MANAGEMENT OF LYING-IN WOMEN. 591 



at all points, pushing it up along the axis of the straits until it has 

 regained its natural situation.* 



1251. The Descent of the womb, which is pretty often met with 

 in the early periods of a confinement, in women who have a very 

 large pelvis, relaxed tissues, a lacerated perineum, or in those who 

 make improper exertions, scarcely requires any thing after the reduc- 

 tion except rest and a horizontal posture; it is allowable only to add 

 some astringent or styptic lotions, the use of small rags moistened 

 with red wine, for example, in cases where there is no. irritation. 

 Pessaries cannot be made use of until a much later period. 



1252. The Anteflexion and Retroflexion, that is to say, the state 

 in which the womb bends like an elbow at right angles, so that its 

 fundus comes to rest upon the sacro- vertebral angle or behind the 

 pubis, a disease very well described by M. Ameline in his disserta- 

 tion, and an instance of which in the dead body was shown to me 

 by M. Comte, would be recognised by the same symptoms as the 

 anteversion and retroversion, and would require nearly the same 

 kind of treatment. * 



1253. Lacerations of the perineum generally get well of them- 

 selves, with the assistance of the hip bath, by avoiding all motion, 

 and by obliging the woman to keep on her side, so that the pus aiid 

 lochia may not stagnate in the wound. They generally cicatrise 

 more or less completely from the anus towards the commissure of 

 the pudendum. The perineum may be perforated through and 

 through, and the cure not be rendered any more difficult, provided 

 that the anal and vulvar edges remain unhurt. I saw a case of this 

 perforation produced by the passage of a large child, which was en- 

 tirely cured by the eighteenth day, and did not hinder the woman at 

 all in her subsequent labors'. In some cases, however, it is neces- 

 sary to cut the bridles, apply the caustic, and take up certain points 

 with the needle, &c., but then the disease returns under the ordinary 

 surgery, and cannot be regarded as one of the simple consequences 

 of child birth. I shall say the same of lacerations of the vagina, 



which may as well take place in an inverted womb as in one not inverted — the 

 womb ought not to be handled; by watching it carefully, at the moment when 

 most free from contraction, the fundus may be pressed with the point of a finger, 

 and indented like the bottom of a bottle; when that much is effected, the com- 

 plete reposition is sure, if only a continual pressure be made: the fundus will be 

 pushed up again through the os uteri and vagina, until the hand is found to be 

 high up in the belly, and contained within the cavity of the reposited organ; 

 — M. 



* For a very good treatise on inversion of the uterus in general, see a thesis 

 maintained, Dec. 1, 1828, at the Faculte de Paris, by M. Ferrance-Demissois. 



