320 MATERNAL DYSTOKIA. 



dilated, and allow the position of the fcetus to be ascertained. In 

 accomplishing this manoeuvre, the fingers can feel a large salient spiral 

 ring which becomes wider as the hand enters deeper into the organ, 

 and which terminates in the cavity of the latter in a wide membranous, 

 fan-like manner. If the torsion is to the left, this ring inclines to the 

 right, and the membranous expansion in the uterus is directed obliquely 

 from right to left towards the fundus of the organ. The spiral twist 

 is in the direction of the torsion, and the uterus is carried towards 

 the left iiank. In torsion to the right, the arrangement is the reverse 

 of this. 



In the half-turn or revolution, occlusion is so marked that the fingers 

 can scarcely be made to enter the obstacle, and the cervix cannot be 

 reached unless the torsion is beyond it. There are always two 

 prominent rings — two mucous folds which cross each other, but which, 

 as they recede from the torsion, become wider apart and spread like a 

 fan. We shall investigate the character of this twist hereafter. 



In the complete turn, the occlusion is such that only one finger can 

 penetrate to a very slight depth in the spiral stricture, and the direction 

 of the rugae is very baffling, as they seem to intersect each other, and to 

 run in opposite directions. 



In some instances, when the mucous membrane of the vagina is 

 involved, the spiral ridge may be distinguished in the roof of that canal, 

 and even near to its commencement. 



When the hand can be introduced into the uterus, it is generally 

 found that the foetal membranes, as well as the footus, are intact, and 

 particularly in the half and complete degrees of torsion. In the quarter 

 revolution, the membranes are sometimes ruptured and the waters 

 discharged for a considerable period. 



The foetus is usually alive soon after the first labour pains ; but it 

 quickly perishes, and its death is almost certain to have taken place 

 within forty-eight hours after parturition has commenced. The period 

 of its decease, however, will greatly depend on the intensity of the 

 " pains." 



The position of the foetus varies according to circumstances. It is 

 most frequently in the dorso- or lumbo-ilial position, rarely in the lumbo- 

 sacral, as it follows the movements of the uterus ; so that in reducing 

 the torsion the foetus should be brought into its normal position. Some- 

 times when the twist is slight and the passage sufficiently large, the 

 foetus partly enters the pelvis, where it may not only be felt, but seized 

 by the parts first presenting. At other times it is entirely lodged in the 

 abdomen ; and at others, again, it may be felt towards the pubis, in a 

 kind of pouch or sub-vaginal tumour, formed by a duplicature of the 

 uterus beneath the inner opening of the os. In the latter case, torsion 

 is complicated with obliquity of the organ, and the tumour not un- 

 frequently considerably elevates the bladder and meatus urinarius. 



The form of the abdomen is sometimes characteristic. The foetus 

 can generally be found higher in it, towards the flank, on the right or left 

 side. This change in the position of the foetus may also be recognised 

 by exploration ])er rectum, which may also possibly allow the torsion of 

 the uterus to be distinguished, as well as its direction. The uterus can be 

 felt through the wall of the rectum as a tense hard mass, while the broad 

 ligaments may be discovered as hard funicular bands. The Fallopian 

 ligaments, which have encircled the cervix uteri and strangle it, can 

 often be felt ; and in recent cases the pulsation of the uterine artery 



