DISEASES FOLLOWING PARTURITION. 243 



from side to side, the womb is stimulated to expulsive contractions and 

 the afterbirth is wound up more and more on the sticks until, finally, 

 its last connections with the womb are severed and the remainder is 

 expelled suddenly en masse. It is quite evident that neglected cases 

 with putrid membranes are poor subjects for this, method, as the after- 

 birth is liable to tear across, leaving a mass in the womb. During the 

 progress of the work any indication of tearing is the signal to stop and 

 proceed with greater caution, or altogether abandon the attempt in this 

 way. 



The third method (that with the skilled hand) is the most promptly 

 and certainly successful. For this the operator had best strip and 

 ;i> for a parturition case. Again, the operation should be under- 

 taken within twenty-four hours after calving, since, later, the mouth of 

 the womb may be so closed that it becomes difficult to introduce the hand. 

 The operator should smear his arms with carbolized lard or vaseline to 

 protect them against infection, and particularly in delayed cases with 

 putrid membranes. An assistant holds the tail to one side while the 

 operator seizes the hanging afterbirth with the left hand, while he 

 introduces the right along the right side of the vagina and womb, let- 

 ting the membranes slide through his palm until he reaches the first 

 cotyledon to which they remain adherent. In case no such connection 

 is within reach, gentle traction is made on the membranes with the left 

 hand until the deeper parts of the womb are brought within reach, and 

 the attachments to the cotyledons can be reached. Then the soft pro- 

 jrrtion of the membrane, which is attached to the firm fungus-shaped 

 cotyledon on the inner surface of the womb, is seized by the little 

 finder, and the other fingers and thumb are closed on it so as to tear it 

 out from its connections. To explain this it is only necessary to say 

 that the projection from the membrane is covered by soft conical proc- 

 esses, which are received into cavities of a corresponding size on the 

 summit of the firm mushroom -shaped cotyledon growing from the inner 

 surface of the womb. To draw upon the former, therefore, is to extract 

 its soft vilhms processes from within the follicles or cavities of the other. 

 (Plate XIII, Fig. 2.) If it is at times difficult to start this extraction it 

 may be necessary to gt the finger nail inserted between the two, and 

 once started the finger may bo pushed on, lifting all the villi in turn 

 out of their cavities. This process of separating the cotyledons must bo 

 carefully conducted, one after another, until the last has been detached 

 and the afterbirth comes freely out of the passages. I have never found 

 any evil result from the removal of the whole mass at one operation, 

 but Shaack mentions the eversion of the womb as the possible result 

 of the necessary traction, and in cases in which those in the most dis- 

 tant part of the horn of the womb can not be easily reached. h advises 

 to attach a cord to the membranes inside the vulva, letting it hangout 

 behind, and to cut off the membranes below the cord. Then, after two 

 or three days' delay, he extracts the remainder, now softened and easily 



