Inversion of the Uterus 835 



head to hold it firmly, and in case of the cow to pinch the nasal 

 septum in order to control the movements of the animal and dimin- 

 ish the straining. One man would stand upon each side of the 

 animal and, with a sheet or other cloth, hold and elevate the or- 

 gan while it is being returned. The fourth man would hold the 

 tail away, and at the same time pinch the back of the cow so as 

 to prevent her straining. 



Great assistance can be rendered by two to four assistants, in 

 exerting pressure upon the prolapsed uterus. A piece of sterile 

 muslin or other suitable tunic is passed beneath the tumor, and one 

 or two assistants grasp each end as near to the organ as will per- 

 mit the operator to work. They then lift the organ at least 

 as high as the vulva, and press it firmly against the vulvar open- 

 ing, thus tending at the same time to push the prolapse back in- 

 to the vulva and to reduce the congestion and size by forcing the 

 blood back into the body vessels. 



Different operators suggest different methods for returning the 

 organ. The plan which we have uniformly followed is that of 

 exerting pressure upon the extremity of the prolapsed organ, or 

 as some would say, against its fundus. The pressure is thus 

 made against that part of the organ which first began to evert, 

 so that in replacing it the operator simply reverses the process 

 by whichthe prolapse took place. In this operation the obstet- 

 rist seeks that point in the gravid cornu where it has ceased to 

 evert, a point which is recognized at the fundus or extremity of 

 the mass, in the center of which there is an excavation or passage 

 representing the apex of the gravid cornu, which has not become 

 everted, but has prolapsed within the everted portion. 



Placing the clinched fist or open hand against this portion, the 

 operator gradually and carefully pushes his hand forward, toward 

 and into the vulva, as far as he can readily reach. Holding 

 the advanced hand in this position, with the other he grasps 

 the portion of the organ immediately surrounding the inserted 

 arm and holds the uterus, while he withdraws the arm which has 

 been advanced, and prevents the replaced portion from follow- 

 ing his arm out. He now carries the other arm up to and 

 through the vulva, pressing with it a succeeding portion of 

 the prolapsed mass. He continues in this way to pass first one 

 hand and then the other into the mass of the organ, and thence 

 through the vulva, carrying with it the distal or ovarian end 



