574 Diseases of the Genital Organs 



vere type is present, to ameliorate it and if possible convert 

 it into a simpler type. 



There is no denying that the presence of the great necrotic 

 and putrefying mass of membranes is a menace to the health 

 and life of the patient and that the earlier it is out of the 

 uterus the better, provided that in the process of removal 

 no injury is inflicted upon the uterus. It should be borne 

 in mind that as a rule an afterbirth which can be removed 

 manually without injury to the uterus will spontaneously 

 drop away a few hours later. Hence in most instances the 

 manual removal of the fetal membranes is not of supreme 

 importance because it can prudently occur but a short time 

 prior to spontaneous falling away. The gentlest manual re- 

 moval possible is not superior to the spontaneous dropping 

 away. There are, however, important limitations to these 

 general statements which should call into action a high de- 

 gree of professional skill and judgment. If at a given date 

 the practitioner finds that the membranes can be prudently 

 removed, it is best to proceed at once with the operation in 

 order to be in position as early as practicable to deal di- 

 rectly and successfully with the underlying metritis. 



Before proceeding with manual removal the operator 

 should thoroughly cleanse and disinfect the tail, vulva and 

 adjacent parts in order to avoid the danger of pushing into 

 the genital tract dangerous infections from the exterior. 

 The operator should very carefully disinfect his hands and 

 arms as a protection to himself and he should keep at hand 

 ample disinfectant solutions for frequent use. But the dis- 

 infectants must be kept out of the genital tract. After dis- 

 infecting the hands and arms, they should be thoroughly and 

 frequently anointed with vaseline, liquid paraffin, or other 

 fat, and liquid paraffin should be introduced in ample 

 amount into the genital tract. By such means the mechani- 

 cal irritation from the operation is reduced to a minimum. 

 The arrangement of the cotyledons, as shown in Plate I, 

 should be kept in mind, and the dorsal rows of cotyledons 

 separated first. Commencing at the cervical end of the uter- 

 us, the hand should be gently pressed into the utero-chorionic 



