Puerperal Diseases of the Uterus 569 



little care the membranes may be detached. Anterior to 

 these the parts are essentially healthy and are readily re- 

 moved. In these cases the placentitis is in its initial stage 

 and the incarceration of the chorionic tufts within the pla- 

 cental crypts not fully established. The separation of the 

 fetal membranes from the diseased uterus occurs in a va- 

 riety of ways. Each type may be recognized in the same 

 case, though one tends to prevail. 



(1) In the simplest type of retention, lymph or pus ac- 

 cumulates within the placental crypts of the uterus and 

 pushes out or detaches the chorionic tufts. In a large meas- 

 ure the tufts may undergo purulent destruction and the 

 chorionic base drop away with but few of its placental tufts 

 intact. This constitutes the most benign type of retention 

 and ordinarily runs the briefest course. The recovery is 

 generally prompt, lactation is not seriously disturbed, and 

 fertility is usually conserved. 



(2) The chorionic tufts and the placental crypts of the 

 uterus become necrotic, the tufts break off from the chori- 

 onic membranes, and later the placental portions of the 

 cotyledons, with the chorionic tufts, slough away from the 

 pedicle of the cotyledons and lie free in the uterine cavity. 

 If the case is not meddled with in an imprudent attempt to 

 remove the membranes manually, the chorionic membrane 

 usually retains its connection with the tufts and the pla- 

 cental area of the cotyledon becomes detached from the 

 uterus and remains attached to the chorion. If the animal 

 survives (the mortality is high) and again conceives (which 

 is improbable), new placental tissues form upon the cotyle- 

 donal stalks. 



(3) In another well-marked type, which is not very rare, 

 many or all the cotyledons undergo total necrosis, slough 

 through the cotyledonal stalk, and remain irremovably at- 

 tached to the chorion. While this process is being accom- 

 plished, the cervix may contract; when the sloughing is com- 

 plete, the fetal membranes with the clinging necrotic cotyle- 

 dons lie imprisoned within the diseased uterus. When all 

 cotyledons are thus involved, the patient usually succumbs. 



