INVERSION OF THE UTERUS. 583 



the larger is the tumor. This increase is due to the violent expulsive 

 efforts of the animal, as well as to the increase in weight of the organ in 

 consequence of the congestion and infiltration which has taken place in 

 its textures : constricted — even strangulated — at its upper part, the cir- 

 culation is maintained with great difficulty, and the capillaries become 

 gorged with blood. The walls of the organ lose their elasticity, become 

 thickened and dense, and darker tinted, until, from its increased volume 

 and altered aspect, it can scarcely be recognized ; while its reposition is 

 rendered extremely difficult, if not impossible. 



In consequence of the excessive hyperaemia, ulceration and gangrene 

 usually supervene ; these are serious lesions, and may induce afatal termi- 

 nation. * 



Such a grave accident as this, in which we have such extensive dis- 

 placement, with severe straining at the suspensory ligaments of the uterus, 

 and sometimes their rupture ; the irritation and perhaps abrasions or 

 wounds of the mucous membrane ; the tension on the vagina, and the 

 compression of various parts or organs — all this might be expected to 

 produce general disturbance. And this is the case. From the very 

 commencement, and even before any thing is apparent at the vulva, the 

 animal is uneasy and anxious-looking; it paws with the fore, or stamps 

 with the hind-feet ; switches the tail as if driving off insects ; lies down 

 and gets up frequently, finding no ease in either attitude ; and strains 

 more or less energetically at closer or wider intervals, thus adding to the 

 extruded mass. Not unfrequently the Mare kicks at the prolapsed uterus, 

 or endeavors to attack it with its teeth. 



At first there is no perceptible fever, and the animal, in the intervals 

 of straining, attentive to what is going on around it, is solicitous about its 

 progenx^, and may even eat. This state is not of long duration, however ; 

 for soon after inversion is complete, indications of fever manifest them- 

 selves : quickened pulse and respiration, elevated temperature, and an 

 expression of anxiety and pain. The straining is more frequent and 

 energetic, and soon exhausts the animal ; and the prostration, together 

 with the great weight of the pendant uterus, compels it to assume and 

 maintain the recumbent posture, in spite of attempts to make it get up. 

 The organ assumes a gangrenous or intensely inflamed appearance," and 

 the animal soon succumbs, either from the nervous prostration resulting 

 from its sufferings, or from the condition of the uterus. 



In woman, sudden inversion of the uterus always leads immediately, 

 according to Schroeder, to great general disturbance — the heart's action 

 is deranged, and syncope, convulsions, vomiting, etc., may sometimes be 

 caused by the sudden change in the position of the uterus. More fre- 

 quently those symptoms depend upon acute cerebral anaemia, to which 

 the sudden emptying of the uterus of its contents already predisposes, 

 but which must be still greater when not only the contents of the uterus, 

 but the whole organ itself, passes out of the abdominal cavity. .The 

 blood then rushes into the vessels of this cavity, which are suddenly 

 under a greatly diminished pressure, and the cerebral anaemia that en- 

 sues is due to the scanty supply which the upper half of the trunk now 

 receives. 



A similar condition is sometimes — though rarely — observed in animals, 

 and particularly in the Mare. A good instance is that furnished by 

 Peuch at page 579 (case 5). 



