DYSTOKIA BY DISPLACEMENT. 303 



Liautard, Pouchy (already quoted), and others, that this happy termina- 

 tion is quite possible ; and indisputable cases are recorded of Cows with 

 unreduced uterine torsions, which have perfectly recovered and fattened, 

 and in the uterus of which, after slaughter, the dessicated or mummified 

 foetus has been found. 



But yet these must be looked upon as exceptional cases ; and while 

 they only prove that spontaneous recovery is possible, it must be admitted 

 that, in the great majority of instances, death is not long in appearing in 

 torsion of the uterus, if the organ is not restored to its normal position. 



Diagnosis. 



The diagnosis of this accident, and the direction and extent of the 

 torsion, are of great importance in an obstetrical point of view. We 

 will therefore consider (i) The presence of torsion ; (2) The direction of the 

 torsion; and (3) The degree of torsion. 



» I. The Presence of Torsion. — To recognize the existence of torsion of 

 the uterus is not attended with much difficulty ; and in describing the 

 symptoms we have, to a certain extent, shown the manner in which the 

 accident manifests itself to the obstetrist. 



It has been stated, that when the hand is introduced into the vagina 

 of an animal the subject of this displacement, it is soon discovered that 

 there is something in the way, and that this appears to be a narrowing of 

 the passage. Passing on, the constriction seems to be increasing, until 

 at the end of the canal there is only a very small opening into which the 

 fingers may pass w^ith difficulty ; when inserted there, it is found that 

 they cannot be pushed straight forward, but have a tendency to deviate to 

 the right or left, and finally to assume a spiral course. 



We have also stated that this peculiarity in the constriction is markedly 

 characteristic and distinctive of uterine torsion, and this statement holds 

 good in the large majority of cases ; so that it is scarcely possible to 

 make a mistake. 



In very exceptional instances, however, the torsion may have occurred 

 in front of the cervix — in the body of the uterus ; and then the cervix 

 may be easily reached, while the os may even be penetrated, without dis- 

 covering any indications of the accident. Such occurrences have been 

 recorded by Stockfieth, Ercolani, and Rueff ; and these excellent authori- 

 ties have also witnessed the torsion limited to the cornu containing the 

 foetus. Here we have neither the constriction of the vagina, nor the 

 spiral involutions of its lining membrane, to guide us to a conclusion, and 

 we must mainly rely on rectal exploration. 



Fortunately, such cases are all but unknown in practice, and probably 

 in ninet3'-nine per cent, it will be found that the twisting has taken place 

 at the cervix, when we have the infallible distinctive sign — the spiral 

 rugae in the vagina. 



2. The Direction of the Torsion. — It has been demonstrated that the 

 uterus may revolve on itself in two different directions, and that in order 

 to make a complete revolution, its upper face may become right lateral, then 

 inferior^ then left lateral, and again superior ; or if it revolves in the oppo- 

 site direction, it will become successively left lateral, inferior, right Literal^ 

 and once more superior. 



We have casually indicated how the direction of the twist may be dis- 

 covered when it has not made a complete revolution. But as Sainl-Cyr 



