PROLAPSE OF THE UTERUS. 
433 
possible, continuous powerful pressure must be exercised over the loins; 
if the animal is standing, a sackful of sand may be laid on the back. 
Where the prolapsed portion is large the rectum and bladder should first 
be emptied. To provoke micturition it is often sufficient in cows, &c., to 
lift the protruding mass and pass one or two fingers into the urethra; 
should this fail the catheter must be passed. 
After carefully cleansing the prolapsed parts with 3 per cent, creolin, 
dilute iodine solution, or, if much swelling exists, 2 per cent, alum solu¬ 
tion, and removing any traces of foetal membranes, the operator must 
discover whether any deep injuries exist. It may be necessary to insert 
sutures. The size of the prolapsed mass often presents a serious obstacle 
to reduction. In such cases the late Professor Robertson used to effect 
methodical compression by passing a long, broad strip of linen around 
the uterus and causing assistants to pull steadily on the ends. A broad 
strip of Macintosh cloth may be used for the same purpose, being applied 
first at the point furthest from the vagina. If the patient be tympanitic 
puncture of the rumen or csecurn may be necessary. 
The first portions to be replaced are those lying nearest to the vulva, 
particularly the upper sections, the other prolapsed parts being mean¬ 
while supported ; an attempt is then made to thrust these through the 
vulva into the vagina, and to pass the entire mass as far forward as 
possible. To prevent ruptures and to assist replacement, the manipula¬ 
tions are made when the animal is not straining. 
The flat hand should be used; not the tips of the fingers or the fist. 
By stretching out the fingers within the uterus, the folds may be com¬ 
pletely got rid of—the same object is served by injecting lukewarm 
water; in cows, several bucketsful may be required. Instruments 
should be avoided. They may cause perforation when the animal strains. 
Becker uses Gunther’s parturition crutch. With the half-closed hand, 
he thrusts the lowest portions of the uterus as far as possible into the 
vagina and pelvis, then introduces the previously well-oiled rounded end 
of the crutch along the arm as far as the hand, and, whilst retaining the 
crutch with the other hand, withdraws the arm from the vagina. An 
assistant holds the crutch firmly, without thrusting it further forward, 
while the operator, by using both hands, passes any portion of the 
uterus still in view into the vagina, reintroduces the right arm, removes 
the cruth, and endeavours to bring the uterus into its proper position. 
The assistant then passes his left arm into the vagina or uterus alongside 
the operator’s right, closes his hand, and whilst the operator removes his 
arm, that of the assistant remains for an hour in position. The cow is 
watched for the next ten to twelve hours to prevent straining, in which 
case the hand should be pressed against the vulva. If possible, the 
animal should, after reposition, be kept standing. Operation is facilitated 
y.s. F F 
