330 MATERNAL DYSTOKIA. 



cases of uterine torsion, in which he resorted to this operation to replace 

 the organ. Two of the cases were attended with complete success ; but 

 in the third the uterus was of such an extraordinary size and weight, that 

 he failed to restore it to its natural position. He proposed in future to 

 facilitate the operation by using a looped cord with which to raise the 

 organ. 



Heichlinger operated successfully on a Cow in the same manner, but 

 the animal afterwards perished through gangrene of the uterus. 



It must be admitted that the operation has not been performed 

 sufiiciently often, and then sometimes in very unfavourable circum- 

 stances, to enable us to draw any satisfactory conclusions as to its 

 value. Darreau, who has been fortunate in some of his attempts, 

 writes: "Direct taxis by an opening made in the flank has had some 

 advantages ; I have even thought for a moment after my first success 

 that it would be the only means I should resort to for the future. But 

 unfortunately, new cases upset my predictions, and compelled me to 

 seek for more efficacious means." And Fausel admits that the con- 

 siderable weight of the uterus may sometimes prove an insurmountable 

 obstacle. 



The dangers attending the operation, even if reposition of the uterus 

 be effected, are as great as its difficulties. Several good authorities have 

 therefore recommended its abandonment, or at least its being adopted 

 only in very exceptional circumstances. Franck, however, shows that 

 it is far from being unsuccessful — the uterus having been untwisted in 

 thirteen out of fifteen cases, nine of the thirteen animals recovering, the 

 other four being operated upon too late. 



Oj^eration. — Different operators have different modes of operating. 

 Some prefer the animal in a standing position ; others throw it down. 

 One selects the left flank ; another, and perhaps with more reason, in- 

 cises the right flank. Saint-Cyr recommends the standing position, 

 with the hind quarters slightly raised. The right hind leg is pulled back 

 by a rope held by an assistant, to prevent the operator being kicked ; 

 while the head is tied short. An intelligent assistant introduces his 

 arm into the vagina, in order to follow and announce the results of the 

 untwisting. The operator then makes an incision in the right flank, 

 not too high, and from six to eight inches long, which should be sufficient 

 to allow the arm to be easily introduced. This incision should be 

 oblique— downwards and forwards — and skin, muscles (following the 

 fibres) and peritoneum are to be carefully cut through. The hand, 

 damped with warm water, is passed into the abdomen, above the uterus 

 if the tzvist is to the left, but below it if it is to the right ; then attempts 

 are made to put the organ in place by pressing and pushing it ; if any 

 part of the foetus can be seized, the labour is lessened, and wearing a 

 cloth glove, or wrapping the hand in a piece of thin cloth, will facilitate 

 holding. The task is also lessened in having the abdomen raised by a 

 sheet placed under it, and held by men on each side ; or a man on hands 

 and knees under the abdomen is even more advantageous, as he can raise 

 any part required by means of his back or loins. 



Having effected detorsion, the wound is closed by suture, and anti- 

 septic dressings are placed over it, these being retained by a wide band- 

 age round the body. The wound quickly heals if peritonitis had not 

 set in before the operation was begun. 



According to Obich, within eight days the wound will have healed by 

 first intention. 



