RETENTION OF THE AFTEBBIETH 331 



placenta from the cotyledons with the thumb. In this manner 

 one goes from one cotyledon to the other, pushing the separated 

 parts through the cervix and vagina into the left hand, so that 

 they may be fixed without. Finally the foetal placentse are 

 stripped off the most distant cotyledons and the part of the 

 chorion in the empty horn is also pulled oat. Now the secun- 

 dines are removed and the uterus syringed with an antiseptic 

 solution ; for instance, a one per cent, lysol or creolin solution. 

 It is not always possible to remove the afterbirth in this way. 

 When a new growth of connective tissue has followed a pre- 

 ceding placentitis, the separation of the foetal placentae is 

 impossible on some places, and there is danger that bits of the 

 foetal membranes remain in situ. The latter is a dangerous 

 thing, as it may lead to serious consequences. For this pur- 

 pose a different line of treatment is indicated. 



It consists in twice daily irrigating the uterus with a 

 warm antiseptic solution ; for instance, a 2 per cent, acidum 

 boricum, 1 or 2 per cent, alum solution, or 1 per cent lysol 

 solution. This prevents decomposition of the secundines and 

 assists in an aseptic maceration of the foetal placentae. Both 

 methods — that is, irrigation of the uterus and manual sep- 

 aration — may be combined. While unbottoming the foetal 

 placentae their separation is more readily effected by introduc- 

 ing warm antiseptic solutions. 



This operation is most successful when performed on the 

 third or fourth day. In some cases it is possible to remove 

 the afterbirth on the day following parturition ; in some cases 

 all cotyledons are not accessible within the first two days after 

 birth. On the third or fourth day the uterus has contracted 

 sufficiently so that all parts can be reached. Therefore one 

 waits for this period, unless its immediate removal is indicated 

 on account of inversio uteri, injuries to the uterus, vagina or 

 vulva, imflammation of the parturient passage and violent 

 straining. 



In case a portion of the secundinse is caught in the empty 

 cornu, it is readily removed with the hand. On examination 

 one feels the slit-like opening laterally in the wall of the once 



