Torsion of the Uterus 703 



in unipara, the twist must occur in the cervix and vagina and 

 not elsewhere. 



The suggestion that the gravid cornu may possibly be the only 

 part involved in a twist is untenable, in so far as it relates to uni- 

 parous animals, where a portion of the fetus has developed and 

 lies within the uterine body. In multipara, like the sow, bitch 

 and cat, torsion of one of the cornua may and does occur, and is 

 more probable than the torsion of the entire uterus. 



De Bruin suggests that, in a large proportion of the cases of 

 torsion, the accident occurs after the os uteri has become dilated, 

 and that it is favored by this fact. He bases his belief upon the 

 clinical fact, that, in a large proportion of cases of uterine tor- 

 sion, when it is reduced, the cervical canal is found dilated and 

 ready for the passage of the fetus. We are not wholly ready to 

 accept his conclusion. We have likened the gravid uterus to a 

 bag filled with fluid. If we leave the mouth of the bag open, 

 retaining its contents, attach it to an immovable object and 

 attempt to turn it upon its long axis, we find this very difiicult 

 or even impossible. 



De Bruin reasons that, because the uterus is contracted, there 

 is more room for it to twist, but the uterus is certainly just as 

 thoroughly filled, if not more so, than, before it began to con- 

 tract, unless the waters have escaped. The common clinical 

 fact, that the cervical canal is found dilated in .some cases im- 

 mediately after torsion is reduced, may readily be explained by 

 the torsion itself. In torsion, the cervix becomes very much 

 stretched longitudinally, and this is one of the greatest elements 

 in the dilation of the cervical canal. The torsion, by involving 

 chiefly the cervix, would destroy first of all its contractile power, 

 very greatly weaken its muscles and tend to favor dilation as 

 soon as the torsion is reduced. De Bruin admits this weakness 

 of the cervical walls, and cautions the obstetrist against applying 

 great force upon the fetus after reduction of the torsion, lest the 

 cervix rupture transversely, but this would scarcely occur ex- 

 cept the muscles had been seriously damaged by over-tension. 



When the fetus becomes emphysematous or undergoes putrid 

 decomposition, and the uterine cavity becomes filled with tran- 

 suded liquids, the disease processes are not confined to the inner 

 surface of the uterus and to its contents, but extend to and beyond 

 the peritoneal covering of the organ. The peritoneal covering 



