Inversion of the Uterus 837 



until the replacement is fully completed, since otherwise expul- 

 sive efforts recur and the organ is almost certain to again become 

 everted and prolapsed. When the uterus returns into the vagina, 

 the operator's hand should follow it and should trace out each 

 part of the cavity. Especially should he clearly distinguish the 

 two cornua of the organ and make a careful search of the gravid 

 horn to see that the invagination of that part has been com- 

 pletely overcome. As a rule it will be found that some invagi- 

 nation still exists, and this must be overcome by placing the 

 clinched fist or the open hand against the invaginating mass and 

 pushing upon it until the intussusception has been completely 

 overcome. 



When the complete replacement has been accomplished, it is 

 well to keep the hand in the cavity of the organ for a few min- 

 utes, until straining and uneasiness cease, and the organ has un- 

 dergone some contraction and begins to recover its . tone. 

 Sometimes severe straining continues, with the probability 

 of a recurrence of the prolapse. The most efficient means for 

 overcoming these expulsive efforts is the introduction into the 

 uterine cavity of a large volume of a warm ^% solution of 

 carbolic acid, which not only completes the replacement but 

 also soothes the organ, washes away any blood clots or 

 extraneous matter, and favors a normal involution of the organ. 

 As soon as the uterine cavity is well filled, the fluid ex- 

 cites expulsive efforts, by which the solution is thrown out, and 

 the contractions aroused in the uterine walls cause each part to 

 become properly replaced. 



If the straining is very persistent, after the organ has been re- 

 placed as well as possible, and the measures above suggested 

 have been carried out, it may be necessary to resort to the use of 

 narcotics or anaesthetics. Among the various remedies to over- 

 come the straining, we should not forget those which may act 

 locally. The tepid saline solution or the very weak solution of 

 carbolic acid acts as a local soothing agent, and tends to decrease 

 the irritation and overcome the straining. Iodoform also acts 

 well as a local anaesthetic, and at the same time tends to guard 

 against infection of the uterus, and consequently becomes of very 

 great importance in retaining the organ in position. The pow- 

 dered iodoform should be introduced into the uterine cavity in a 

 gelatin capsule, the capsule opened and the powder scattered 

 thoroughly. 



