Rupture of the Uterus ayid Vagina 819 



uterus in all instances where there has possibly' been tampering 

 before the veterinarian has been called, and should clearly im- 

 press the practitioner with the importance of using all due pre- 

 cautions in any manipulations which he undertakes. It must be 

 evident to him that, when he is attempting to adjust a retained 

 foot, he should be very careful not to bring excessive pressure 

 upon this point of danger at the pubic brim, because of the con- 

 stant possibility of causing a small perforation of the uterine 

 floor. We have suggested that, in the extension of a foot which 

 has been retained, the operator should always grasp the toe 

 in the palm of his hand, and cause it to glide over the pubic brim 

 without coming in contact with the uterine floor. This point is 

 highly important, not only because it actually facilitates the ope- 

 ration, but also because it affords a highly necessary security 

 against serious or fatal injury to the organ. 



The handling of rupture of the uterus must be adapted to 

 each individual case. When the uterus is in position, it is rarely 

 possible to close a rupture by means of sutures or otherwise. It 

 should always be remembered that the involution of the uterus 

 brings about a great decrease in the size of a rupture in its 

 walls. 



When the organ is prolapsed and ruptured, it is comparatively 

 simple to close the opening by means of sutures under proper 

 aseptic precautions. The sutures should be of silk, and of the 

 intestinal type, that is, the peritoneal surfaces should be brought 

 in contact with each other while the wound margins project into 

 the uterine cavity. When the rupture is in the roof of the uterus 

 or well up on its side, there is always a pos.sibility of spon- 

 taneous recovery, and every opportunity should be allowed for 

 its occurrence. 



In all ca.ses of uterine rupture it is clearly inadvisable to inject 

 liquid antiseptics or other fluids into the uterus, and take the risk 

 of their escaping into the peritoneal cavity. If it is essential to 

 remove blood clots, fetal envelopes or disease excretions, this 

 should be accomplished without irrigating the organ. The opera- 

 tor may largely remove these with the hand, which can be used 

 somewhat as a scoop, and the cleansing may be completed by 

 means of a piece of gauze saturated with an antiseptic. 



Rarely it may be practicable to grasp a ruptured uterus, 

 and by traction, with the patient under general anaesthesia, draw 



