The Central or Embedded Corpus Luteum 423 



Pathologically, when there is extensive pyometra follow- 

 ing closely upon parturition, or retention of a fetus with 

 putrid maceration or desiccation, the corpus luteum, with- 

 out undergoing either material reduction in size or cystic 

 degeneration, commonly sinks deeply into the ovarian tissue 

 and comes to rest in a comparatively central position, to re- 

 main unchanged for an indefinite period of time. Ordina- 

 rily its presence does not directly call for clinical diagnosis, 

 because it is a mere adjunct to a grosser, more striking con- 

 dition. The presence of an embedded corpus luteum may, 

 therefore, be diagnosed usually with fair safety by the pres- 

 ence of the retained fetus or the pyometra. If the ovary is 

 palpated, the corpus luteum may not be very evident to the 

 inexperienced practioner. The ovary is spheroidal and un- 

 naturally plump, but the corpus luteum is so deeply em- 

 bedded that it is not clearly palpable. Careful and deliber- 

 ate palpation finally enables the examiner to detect a firm 

 central body or "core" in the gland which, in conjunction 

 with the retained fetus or pyometra, leads to a positive diag- 

 nosis. In one or two instances I have encountered clini- 

 cally an embedded corpus luteum without retained fetus or 

 pyometra. It then had the significance of the ordinary re- 

 tained corpus luteum ; it inhibited estrum over an indefinite 

 period. Professor Hess was first to draw definite attention 

 to the inhibitory pawer of retained and embedded corpora 

 lutea. They not only inhibit estrum but at the same time 

 inhibit the spontaneous expulsion of the fetal cadaver or 

 the pus contained in the uterus. 



The embedded corpus luteum, like the retained yellow 

 body, should be located and, in order to accelerate uterine 

 contraction, should be dislodged. The removal of the cor- 

 pus luteum, the best method known for causing the expul- 

 sion of a desiccating fetal cadaver, adds materially to the 

 efficacy of other agencies in the handling of pyometra. 

 Often the removal of the corpus luteum is far from easy. 

 The coordinate disease of the uterus, with the increased 

 weight and volume, drags the ovary downward and for- 

 ward into the abdomen, where it is difficult to reach. Since 



