JiETKXTIOX OF TIIK FU-ITAL EM'KLoI'KS. 571 



maternal placenttc has advanced sufficiently to permit the hand to com- 

 plete the disunion without need for violence. It sometimes happens, 

 however, that extraction can be elTected so late as the fifth or eighth 

 day after delivery ; but then the membranes are extremely friable, and 

 will scarcely withstand any degree of traction. Besides, the operator 

 himself incurs great risk of infection, either local or general, from the 

 absorption of the putrid matters in the uterus by the skin of the hand 

 and arm. 



An assistant holds the tail of the animal to one side, and the hand 

 and arm, well oiled, are passed into the vagina; if a portion of the 

 membranes is in tiiis canal, then the operation is not so dilVicult, as the 

 OS will probably be more or less relaxed, and this portion lying towards 

 the palm of the hand — the back of which is upwards — serves as a 

 guide ; while the left hand pulls at it gently, as occasion requires. 

 When, however, nothing of the envelopes is to be found outside the 

 OS, and that opening is firmly closed — as happens four or six days after 

 birth — then it may be very difficult to reach the interior of the uterus. 

 One finger must be at first introduced, then two, three, and so on, 

 until the hand in the form of a cone, and by a semi-rotatory motion, 

 can be passed through. This operation is often long, troublesome, and 

 fatiguing, and requires to be carefully managed, so as not to bruise, 

 irritate, or wound the organ. 



When the hand reaches the interior of the uterus, it is pressed 

 forward between the mucous membrane of the latter and the chorion — 

 the palm towards the latter — separating them as it advances until it 

 meets with the cotyledons. Some of these— the maternal— may be 

 detached from the membranes, while others are still imbedded in them, 

 as it were, through their foetal cotyledons. These last have to be 

 enucleated ; and to effect this, the cotyledon is gently pressed at its 

 base between the thumb and index finger, and, if necessary, the fingers 

 are moved over each other as if removing a button from its buttonhole. 

 Other practitioners make pressure on the summit of the cotyledon by 

 the three first fingers, and thus destroy the adhesion. In this manner 

 the hand passes from one cotyledon to another, efTecting disunion as 

 rapidly, yet carefully, as possible. At times a cotyledon will be met 

 with which adheres so very firmly that it cannot be detached in the 

 way just mentioned. Then the nail of the thumb or other finger must 

 be gently insinuated at the border, so as to gradually raise it, and pass 

 the finger over its entire surface. 



The tediousness of the operation will be inferred when it is known 

 that the number of adherent cotyledons may sometimes amount to 

 more than a hundred ; and the fatigue is often so great that the right 

 and left hand have to be employed alternately — a circumstance which 

 has advantages otherwise. 



When a certain number of cotyledons are detached, the portion of 

 envelopes so released is carried into the vagina and beyond the vulva, 

 where the other hand, or an assistant, seizes and pulls gently on it. 

 As the bulk of this increases by the detachment of more cotyledons, 

 the pulling must cease, and the mass will require to be supported so 

 as to prevent tearing the membranes, or painful dragging on the fundus 

 of the uterus. 



As the hand reaches the cornua the cotyledons increase, and it 

 becomes difficult to reach them — particularly the cornu in which the 

 hind-limbs of the Calf were lodged, because of the insufficient length 



