Puerperal Diseases of the Uterus 577 



The closed end of the bag may be pushed into the uterine 

 cavity with a sound, followed by packing the bag through 

 the open end, filling as well as space will permit that por- 

 tion of the bag lying within the cervical canal. Prior to 

 application, the gauze should be saturated with iodoform 

 oil or vaseline and should be renewed daily until the dila- 

 tion is sufficient. 



In discussing the various types of retention it has already 

 been pointed out that the placentitis typically begins at the 

 cervical end of the uterus and advances slowly toward the 

 ovarian extremity. The retention may be in the very early 

 stages and the entire mass of membranes may readily be re- 

 moved soon after calving if the few diseased cotyledons 

 about the cervical end be manually released. Perhaps my 

 meaning will be clearer by giving a definite instance. A 

 colleague in charge of a valuable herd made it a rule to ig- 

 nore retained fetal membranes until forty-eight hours post 

 partum, when he would make an effort to remove manually. 

 I was asked incidentally to examine a cow which had 

 calved about thirty hours previously. I found nearly all the 

 fetal membranes detached and hanging from the vulva. A 

 careful examination revealed the fact that the membranes 

 were adherent to a few cotyledons at the base of the gravid 

 horn. The dragging of the detached masses upon one small 

 area had caused an intussusception of the base of the gravid 

 horn and its prolapse through the cervix into the vagina. 

 It can not be denied that I was right in detaching the few 

 adherent cotyledons and replacing the prolapsed organ. 

 My colleague had evidently erred. The only means for avoid- 

 ing the error lay in a careful examination of the patient. 



The first step in the handling of retained fetal mem- 

 branes, as in other diseases, is an early and careful exam- 

 ination with an accurate diagnosis. The degree of uterine 

 paresis is to be noted carefully because it indicates more 

 than anything else the probable severity of the retention. 

 If the uterus is extremely large and flaccid, the retention 

 will probably be prolonged and severe. If the uterus is well 

 contracted, firm and not over-sensitive, the duration of the 



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