IXrEJiSIOX OF THE UTERUS. 583 



Treatvient. 



Whatever may be the cause of inversion of the uterus, the obstetrist 

 must lose no time in remedying the accident ; as when interference is 

 not prompt, a fatal termination, or, at the very least, serious conse- 

 quences, will rapidly follow. 



In treating it, several important indications ai'e to be observed, but 

 they may be classed as : (1) the immediate or preliminary measures 

 which the local symptoms demand, {'2) the reduction or reposition of tlie 

 uterus, (3) the retention of the organ, (i) the after treatment ; should re- 

 position be impossible or contra-indicated, then recourse must be had 

 to (5) amputation of the uterus. 



Pkeliminauy Measures. — The preliminary measures consist in com- 

 bating the local and general symptoms. 



The animal is sometimes standing, sometimes lying down. If the 

 latter, it must be got up ; as the standing attitude is by far the best for 

 reducing the inversion, there being more space in the abdomen when 

 its walls are not compressed by the ground, and the obstetrist can 

 operate more easily and quickly, while the downward inclination of the 

 lower surface of the pelvis and abdomen is favourable for reduction and 

 retention. If the animal is not very feverish, but only debilitated, and 

 there is otherwise no great urgency in the case, a strong diffusible 

 stinmlant may be administered, with the view to enabling it to get up. 

 It may also be induced to rise by bringing a dog before it ; or it may 

 be aided by a sack or sheet passed under the chest. 



If it cannot be made to get up, or is unable to stand when raised, 

 reposition must be effected while it is lying — fatiguing, and often trouble- 

 some as the operation then is. This fatigue and ditViculty may be 

 somewhat diminished in raising the hind-quarters of the animal as nmch 

 as possible, by nieans of bundles of straw placed under them, — all the 

 litter being removed from beneath the abdomen, so as to relieve its 

 contained viscera from pressure as much as possible. Cosse, Tyvaert, 

 Ilaubner, Anderson, and others advise placing the animal on its back, 

 with the croup so raised ; while Viborg, Fiissler, Bettinger, Obermayer, 

 Ilering, Merkt, Adam, and several other obstetrists recommend raising 

 or suspending it by the hind-limbs, over a beam — a procedure which, 

 they assert, is most advantageous when reposition is possible or advis- 

 able. But, as has just been said, the recumbent position with the 

 larger animals is always to be avoided when possible, and every means 

 should be tried to make them stand. With the smaller animals — as 

 the Sheep, Goat, Sow, Bitch, or Cat — it is convenient to place them on 

 a bench or table, and lying either on the side or back, with the hind- 

 quarters well raised. 



If the accident is recent— an hour or two, or even a little longer— the 

 uterus may be returned at once ; but should a longer inters'al have 

 elapsed, it is well to ascertain the condition of the rectum and bladder, 

 and to empty them if necessary ; though it must be confessed that it is 

 often a most difficult task to accomplish evacuation of the bladder. It 

 may be done, however, by causing assistants to raise the uterus, then 

 seeking for the meatus urinarius on its lower surface, near the vulva, 

 and introducing one or two fingers into that canal, or a catheter through 

 it into the bladder. 



Should the foetal membranes still be adherent to the uterine surface 



