Puerperal Diseases of the Uterus 545 



ior of the cervix should be watched and the removal of the 

 clot attempted sufficiently early. The chief mass of the clot 

 is best removed by carefully breaking it down with the 

 hand, and flushing out the detached pieces with physiologic 

 salt solution. The douching should be done with the great- 

 est possible gentleness, preferably by means of a hospital 

 irrigator to which is attached the seven-foot pure rubber 

 catheter designed for douching the sheaths of bulls. This 

 catheter is soft and pliable, and can not readily damage the 

 endometrium. Its small calibre, permitting the solution to 

 enter the uterus slowly, avoids any sudden distension of the 

 organ. While the salt solution is entering the uterus, the 

 operator should carefully break up the clot with his fingers. 

 After the clot has been removed, the uterus should be 

 watched closely for untoward developments. 



The clinical diagnosis of the desiccated hematoma has not 

 fallen to my lot. Apparently it should be easy. The mass 

 is doughy and firm, as in the first stages of fetal desiccation. 

 In the latter case, however, the fetus is usually palpable, 

 especially its head or the feet, some of which may lie in 

 close proximity to the uterine wall. Later the desiccated 

 fetus becomes extremely hard and its skeletal outlines clear. 

 The cervical canal is sealed in desiccated fetus, but open in 

 desiccated hematoma, except, as in one instance mentioned 

 above, when a hematoma was present in one horn and an 

 embryo in the other. One may meet clinically the very old 

 tesselated hematoma of Fig. 178. It is almost as hard as a 

 desiccated fetus, but the skeletal outlines of the mummy are 

 absent and the hematoma is even in its general contour, 

 with the small depressions where the clot has become fis- 

 sured. 



I have had no occasion to handle the desiccated uterine 

 hematoma and know of no rule upon which to proceed. 

 Evacuating the uterus by douching is well-nigh hopeless, 

 as the sticky content is virtually insoluble in water. The 

 dislodgment of the corpus luteum gives little promise be- 

 cause, in my one observation, the corpus luteum had atro- 

 phied in order to permit the animal to ovulate from the op- 



35 



