Puerperal Diseases of the Uterus 579 



the cotyledons, the uterus can not be douched by any known 

 method. Fluid may be introduced into the sac of the adher- 

 ent chorion where the fetus formerly lay, and in some cases 

 may be taken out again. The fluid does not reach the uterus 

 except at points where the membranes have become de- 

 tached. The uterus is frequently too paretic to expel the 

 fluid poured into the sac of the chorion. If the veterinarian 

 attempts to siphon out the fluid, fragments of the amnion, 

 chorion or umbilic cord block the siphon. Some claim to 

 guard the intake to the siphon with the hand, but in a very 

 flaccid uterus the end of the organ is out of reach and the 

 hand can not effectively guard. For example, in the ex- 

 treme case of retained membranes following unicornual 

 twins, if the uterus is severely inflamed it may retain its 

 length of more than eight feet. It is useless to discuss the 

 siphoning of fluid out of such a uterus. In many cases fol- 

 lowing ordinary pregnancy, siphoning fluid out of the chori- 

 onic sac is impracticable. Even if accomplished, the opera- 

 tion has very scant, if any value to commend it. 



If the uterus is in such condition that the vagina may be 

 douched without the fluid falling largely into the paralyzed 

 uterus or into the sac of the chorion it contains, that may be 

 of value. Perhaps it is also of value, when a portion of the 

 uterus has been freed from its membranes, to douche that 

 portion, if conditions render it practicable. But introduc- 

 ing quarts or gallons of liquid into the sac of the retained 

 chorion and leaving it there is malpractice. The weight of 

 the fluid in the paretic organ does great harm. In some 

 cases the uterus may be so atonic and weak that the me- 

 chanical weight of the liquid may cause rupture. The dan- 

 ger of uterine rupture is greatly heightened when the opera- 

 tor is so imprudent as to use a pump for introducing the 

 fluid, or when, introducing by gravity, he uses too great a 

 column of water. The danger is aggravated when the uterus 

 is very paretic and the cervix contracted. I have ruptured 

 the uterus very unexpectedly when using the pump, al- 

 though the rubber tube of the pump passed the cervical 

 canal freely with abundant room about it. Just what oc- 



