702 PARTURITION 
no doubt, that a fpontaneous inverfion has fometimes 
occurred. 
When the uterus, with the placenta attached to it, is 
drawn in an inverted date without the vagina, no doubt 
can exift as to the nature of the accident ; but, if it Ihould 
happen after the exclufion of the placenta, more difficulty- 
in forming an opinion would arife. The following rules, 
however, would lead to a corredt judgment. If a globular 
tumour is found foon after delivery, in the vagina, or 
protruded through the os externum, it mud: be fuppofed 
to be, either a polypous excrelcence, a prolapfed uterus, 
or an inverted uterus. If it were a polypus, it would be 
known by its infenfibility, its mobility, and its pedicle, 
which a careful examination could hardly fail to difcover: 
the edges of the os uteri furrounding the tumour 
would likewife be perceptible. A prolapfed uterus may 
always be known, by the os uteri being fituated at the 
moll depending part of the tumour. The inverted ute¬ 
rus is fenfible to the touch, is lefs moveable than the 
polypus, has no pedicle, nor a dependent mouth; in a 
recent date it is entirely covered with a grumous dif- 
charge, proceeding from numberlefs blood-veflels upon 
its whole furface. 
The prefence of an inverted uterus being afcertained, it 
becomes the accoucheur to ufe the mod prompt and 
decifive means of relieving his patient: and this can 
only be done by immediately re-inverting the uterus. 
To effect this, he mud fird return the uterus within the 
vagina; then, having his arm bare and well fmeared with 
lard, he mud pafs his hand through the os externum, 
and, reding the backs of his folded fingers againd the 
fundus uteri , he mud carry it forward, till he finds his 
hand within the cavity of the uterus ; and, dill purfuing 
his objedt, he mud pulh his hand onwards, till he is fully 
fatisfied that he has completely re-inverted the uterus, 
and that the contradlion of the os uteri will prevent any 
future mifchief. 
Puzos, Dionis, and others, have recommended to re¬ 
move the placenta from the inverted uterus, before any 
attempt is made to revert the womb : but Dr. Denman 
and other writers, confider it better to return the inver- 
fionj while the placenta is dill attached. 
A cafe of the latter kind, which occurred in the prac¬ 
tice of Mr. Browne of Camberwell, is related in the Me¬ 
moirs of the Medical Society of London, vol. v. Eliza¬ 
beth Emmett, a woman of a good habit of body, and 
tolerably well proportioned, fent for me to attend her in 
labour, between two and three o’clock in the morning 
of Monday, Sept. 19, 1796. About nine o’clock, a 
rupture of the membranes took place, and it appeared 
clearly to be a footling cafe, which I delivered in the 
ufual way. The child was dead, and in a very fphace- 
lated date. After the delivery fome pain enfued ; and, 
by a very flight effort to extract the fecundities, the fu¬ 
nis broke (it being alfo very putrid). The pains, how¬ 
ever, not only continued, but became more exceffive, 
with a degree of bearing-down hardly to be conceived ; 
and an aftual inverfion of the uterus, with the placenta 
completely adhering, took place. The dangerous date 
of the patient admitted of no delay ; and having conli- 
dered whether I Ihould feparate the placenta, and return 
the uterus, or reduce both together, on palling my finger 
round the placenta, finding it in no part detached from 
the uterus, I determined on returning them together, 
and happily fucceeded. During this time no hemorrhage 
enfued, and I was therefore very averfe to excite one, 
which a hady reparation of the fecundines, in that relaxed 
date of the uterus, mud have occafioned ; having there¬ 
fore waited a confiderable time, (the patient being as 
little didurbed as might be. expe&ed, confidering what 
had occurred,) I endeavoured to imprefs on the minds of 
the friends prefent, that no inconvenience would refult; 
I gave her an anodyne, and dire6led proper nourifliment, 
and fuch febrifuge aperient medicines as were requifite to 
prevent inflammatory fymptoms, which, indeed, did not 
intervene ; and on Thurfday, September 22, in the everr- 
ing, four days from the time of her delivery, a fanguine- 
ous difcharge, to no great degree, took place, which gave 
me hopes that the contraction of the uterus was fponta- 
neoufly occurring : the expuliion of the burden (which 
I anxioufly waited for) happened on Friday the 23d, after 
a retention of five days, and at this time, (now more than 
a month from her being put to bed) ffie has every ap¬ 
pearance of recovering as favourably as in any of her 
former labours, ffie having had thirteen children. 
