482 Diseases of the Genital Organs 



become suspended to constitute part of the pus. The bones 

 separate at their epiphyses but fail to dissolve. I have ob- 

 served cases where fetal death had occurred two years prior 

 to the examination. The condition of the fetal bones ap- 

 peared static. The bones become closely packed together in 

 a somewhat irregular oblong mass in the base of one horn. 

 The interstices between the bones are largely filled with 

 thick, desiccated, intensely fetid pus. 



The diagnosis of this type of fetal maceration is compara- 

 tively simple when the general outlines of the condition are 

 known, but is often quite difficult for the beginner. There 

 is a history of apparent pregnancy following breeding. 

 Later the progress of pregnancy apparently halts and a 

 highly fetid purulent genital discharge ensues. Estrum is 

 absent. The genital discharge may be sanious, owing to 

 pieces of the jagged fetal bones lacerating the endometrium 

 and causing hemorrhage. Palpation of the uterus per rec- 

 tum reveals a hard, irregular enlargement in one horn (ex- 

 cept in maceration of bicornual twins) . A careful study of 

 the enlargement shows that the parts of the tumor move 

 upon each other with definite crepitus. The cervical canal 

 is generally narrow, and the cervix hard. If a catheter is 

 introduced and the uterus douched, the pus may be largely 

 washed out and the size of the mass rendered slightly more 

 "distinct. The bones then move more freely when palpated, 

 rendering the diagnosis clearer. In one instance, in a tu- 

 berculin reactor, the fetal mass was mistaken for uterine 

 tuberculosis. Uterine tuberculosis, however, is usually sym- 

 metrical. The actual differentiation lies in the recognition 

 of the fetal bones. In another case the admixture of blood 

 with the pus caused a diagnosis of uterine tumor. This 

 error should have been avoided by more careful palpation. 

 In the earlier stages fetal maceration and fetal desiccation 

 may be confused. In desiccation the hematoma dims or 

 completely hides the outlines of the fetal cadaver ; in early 

 maceration the fetal outline remains. In maceration the 

 cervical canal is generally or always unsealed; in desicca- 

 tion the uterine seal is ordinarily perfect. The progress of 



