INVERSION OF THE WOMB. 113 



vomiting, fainting, cold, clammy sweat, and feeble or imperceptible 

 pulse. 



Complete inversion is recognised by the presence of a reddish, 

 livid tumour, filling the vagina, and protruding beyond it, resembling 

 in shape the uterus after delivery. The os uteri may be felt at the 

 superior extremity of the tumour, forming a kind of circular thicken- 

 ing at its apex, and the uterus is wholly wanting in the hypogastric 

 region. 



Causes. — It may occur spontaneously in atony of the uterus, or 

 from irregular contractions. Violence in extracting the placenta, 

 shortness of the cord, delivery in the upright position, tumours of 

 the uterus unconnected with parturition, have all been mentioned as 

 causes of this accident. 



Treatment. — By some it is recommended to compress the tumour 

 and pass it in through the vaginal orifice, followed by the hand, 

 which, when in the vagina, should be formed into a cone, and made 

 to press mainly upon the fundus uteri ; after a while it will be found 

 to recede, and on being farther pressed, it suddenly starts from tlie 

 hand, and the organ is returned to its natural condition. 



Others advise that no compression be made ; the womb should not 

 be handled, but watching it carefully, at the moment when free from 

 contraction, the fundus should he pressed with one finger and in- 

 dented like the bottom of a bottle ; when that much is effected, the 

 reposition is sure, provided continual pressure be made : the fundus 

 will be pushed up again through the os uteri and vagina, until the 

 hand is found high up in the cavity of the uterus. 



If the placenta be adherent, some recommend that it be reduced 

 with the fundus ; others, and the majority, that it be first removed, 

 and then that reduction take place, as this procedure will facilitate 

 the operation. 



THE END. 