“ The death of the foetus, by the mother’s account, ap¬ 
pears to have taken place about the 20th of Auguft, ffie 
having on that day accidentally received a fevere blow on 
the abdomen, and never felt it move from that period. The 
fcetus and funis, as before obferved, were highly putrid 
and offenfive; the placenta, on the contrary, was per¬ 
fectly found, and had acquired its original lize, no doubt, 
from the maternal circulation being continued till its ex¬ 
puliion.” 
In the two following cafes, the placenta was feparated 
before the uterus was replaced. We do not, however, 
quote them merely on that account, but becaufe they are 
related with great perfpicuity, and exhibit the higheft 
Ikill, judgment,, and dexterity, in the operators. Dr. 
Squire and Dr. Merritnan. 
Cafe by Dr. Squire.—“ Mrs. Schroeder, Green-court, 
Brewer-llreet, aged about 21, after the birth of her firfk 
child, had the uterus completely inverted, with the pla¬ 
centa adhering to the fundus. The midwife, who atten¬ 
ded her, fent for me, and I was with the patient about 
twenty minutes after the accident; and, on enquiring in¬ 
to the fituation of the poor woman, I was informed there 
had been a profufe hemorrhage, and the people about her 
fuppofed her really dead ; nor had Ihe indeed much ap¬ 
pearance of life, for there was no pulfe at the wrilt, ncr 
could it be perceived that (lie breathed. 
“ Examining, I found the uterus completely inverted, 
and immediately feparated the placenta ; and, whilft I was 
attempting to replace the uterus, Dr. Douglas, who had 
been likewife fent for, came into the room. By keep¬ 
ing a Heady and firm prefl'ure at the fundus, the uterus 
palled gradually before my hand ; but, when getting juft 
above the arch of the pubes, it Ihot up fuddenly with, a 
hind of fpring, as is frequently perceived in a rupture* 
when a part of the contents has been returned. Dr. 
Douglas a (lifted me, and we were both fatisfied that the 
uterus was replaced. We remained with the poor wo¬ 
man for fome time, it being long doubtful .whether Ihe 
'would not have died from the great lofs of blood 5 and it 
was near an hour before it could be pronounced that there 
was a probable chance of her recovery. The day follow¬ 
ing, a fever fupervened, with a tenfe abdomen and great 
pain, which lafted feveral days. Dr. Douglas vilited with 
me till we faw the patient free from danger. At the end 
of the month ffie was perfectly recovered. About four¬ 
teen months after this accident, Hie brought forth ano¬ 
ther child without any untoward fymptom in or after la¬ 
bour.” 
By Dr, Merriman —“ In January 1802, Mrs. Edwards, 
refiding in Brick-ftreet, Piccadilly, was delivered of her 
firft child by Mrs. Cobb, a midwife of much practice. 
The labour was natural, and of no confiderable duration 
Some little time after the child was born, the midwife en¬ 
deavoured,. by tightening the navel-ftring, to extract the 
placenta, when a violent pain came on, and the uterus 
was completely inverted, the placenta remaining attached 
to it. On this, my friend the late Dr. Scares was imme¬ 
diately called in ; and he, finding things in this Hate, 
deli red that I might likewife be fent for. When I ar¬ 
rived, which was in about fifteen or twenty minutes after 
the accident happened, the body of the uterus, with the 
adhering placenta, was lying without the os externum ; 
blood was flowing profufely from the internal furface of 
the uterus, efpecially from thofe parts where the placenta 
was detached 5 and the woman was in fuch an exhaufted 
3 ftate. 
