INVERSION OF THE UTERUS. 



587 



ceeded by inversion ; while, on the contrary, the easiest and most rapid 

 birth sometimes is. 



The retention of the foetal placenta beyond the ordinary period, must 

 also be taken into account as one of the exciting causes ; as it then acts 

 as a foreign body, irritates the interior of the uterus, and so by a reflex 

 action induces contraction of its muscular layer — thus giving rise to in- 

 vagination of the extremity of one of the cornua, which is supposed to 

 be the commencement of inversion. 



It is also extremely probable that injudicious traction on the foetal 

 membranes may, for mechanical and physiological reasons, bring about 

 this result in a flaccid and dilated uterus, when the cervix is also relaxed. 

 More especially is this likely to happen if the placenta is adherent to- 

 wards the fundus of the organ, or in one of the cornua. 



Much mystery appears to have attached to this inversion of the uterus, 

 and though various causes have been assigned as operating in its produc- 

 tion, yet as these were not present in every case, it has been admitted 

 that a particular predisposition must have existed. 



We are much inclined to believe that several causes may be invoked to 

 account for the accident. A flaccid, non-contracted uterus after birth, 

 with a weak cervix and dilated os, and relaxed broad ligaments, we would 

 certainly look upon as a predisposing condition ; and this is most likely 

 to be present in lymphatic animals, or those suffering from atony, brought 

 about by debility through disease, or bad or insufficient food, exposure to 

 weather, etc. When this condition is present, it is easy to understand 

 why inversion may occur from abdominal pressure at the cornua or fun- 

 dus of the organ, or external mechanical force ; and we can also compre- 

 hend why an antiperistaltic movement of one of the cornua, or a portion 

 of it — ^just as happens in intussusception of the intestines — may take 

 place sometimes, and lead to this condition immediately after birth, and 

 before the cervix has had time to contract. Any trifling irritation may 

 lead to this wrong movement, and once commenced it is far more likely 

 to continue than to cease — as in the case of the intestines, when one por- 

 tion becomes invaginated within another. 



We believe this will be found to be the correct opinion. 



♦ Treatment. 



Whatever may be the cause of inversion of the uterus, the obstetrist 

 must lose no time in remedying the accident ; as when interference is not 

 prompt, a fatal termination, or, at the very least, most serious conse- 

 quences rapidly ensue. 



In treating the inversion, several important indications are to be ob- 

 served, but they may be classed as : (i) the imfjiediate ox preliminary mea- 

 sicres which the local symptoms demand, (2) the reduction or reposition of 

 the uterus^ (3) the retenfiojt of the organ, (4) the after-treatment ; or should 

 reposition be impossible or contra-indicated, then recourse must be had 

 to (5) excision or a7npiitation of the uterus. 



Preliminary Measures. 



The preliminary measures consist in combating the local and general 

 symptoms. 



The animal is sometimes standing, sometimes lying down. If the lat- 

 ter, it must be got up by some means or other, as the standing attitude 



