Inversion of the Uterus 831 



The handling of complete prolapse or inversion of the uterus 

 offers two different plans — replacement and amputation. 



The replacement of the organ, and its retention in position, is 

 always the most conservative and desirable, and should be applied 

 in the vast majority of cases, including all those in which it is pos- 

 sible to replace and retain it, and in which the state of the uterus 

 is such that the veterinarian ma}' reasonably hope that it may re- 

 cover from any injury or disease existing at the time of its pro- 

 lapse or acquired as a result of the accident. 



For the replacement of the organ it is important that the 

 animal should be placed in the most favorable position pos- 

 sible. In the larger domestic animals, where the prolapse has 

 not existed for a very great period of time, the standing position 

 of the animal is frequently preferred. Whether the animal is 

 standing or lying, it is always to the advantage of the obstetrist 

 that its body should be more or less sharply inclined from be- 

 hind downwards and forwards, so as to throw the weight of the 

 abdominal viscera against the diaphragm and away from the pel- 

 vis, in such a way as to favor a spontaneous reduction of the pro- 

 lapsed organ. 



When the prolapse is complete, the position of the body of the 

 patient becomes of the very greatest importance. Though many 

 veterinarians prefer to have the animal standing, those who have 

 had extensive experience in very severe and difficult cases are 

 very much inclined to prefer that the animal be placed in the 

 recumbent position, but never in sternal recumbency. If the 

 animal is to be handled in the recumbent position, it is desirable 

 that it be placed upon its side. Some hold that it is even better 

 to place the animal upon her back. 



The attitude of the patient should be borne in mind, in every 

 ca.se of uterine prolapse, because it modifies the difficulties to 

 be overcome, to a degree which almost surpasses belief. We 

 might well illustrate this fact by an occurrence in our practice, 

 where we had worked long and hard to return the prolapsed 

 organ in a cow. We had worked with the patient in the stand- 

 ing position, and several times had progressed far enough that 

 almost the entire organ had been returned through the vulva. 

 Then violent expulsive efforts would come on, and the cow would 

 throw herself to the ground and undo all our work. When this 

 had occurred several times, and we had worked more than an 



