TORSION OF THE UTERUS. 557 



a pendulum, the bob being represented by the fcetus and its envelopes. 

 The suspensory apparatus can be divided into three parts, viz., the 

 two broad ligaments and the tissue connecting the uterus to the 

 vagina. 



The pull on the vagina increases greatly as soon as the gravid 

 uterus is twisted either to the right or left, for, torsion being attended 

 with more or less extensive displacement towards the lower abdominal 

 wall, the tension on the vagina must become more marked. 



Considering now how the sjiiral folds and the constrictions which 

 are of such importance in diagnosis are formed, we find that both 

 structures, viz., the wall of the uterus and the ligaments, are impli- 

 cated, though to dilierent degrees. Whilst the spiral folds are more 

 particularly formed by the wall of the uterus, the broad ligaments are 

 chiefly responsible for the constrictions, though to some extent the 

 spiral folds also contribute to their production. The spiral folds of 

 the body of the uterus are formed solely by twisting of its own walls. 

 This can easily be shown by taking any tubular organ whose walls 

 are not too rigid, and twisting it round its horizontal axis. 



The broad ligaments contribute less to the formation of the spiral 

 folds, though they play a more important part in producing con- 

 strictions and thus in compressing the wall of the uterus. 



The symptoms are ill-defined. Sometimes there is difficulty in 

 micturition, but as a rule little evidence exists of any abnormal con- 

 dition until the advent of labour pains. The first pains, which are 

 usually feeble and separated by rather long intervals, are succeeded 

 by colic. The succeeding efforts steadily become more violent and 

 frequent, but the "water-bag" fails to appear, and in a period varying 

 between twelve and forty-eight hours the pains subside. Kumination 

 is at first suspended, the pulse and respiration are accelerated, and 

 the surface temperature is irregular. 



If treatment is not undertaken similar symptoms, but of exaggerated 

 intensity, may again appear in from one to six days. Failing relief 

 death always follows after a varying interval. 



The diagnosis is not difficult, provided the maternal passages be 

 examined. On passing a carefully lubricated hand into the vagina the 

 operator discovers, at a varying distance, from the os uteri, signs of 

 collapse and twisting of the canal. In cases of quarter twist it is 

 often possible, by rotating the hand so as to follow the spiral folding 

 of the vagina, to introduce the fingers as far as the os uteri ; but in 

 half or complete rotation only one or two fingers can be passed so 

 far, or it may be altogether impossible to reach the os. 



In the Berliner Archiv for 1902 Lempen gave a summary of the 

 extensive literature dealing with this disease and of the varying views 



