INVERSION OF THE UTERUS. 585 



tightened every minute, by placing the open hand beneath the mass, 

 and with the other hand pulling at the upper end of the wrapper. This 

 equable, gentle, and sustained pressure over the entire organ in fifteen 

 to twenty minutes brings about a marked diminution in its size, and 

 renders its reduction easier. 



Esmarch's india-rubber bandage has been suggested to overcome the 

 uterine congestion in these irreducible cases, but there is no record of 

 its having been tried. 



If the uterus is torn, it may be necessary to close the wound by the 

 continuous suture — but this must not be drawn too tight, mere apposi- 

 tion of the edges being all that is necessary. If the wound is not exten- 

 sive, it need not be closed ; indeed, there are many cases on record in 

 which wounds of the uterus have not been sutured — the organ having 

 been merely returned to the abdominal cavity, and yet recovery has 

 taken place. 



Careful washing witli a weak solution of boric acid is perhaps the 

 best course to adopt before reposition is attempted in any case. 



If hernia of the intestine or any other viscus is present, then, of 

 course, this must be reduced before the uterus. 



Keduction ou Reposition. — "When inversion of the uterus is incom- 

 plete — a very rare occurrence — and the organ has not passed beyond 

 the vagina, reduction is comparatively easy. It is sulhcient, with the 

 larger animals, to introduce the closed list into the vagina, and to push 

 the uterus as far into the abdomen as may be deemed necessary. When 

 the animal strains, the operator must not push, but maintaining what 

 he has accomplished as well as he can, recommence as soon as the 

 expulsive effort has ceased. Whether inversion is complete or incom- 

 plete, and if the animal is standing or lying, it is always well to have 

 the hind-parts higher than the fore. 



When it is complete, then four assistants are generally necessai'y. 

 One of these stands at the animal's head, and holds it firmly — if a Cow 

 he may seize it by a horn with one hand and nasal septum by the 

 other ; if it is a Mare, a twitch on the nose or ear may be required, and 

 it may even be necessary to have a side-line on one of the hind-limbs 

 Another assistant holds tlie tail over the croup with one hand, and with 

 the other he presses or pinches the loins in order to diminish the strain- 

 ing ; while a man stands at each side of the croup to aid in raising and 

 returning the uterus. It is well to attract the animal's attention as 

 much as possible, as it then offers less opposition to the manipulations, 

 and does not strain so violently. I'incliing the nose and loins will be 

 found ver}' efTective in this respect, and if a Cow, a Dog may be intro- 

 duced in front of it. Should the animal be much exiiaustcd or un- 

 steady, two additional assistants may be required to stand at each 

 side. 



The utems must be placed on a cloth or sheet in two or three folds 

 and well moistened, the ends being held by the two assistants at the 

 croup, so that the organ may be lifted as high as the vulva. By doing 

 so, there is neither traction nor compression on the mass, and as the 

 circulation in it is thereby much facilitated, the tumefaction subsides to 

 a corresponding degree. It also allows the operator more freedom, as 

 he could not sustain the weight of the prolapsed organ — which is some- 

 times as much as 100 to 140 pounds — and at the same time attempt its 

 reposition. Indeed, some practitioners recommend that the two comers 



