TORSIOy OF THE UTERUS. 325 



This being fully uudorstooj, it now remains to demonstrate how tlie 

 different torsions may be distinguislied in the living animal, by vaginal 

 exploration. In doing so, we will follow the remarkably lucid directions 

 furnished by Saint-Cyr, to guide practitioners in forming a diagnosis. 



Supposing the riijht hand introduced in a state of pronation (palm 

 downwards) into the vagina of a Cow supposed to be suffering from 

 uterine torsion, it is evident that, in order to follow the direction of the 

 spiral folds met with, it must execute a kind of rotary or screw-like 

 movement on the wrist. If this movement is such that the cubital 

 border of the hand, to the rirjlit at first (Fig. 91, position A), becomes 

 inferior (little linger downwards — position 13), then internal, so as to 

 arrive at a state of supination (palm upwards — position C), then the 

 torsion is to the riijht. 



On the contrary, if the hand, in following the spiral folds in the 

 vaginal canal, rotates in the opposite direction, of course tJie torsion is 

 to the left. For instance, as in the other case, the hand is introduced 

 in a state of pronation (Fig. 92, position A), but instead of the thumb 

 turning upwards and round to the right, it inclines downward to the 

 left ^position B), the little finger ascending until it is uppermost, and 

 the palm of the hand is turned outwards (position C). 



This is a very simple matter, apparently ; and yet in practice it may 

 be very important. It may be sufficient, then, if the fact is impressed 

 upon the young obstetrist, that when the palm of the hand turns to the 

 left, or inwards, the torsion is to the right ; and when it inclines out- 

 wards, or to the right, then the twist is to the left. 



■i. The Degree of TorsioJi. — To ascertain the degree of torsion is more 

 diflicult than to discover its existence or direction ; though every 

 endeavour should be made to satisfy one's self in this respect, as the 

 " detorsion " will be easy as the torsion is slight, and vice versd. 



It has been stated that it may exist as a quarter, half, throe-quarter, 

 or a complete revolution ; and that it may even extend to a double, 

 treble, or quadruple twist. But it must be always doubtful whether we 

 can diagnose with certainty these different degrees of torsion which may 

 be met with in obstetrical practice. 



It is evident, however, that the greater the amount of torsion, so the 

 more will the vagina be constricted, and penetration by the hand 

 rendered difficult. We have already, in treating of the symptoms, 

 drawn attention to the condition of the vagina and cervix uteri in the 

 more simple cases. When, for instance, the hand can be passed 

 without very much trouble as far as tlie cervix, and the os can be 

 penetrated to such a depth that some parts of the fcctus are felt, then 

 it may be presumed that the organ has only made about one-fourth of a 

 revolution on itself. If the passage is more constricted, the spiral folds 

 closer together, and the cervix can be reached with much difficulty — 

 perhaps only one or two fingers entering the os — we may expect that 

 the uterus has made a half or three-quarter revolution. 



But if the vagina is completely occluded not far from the vulva, the 

 fingers being only able to pass into the funnel-shaped infundibulum for 

 a very short distance, and cannot reach the cervix, then there may be 

 one or more complete twists. The spiral folds will also be close and 

 numerous, and for this reason their direction will be all the more diffi- 

 cult to ascertain. 



