P A R T U 
ftate, that we doubted if the could furvive till the uterus 
fhould be replaced. We perfectly coincided in opinion 
refpe&ing the plan to be purfued ; and, as no time was to 
be loft, Dr. Seares removed the partially-feparated placenta, 
and returned the uterus within the vagina, while I was 
laying bare my arm. I then introduced my hand, car¬ 
rying the fundus uteri before me, till I had palled my 
arm quite to the elbow within the vagina ; at this moment 
I found the fundus uteri fpring from the bach of my hand, 
and the os uteri began to contract; I therefore cautioufly 
withdrew my hand, and loon had the fatisfadlion to find 
that the hemorrhage ceafed. Mrs. E. during the whole 
operation, was in a date or fyncope ; but, on our giving 
her fome wine and other cordials, Ihe revived, and after¬ 
wards recovered perfectly without a fingle bad fymptom. 
She has fince borne feveral children, and has never found 
any inconvenience from this alarming and dangerous 
accident. 
“ Had a very little time longer been fullered to elapfe, 
before this inverfion was reduced, either the patient 
would have funk beyond recovery, from the profufe he¬ 
morrhage ; or, had the hemorrhage been Hopped by the 
contraction of the uterus, that very contraction would 
have prevented us from making any impreffion on the 
fundus, and the os uteri would have been clofely Ihut 
againlt any attempt we could have made to relax it. De¬ 
lay indeed, in fuch cafes, is, above every thing, to be de¬ 
precated ; for fometimes the contraction of the womb is 
fo rapid, that, unlels the inverfion be reduced in a few 
minutes after the accident has happened, all attempts to 
return it will be ineffectual.” Yet in White’s Midwife¬ 
ry, 5th ed. (1791.) a cafe of inverfion is recorded, in 
which, by grafping with the hand, and thus compelling 
the uterus, Mr. W. fucceeded in re-inverting it, though 
as much as two hours mull have elapfed after the accident. 
In general a much Ihorter fpace of time than this is fuffi- 
cient to render the reduction impracticable. 
A cafe of fpontancous inverfion of the uterus occurred in 
the practice of the late Dr. Merriman.—Mrs. Bilhop was 
fo much diftorted in the pelvis, that it was found impof- 
fible for her to be delivered, till the child’s head had been 
lelfened by the perforator. Having feveral times fuccef- 
fively undergone this procefs, Ihe was at laft prevailed 
upon to have premature labour induced, when in the 
eighth month of pregnancy ; but, the child prefenting the 
nates, it was unfortunately dead born. .Mrs. Bilhop, 
however, fullered, comparatively, lo little from this la¬ 
bour, and recovered fo well and fo fpeedily after it, that, 
in her next pregnancy, Ihe was quite impatient for a repe¬ 
tition of the operation. 
“ On this occalion, the membranes were not pierced : 
but the connexion between the chorion and the uterus 
was deftroyed, by means of the common long flat female 
catheter, carefully introduced between them. In confe- 
quence of this irritation, a muco-fanguineous difeharge 
was produced, and the labour came on in two or three 
days. The child was born alive, and in health, and the 
placenta came away without any difficulty, and certainly 
without any fufpicion of injury to the uterus. The mo¬ 
ther recovered in the ufual time, and was enabled to fuc- 
kle her child, a fine boy. Between fix and leven months 
after her delivery, and while the child was Hill living 
upon the bread, upon fome flight drain, Ihe fuddenly felt 
fomething give way within her, and immediately after¬ 
wards was fenfible of a weight or p re flu re low down in 
the vagina; upon which the late Dr. Rowley was fent for, 
who, upon examination, found the fundus uteri fo low 
in the vagina as almoft to protrude through the os 
externum. Dr. Rowley, finding matters in this fituation, 
lent for Dr. Merriman, and they jointly endeavoured to 
re-invert the uterus; Dr. Denman likewife, and feveral 
other accoucheurs, faw the cafe; but no means that could 
be ufed were fuccefsful in reftoring the parts to their na¬ 
tural ftate; and the patient remained with the uterus in 
RITION, 703 
this ftate till her death, which occurred in about two 
years.” 
