586 ACCIDENTS AFTER PARTURITION. 



of each end of the cloth on which the uterus is placed, should be tied 

 round the neck of the assistants, so that their hands may also be free 

 to aid the operator in his manoeuvres : though the device must, one 

 would imagine, have more disadvantages than conveniences. 



When the animal strains very severely and continuously — as some- 

 times happens during reposition — it is useful to constrain the chest 

 as much as possible by a girth, so as to prevent its expansion. It 

 may even be necessary to give a strong anodyne draught of chloral or 

 opium, or a dose of alcohol sufficient to produce semi-narcosis. Indeed, 

 with the Mare, in serious cases it is most advantageous to administer 

 chloroform or ether, in order to produce general anaesthesia before 

 attempting to handle the uterus. 



For effecting reposition, two methods are recommended, and these we 

 will now notice — merely observing that, whichever be adopted, the 

 operator always places himself directly behind the animal, with the 

 inverted organ immediately before him. 



First Method.— \i the inverted tumour formed by the uterus is not 

 very voluminous, and if by the application of cold water to it — should 

 it be tumefied — it is reduced in size, then reposition may be effected by 

 pressure on the fundus of the organ. This pressure is to be made by 

 the closed fist against the central part of the tumour ; and in some 

 instances, if it is well directed, and the inversion not serious, the organ 

 may be returned to the pelvic cavity by one push, while another will 

 carry it into the abdomen. 



Eainard and other practitioners approve of this method, and describe 

 it somewhat in detail. The operator is to seek for the largest cornu — 

 that which contained the foetus — seize it by the fundus, and reduce this 

 by pushing it inwards, as we would the finger of a glove which has 

 been turned outside in — continuing the reduction by successive portions 

 until the pedicle of the tumour is reached, when more serious resistance 

 is encountered from the os uteri. This being overcome, the body of the 

 uterus is next replaced, either by the fist pressing against the widest 

 part, or by using a pessary. The pressure is to be directed straight 

 forward, through the vulva and pelvic canal, upwards and inwards. 



Great care is necessary in exerting the pressure, which should not 

 be applied while the animal is straining. During expulsive efforts the 

 operator must be content to wait, merely keeping the parts where he 

 has carried them, until the straining has ceased. The pressure must be 

 steady and well directed, so as not to bruise or lacerate the uterus. 

 "When a portion is got within the vulva, it is held there by one hand, 

 while the other manipulates the next part to be returned. Eeduction 

 must be effected progressively, so that the organ may be completely 

 replaced ; if it is not, then re-inversion is certain to occur. 



Some practitioners employ the pad or cup-shaped pessary, to aid them 

 in this operation ; the round end is applied to the fundus of the uterus, 

 and pressure is made at the other end of the instrument by the chest 

 or abdomen of the operator, whose hands are thus at liberty to direct 

 the viscus into the vulva and vagina. 



Second MetJiod. — If the uterine tumour is voluminous, and hangs 

 heavily as low as the hocks, then the first method is dangerous, if not 

 impracticable, and must not be attempted. The best method now un- 

 doubtedly is to return, first, tJie jJarts of the organ nearest the vulva, and 

 not act directly on tbe fundus of the uterus until the greater portion 

 has been replaced in the pelvis. 



