DYSTOKIA BY DISPLACEMENT. 



313 



an opening made in the flank has had some advantages ; I have even 

 thought for a moment after my first success that it would be the only 

 means I should resort to for the future. But, unfortunately, new cases 

 upset my predictions, and compelled me to seek for more efficacious 

 means." And Faussel admits that the considerable weight of the uterus 

 may sometimes prove an insurmountable obstacle. 



The dangers attending the operation, even if reposition of the uterus is 

 effected, are as great as its difficulties. Several good authorities have • 

 therefore recommended its abandonment, or at least its being adopted 

 only in very exceptional circumstances. 



Operation. — Different operators have different modes of operating. 

 Some prefer the animal in a standing position ; others throw it down. 

 One selects the left flank ; another, and perhaps with more reason, in- 

 cises the right flank. Diccas, whose procedure appears to be preferred by 

 Saint-Cyr, operates as follows : The animal is led into a suitable place, 

 and secured as if to be operated upon for internal hernia. The skin and 

 muscles of the right flank are carefully divided for about five or six 

 inches, the opening being directed downward and slightly forward. The 

 cord fixing the hind quarters of the animal (which is standing) is slack- 

 ened a little, and the hand is introduced into the abdominal cavity and 

 pushed towards the left side, passing it above the uterus if the torsion is 

 from right to left ; but towards the right side and below the uterus if the 

 twist is in the opposite direction. The displaced organ is then seized, 

 and endeavors made to bring it into its normal position by lifting and 

 drawing it towards the incision. To prevent the hand slipping on the 

 surface of the uterus, it is wrapped round with a piece of thin cloth. Two 

 assistants are required, one of whom exercises a certain amount of pres- 

 sure on the abdominal w^alls ; while the other finds out, by vaginal palpa- 

 tion, the extent of replacement which the uterus undergoes. 



When reposition is complete, the hand is withdrawn from the abdomi- 

 nal cavity, and the lips of the wound are brought together by four or five 

 tape or wire sutures, aftd, if thought necessary, a pitch plaster may be 

 fixed over it. 



According to Obich, within eight days the wound will have healed by 

 first intention. 



2. Vaginal Hysterotomy. — We have noticed that Vieillard, so long 

 ago as 1823, removed the foetus from a twisted uterus by means of vagi- 

 nal section. In 1856 Ercolani proposed vaginal hysterotomy, ih^o^^xixw^ 

 being made through the upper wall of the vagina, for the reposition of 

 the twisted uterus. The operation is of the same kind, and is conducted 

 in a similar manner, as that for the castration of Cows, introduced by 

 Charlier ; except that, instead of the ov^aries being seized, the uterus is 

 grasped through the wound, and attempts made to untwist it. Rueff 

 speaks in favor of the proceeding ; but we cannot find that it has ever 

 been carried into practice, and serious doubts may be entertained as to 

 the likelihood of its being successful, from the weight and size of the 

 gravid uterus, and only one hand being employed to turn the displaced 

 mass, unless the displacement should be very trifling ; in which case a 

 simpler operation might succeed. * 



If attempted, not much risk may be apprehended from incising the 

 vagina, as it has generally been found to be attended with little danger, 

 and cicatrization soon takes place. 



