Infections of the Gravid Uterus 473 



The prognosis is fair under surgical interference, but 

 highly unfavorable when left to natural resources. 



The removal of the fetal cadaver by mechanical interven- 

 tion is unjustifiable and highly dangerous. Any attempt to 

 dilate the cervix mechanically and to extract the rigid, an- 

 gular cadaver is very difficult and full of peril. Pituitary 

 extract has not been tried, so far as I have seen recorded. 

 In large doses, should it cause uterine contractions of a se- 

 vere type, it v^'ould be highly dangerous. Dislodgment of 

 the corpus luteum has promptly and uniformly caused the 

 expulsion of the cadaver in from five to twelve days. The 

 action is very gradual and unaccompanied by any visible 

 danger. In most cases the ovary can be drawn back over 

 the vagina and the corpus luteum dislodged by compression 

 through the vaginal walls. When fetal death occurs late, the 

 ovary may be dragged too far forward for the vaginal meth- 

 od. Removal must then be attempted very cautiously per 

 rectum. It is to be remembered that in long-standing cases 

 the yellow body is deeply embedded and requires firm com- 

 pression for its dislodgment. Since the resistance of the 

 rectal walls is low, the operator must exercise great care in 

 order to avoid rupture. Using care, I have succeeded in each 

 case without injury to the rectum. 



If the dislodgment of the corpus luteum can not be accom- 

 plished safely by rectal manipulation, laparotomy should be 

 performed upon the involved side and the ovary directly 

 compressed. Care should be taken to dislodge all lutein tis- 

 sue, since any remnant may continue to inhibit estrum and 

 serve as a foundation for the formation of a new corpus lu- 

 teum, which may necessitate a second operation. 



After the cadaver has been expelled, the uterus should be 

 closely watched and any remedial measures applied which 

 may be indicated by the conditions present. The expulsion 

 of the desiccated fetal cadaver inevitably causes contusions 

 and abrasions of uterus, cervix, vagina, and vulva. The 

 most prudent action which can be suggested at present is 

 to introduce into the uterine cavity four to eight ounces of 

 white mineral oil or liquid paraffin, to which has been added 



