Puerperal Diseases of the Uterus 573 



more perilous types. The least error in the plan of handling 

 serves to push the case out of the simpler type into the more 

 serious classes. Everywhere the uterine mucosa is diseased 

 and its epithelium depressed or destroyed and extremely 

 sensitive to the faintest abuse. If the practitioner attempts 

 to detach manually the chorionic from the uterine placenta, 

 any imprudent stress w^hich tears the walls of the placental 

 crypts, or merely tears away the already damaged protective 

 epithelium, creates a favorable avenue for more damaging 

 bacterial invasion. The damage is not alone to the placental 

 areas. The non-placental endometrium is largely denuded 

 of its protective epithelium and is highly sensitive to the 

 least insult. If the practitioner inserts his hand none too 

 gently into the uterine cavity and laboriously detaches the 

 membranes from the cotyledons, his hand constantly abrades 

 the inter-cotyledonal mucosa and breaks down the feeble 

 barrier maintained against the invading swarm of bacteria. 

 The pain endured by the cow induces severe straining, which 

 in turn further damages the tissues and increases the infec- 

 tion. Any veterinarian having mediocre powers of observa- 

 tion can remember clearly how in his own personal experi- 

 ence he has left his patient evidently worse after having 

 made an apparently successful attempt, viewed from a me- 

 chanical standpoint, to remove retained membranes. Equally 

 disastrous attempts are made to disinfect the uterus and re- 

 tained membranes. The infected puerperal uterus can not 

 be disinfected and is utterly intolerant of freely soluble dis- 

 infectants. The necrotic chorion defies disinfection by any 

 available means, and lying behind it wholly out of reach is 

 the great mass of infection proceeding with its destruction, 

 regardless of any disinfectants placed upon the opposite 

 surface of the chorion. Such a multitude of errors have 

 been made and are still being made that it is difficult to lay 

 down a line of action which may be advantageously followed. 

 In principle the aim should be to pursue a course devoid of 

 danger of injury to the diseased parts, which will tend to 

 lessen the danger of infection passing from the milder type 

 into one of the more severe, or, in cases where the very se- 



