REPLACEMENT AND RETENTION OF UTERINE PROLAPSE 449 



orifice. Two pieces of soft but firm rubber tubing about five 

 inches long, and braided silk, are employed for this purpose. 

 Simple stitching of the vulva, packing the vagina with gauze 

 or similar substances, the application of rope trusses of 

 various designs, are so many more or less popular methods 

 of accomplishing the same purpose. 



When the prolapse recurs despite these efforts, amputa- 

 tion, as in prolapse of the rectum, is indicated. The operation 

 is performed in precisely the same manner as in prolapse of 

 the rectum, with the one exception that care must be exer- 

 cised not to engage the urinary channel. 



Replacement and Retention of Uterine 

 Prolapse. 



Prolapse of the uterus occurs chiefly in cows and mares. 

 It is a post-partum accident whose cause has never been sat- 

 isfactorily explained, but whose nature places it in the cate- 

 gory of tubular invaginations. At the beginning it is uncom- 

 plicated by any pathological condition of the organ itself, 

 but owing to the weight of the hanging mass the circulation 

 is soon impaired and on account of its exposure to cold, to 

 the filth of the litter and to the excrement that is certain to 

 be voided over its surface, serious complications are sure to 

 arise, unless immediately restored to its normal position. 



The success of treatment depends, therefore, upon prompt 

 reposition. The chances of recovery diminish with the dura- 

 tion of the prolapse, although they may also be influenced 

 by the nature of the exposure. 



TECHNIQUE.— The first step of the treatment is to 

 remove the afterbirth without resorting to any force to de- 

 tach it from points to which it adheres firmly. Shreds are left 

 attached by trimming them closely rather than to wound the 

 mucous membrane by tearing them loose. Particles of litter 

 and dirt are removed with the fingers and the excrement on 

 its upper surface may be moderately wiped off with a moist 

 sponge. Further, no cleansing at this stage should be at- 

 tempted, because washing with water, no matter how ap- 

 plied, provokes straining that will defeat the purposes of 

 operation, and besides causing the ejection of more feces 

 is more apt to wash infectious matter into the recesses of the 

 relaxed mucous membrane than to wash dirt out. In fact, 

 this cursory cleansing is indispensable to the success of the 

 operation. 



The next step is to reduce the size of the protruding mass 



