INJURIES OF THE UTERUS, VAGINA AND VULVA 303 



the excavation, eventration may follow straining. All penetrat- 

 ing wounds, even without eventration, lead to peritonitis. 



Injuries of the inferior wall are followed by serious hem- 

 orrhage ; a great many cases of metrorrhagia depend on it. 

 During the examination the squirting of the arteries can often 

 be felt. The mucosa may be torn from the muscularis to quite 

 some extent. This is frequently the case when the anterior or 

 posterior half of the body is wedged in the pelvic canal, and 

 the calf turned forcibly around its long axis. 



Course and Prognosis. — Injuries of the upper wall of the 

 cervix not extending to the excavation usually heal. There is 

 great danger of infection in emphysematous calves and in 

 these where the afterbirth is decomposing. Under such cir- 

 cumstances the prognosis is less favorable. 



Wounds which extend into the excavatio vesico-uterina, 

 either with or without eventration, always force us to give an 

 unfavorable prognosis. 



Treatment. — The essential point lies in the prevention of 

 infection. For this purpose the secundines are to be removed 

 immediately after birth, and contraction of the uterus is to be 

 effected by a subcutaneous injection of extractum secalis. 



When in serious hemorrhage th3 artery can be grasped 

 with the ringers it must be twisted or ligated. This is some- 

 times possible. 



Should it be possible, the os uteri is tamponed with jute 

 or cotton previously soaked in a boracic acid solution. Klin- 

 kenberg (Holland) used in such a case six towels and one 

 pound of jute; the vulva was sutured to retain the tampon. 

 The tampon is removed in twenty-four hours. 



As a rule, the uterus has between times contracted suffi- 

 ciently ; when necessary, the injection of ergot of rye may be 

 repeated. 



In small injuries of the cervix, local and antiseptic treat- 

 ment suffices. 



It is evident that irrigations of the uterus must be omitted 

 in penetrating wounds of the uterus. When a piece of the 

 omentum has entered through the cervical wound into the 



