576 Diseases of the Genital Organs 



it is prudent to remove cotyledons can be determined only 

 by the person in immediate charge. I attended a cow for 

 dystocia (the dystocia of uterine inertia) and extracted an 

 apparently healthy calf. Forty-eight hours later the fetal 

 membranes were completely retained and all her cotyledons 

 were enormously swollen and necrotic. Her temperature 

 was high and her condition critical. All the cotyledons were 

 readily detachable without pain or hemorrhage. They were 

 removed with the membranes still attached. The uterus 

 was then douched. Within twelve hours her temperature 

 had become normal, her recovery was prompt, and her fer- 

 tility preserved. This was an extreme case cited to show 

 the value of the removal of necrotic cotyledons, when prop- 

 erly done at the right time. In any other cow I have at- 

 tended, the removal of cotyledons so early after calving 

 would have been wholly unjustifiable and would have done 

 incalculable harm. Each case of retained fetal membranes 

 constitutes an individual problem, the details of which must 

 be worked out separately. Two principles regarding man- 

 ual removal appear to me to be applicable generally. First, 

 whenever the membranes (including necrotic cotyledons) 

 can be removed completely without injury to the uterus, 

 this should be done. Second, if the membranes can not be 

 removed promptly, measures should be taken to delay the 

 contraction of the cervix and imprisonment of the putrefy- 

 ing tissues. This precaution preferably consists of permit- 

 ting or causing portions of the membranes to occupy the 

 cervical canal. When this can not be done there may be 

 substituted a tampon of gauze, which may be made in the 

 form of a gauze bag, two or three feet long, the closed end 

 pushed into the uterine cavity and then a sufficient amount 

 of gauze pushed into the closed end from the exterior to 

 produce an enlargement which will not drop out through 

 the cervix. The presence of the collapsed portion of the bag 

 lying in the cervical canal will retard cervical contraction 

 and afford better opportunity for the manual examination 

 of the uterus. A similar plan may be used to dilate an al- 

 ready contracted cervix with imprisoned fetal membranes. 



