyledons close to the internal os uteri. The fcetal 

 placentae are readily removed from them ; those cotyledons 

 further away are beyond reach of the hand. 



