Inversio7i of the Uterus 833 



should be accompanied b}' gentle massage, which will tend to 

 overcome the congestion of the organ, thereby decreasing its 

 volume. 



It should be constantly borne in mind by the obstetrist that 

 the position of the organ, as related to the body of the patient, 

 affects its size, and that, if the organ can be held somewhat above 

 the level of the vulva, or at least as high as that organ, the blood 

 tends to pass back into the body, thus relieving to an appreciable 

 degree the engorgement of the organ, and rendering it« replace- 

 ment more practicable. 



If the uterus has been torn or abraded, the wounds should be 

 given proper attention. If any perforations have occurred in the 

 organ, the}' should be closed by means of sutures, in such. a 

 manner that the two peritoneal surfaces of the organ are brought 

 in contact. Should any blood vessels be wounded, they should 

 be ligated or twisted, or the hemorrhage should be otherwise 

 controlled before it is attempted to return the organ to its position. 



In some cases it may become necessary or desirable, before at- 

 tempting replacement, to reduce the volume of the organ by 

 removing a portion of the blood from it. Two plans for decreas- 

 ing the volume of blood in the organ, and thereby lessening 

 its size, have been proposed. 



The most direct and radical of these is .scarification of the 

 mucous surface of the organ. While some writers upon veterinary 

 obstetrics recommend this, they do not seem to speak from the 

 standpoint of experience, but rather theoretically. There can be 

 no question but that the.se scarifications will reduce the volume 

 of the congested organ, but the safety of the operation does not 

 .seem so clear. Saint-Cyr relates that early in his experience he 

 applied scarification in a case of uterine prolapse in a mare, and 

 she died from bleeding. This would seem to be a very natural 

 con.sequence of such an operation. It would be well-nigh im- 

 possible to perform very extensive scarification without injuring 

 vessels of large size, and when this is done in an organ which has 

 become weakened by displacement the control of the hemorrhage 

 would become difficult, if not impossible. Aside from the ques- 

 tion of hemorrhage, however, scarification opens up an extensive 

 avenue for the entrance of infection, and the conservative obstetrist 

 would avoid making these wounds. The extraction of the blood 

 53 