Mr. White, furgeon, of Paifley, after relating a cafe of 
inverted uterus which terminated fuccefsfully under his 
management, concludes as follows: As, in making the 
reduction in the above cafe, I experienced much incon¬ 
venience from the fhortnefs and fmallnefs of my fingers, 
I would beg leave to propofe the trial of the following 
Ample inftrument, if the like difficulty fhould ever happen 
to any other practitioner. It confills of a bit of light 
wood, about fourteen inches long, not quite cylindrical, 
but (lightly tapering from the ends to the middle, and 
the ends rounded, like the head of a walking-cane. The 
diameter of the one extremity is an inch, and the other 
an inch and three quarters; the one or the other to be 
employed as the particular circumftances of the cafe may 
l'eem beft to fuit. The whole of it is covered withfmooth 
x and (oft leather, and the ends are thickly dulled with 
wool or foft hair ; fo that they can hardly do any injury 
to the uterus, unlefs employed in the mod inattentive 
and improper manner.” Duncan’s Med. Com. 1795. 
Many writers, on the other hand, have fuggefted the pro¬ 
priety of amputating the uterus, when in a date of inver¬ 
fion ; but, fo great a dread has been generally entertained 
of fuch an operation, that, though cafes have been cited 
from ancient authors to prove its poflibility, yet in mo¬ 
dern times, the excifion of the uterus does not appear to 
have been attempted till of late years. Mr. Chevalier ex¬ 
tirpated the uterus of a poor woman, in 1804, who lived 
many years afterwards: and other cafes have been re¬ 
corded by other furgeons. Notwithdanding, therefore, 
the incredulity of fome writers, refpeCting the truth and 
accuracy of the cafes cited, (and little doubt can be en¬ 
tertained, that miftakes have been committed on the fub- 
je< 5 t,) the faft, that the operation has been feveral times 
fafely performed, is fully eftablifhed. The cafe furnifhed 
by Mr. Chevalier is given by Dr. Merriman, Syuopfis, p. 
286. with an engraving. 
A cafe of favourable termination of parturition by the 
natural efforts, when there was complete hernia of the ute¬ 
rus has been related to the Royal Medical Society of Co¬ 
penhagen, by Mr. Saxthorpe. There is not, it is fuf- 
pe&ed, a fimilar inftance recorded in the annals of me¬ 
dicine. It was not precifely evident whether the uterus 
pafled from the belly above or below Poupart’s ligament. 
It reached nearly to the knee, on the right fide. The 
mother declared that (lie felt the motions of the foetus in 
it, as fire had done in former pregnancies, when the ute¬ 
rus was within the abdomen. Thefe motions were, to¬ 
wards the termination of the ordinary period of geftation, 
fenfible to the phyficians who examined her, on handling 
the tumour. The (hape was precifely that of the uterus 
in ordinary pregnancies at the fame period. The woman 
had had a tumour in the groin appear in her childhood, 
after a fall. Her laft pregnancy had been four years pre- 
vioufly. Soon after that, die remarked that the tumour 
was about the lize of a turnip. About the ufual epoch, 
pains like thofe of ordinary labour were experienced in 
the tumour; and this could be difeerned contracting from 
the fundus. The mouth of the uterus (which could be 
felt as ufual from the vagina, but not its neck) began to 
dilate; the head of the foetus prefented, and the labour 
was completed without the occurrence of any remarkable 
circumftance. The infant was dead ; it was of the fe¬ 
male fex, weighed five pounds and a half, was eighteen 
inches in length, and the head was five inches and a half 
in diameter from the occiput to the chin. The tumour 
was found to be much lelfened in fize immediately after 
the expulfion of the foetus, and it could then be difeerned 
that it did not efcape from a natural opening, but be¬ 
tween the fibres of the abdominal nnifcles x The hiftory 
of this cafe is detailed in the London Medical and Phyfi- 
cal Journal for March 1820. It terminated very fortu¬ 
nately ; the delivery was effected on the 2d of OCtober, 
18175 
\ 
