068 THE REPRODUCTIVE ORGANS OF THE FEMALE. 



the vagina. It usually occurs when the uterine walls are relaxed, and may be due to 

 traction on the placenta during parturition. It may take place spontaneously after 

 parturition. It may be produced by intra-uterine tumors. The mucous membrane of 

 the inverted organ is frequently inflamed, particularly when the inversion is complete. 

 The epithelium may become squamous and la.mellated in type. 



HERNI/E of the uterus are rare. Ventral hernia may occur during the latter months 

 of pregnancy, the peritoneum, aponeuroses, and skin being forced outward to form a 

 sac in which the uterus lies. Crural hernia are produced by the drawing down of the 

 uterus and ovaries into the sac of an intestinal hernia. Inguinal hernia may be pro- 

 duced in the same way or be congenital. Ischiatic hernia has been seen. Pregnancy 

 may occur in the uterus while it is within a crural or inguinal hernia. 



RUPTURE AND PERFORATION. 



Rupture of the unimpreguated uterus is rare. It may, however, 

 occur when the uterine cavity is distended with blood or serum, or in 

 connection with large myomata of the uterine walls. 



In the gravid uterus ruptures have been seen in nearly every month 

 of pregnancy, but most frequently toward the end. The rupture may be 

 due to a thinning of the uterine wall by tumors, or by violent contusions, 

 or as the result of cicatricial contraction of the os. 



It most frequently takes place in parturition. Malpositions of the 

 fo3tus, narrowing of the pelvis, protracted labor, thinning of the uterine 

 wall from tumors, forcible use of the forceps and other instruments, are 

 the ordinary causes. The rupture may be in the body of the uterus or 

 the cervix, or both ; it may be large or small ; it may extend completely 

 or only partly "thro ugh the uterine wall. The consequences of partial 

 rupture are haemorrhage, gangrenous inflammation of the edges of the 

 rupture, peritonitis, and usually death. In rare cases the rupture cica- 

 trizes and the patient recovers. Complete rupture usually leads to death 

 in a short time. The foetus may escape partly or completely into the 

 abdominal cavity. If the patient survive the immediate shock, fatal 

 peritonitis usually soon ensues. In rare cases the foetus is shut in by 

 adhesions and the patient survives. 



Perforations of the uterus may be produced by carcinoma, by ab- 

 scesses in its neighborhood, and by ovarian cysts. 



HYPER^MIA-UTERINE AND PERI-UTERINE HEMORRHAGE. 



Hypersemia. Aside from the active menstrual hyperaemia, the uterus 

 may be hyperaemic in acute and chronic inflammation, as a result of dis- 

 placement of the organ, and in certain forms of heart disease. The organ 

 is usually enlarged, the mucous membrane swollen, and the veins are more 

 or less evidently dilated. (Edema may be associated with hyperaemia. 



Haemorrhage. Effusion of blood into the cavity of the uterus occurs 

 normally at the menstrual periods. For the abnormalities to which this 

 function is subject we refer to works on gynaecology. Effusions of blood 

 at other than the menstrual periods may be associated with mechanical 



