578 Diseases of the Geiiital Organs 



retention will probably be brief and the course favorable. 

 If the membranes can be easily detached without causing 

 pain or irritation to the patient, their removal is good sur- 

 gery because it is only after the removal of the fetal mem- 

 branes that one can handle with any directness the funda- 

 mental metritis which caused the retention. The basic ques- 

 tion is not the desirability of removing from the uterus the 

 necrotic membranes, but the possibility of removing them at 

 a given date without causing greater injury and danger 

 than the retention is already producing. If not prudent to 

 attempt the removal at the first examination, repeat the ob- 

 servations at comparatively frequent intervals, at least 

 every second or third day, and watch the progress of the 

 disease. 



Various plans have been recommended as substitutes for 

 the manual removal of the membranes, but they have failed. 

 Numerous drugs have been lauded, such as savin, rue, and 

 various aromatic substances, but there is no dependable evi- 

 dence of their value. A few years ago it was proposed to 

 detach the membranes by injecting into the cavity of the 

 chorion, where the fetus formerly lay, a weak solution of 

 hydrogen peroxide, but it could act only upon the inner or 

 fetal surface of the chorion and could not possibly affect the 

 part really at fault, as it could not get near it. Next some- 

 one proposed to detach the membranes by injecting salt 

 solution into the broken ends of the umbilic arteries and 

 thence into the capillaries of the incarcerated chorionic 

 tufts, but the promoters of the plan ignored the fact that 

 the placental capillaries were blocked by thrombi which 

 would not permit water to enter, and equally disregarded 

 the fact that the physiologic detachment of the placentae is 

 due, not to distension of the capillaries, but on the contrary 

 to their becoming empty. If the salt solution could be 

 forced into the placental capillaries, it would increase their 

 incarceration. 



Much has been said for and against douching the uterus 

 when the fetal membranes are retained. As a plain matter 

 of fact, so long as the fetal membranes remain attached to 



