On acute inversion of the uterus / by Thomas More Madden.

Date:
1870
Catalogue details

Licence: Public Domain Mark

Credit: On acute inversion of the uterus / by Thomas More Madden. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    12/12 (page 12)
    inversion by reducing its volume, that the proper method in general would be to peel it off before attempting to restore the organ.” The mode of effecting the reduction of the displaced uterus, though the subject of much controversy in some of the standard works on the question, is when freed from the unnecessary circum- locution in which the subject has, I think, been involved, is in reality simple enough. The placenta, if adherent, having been first gently, but as quickly as possible, peeled off, the displaced uterus is to be grasped in the operator’s right hand, and pushed firmly, in globo, into the vagina, the cervix being first returned. No attempt should of course be made to re-invert the uterus until fairly within the vagina, as otherwise a double inversion would be the result. But, when the uterus has been passed as high up within the vagina as possible, steady pressure should be made with the pulp of the three fingers within the vagina on the fundus, which should thus be pressed through the cervix, great care being taken that the pressure should not exceed the resisting power of the uterine wall, or else a fatal laceration of the fundus might be very easily produced; in this way the fundus should be insinuated back through the cervix, when pressure with the knuckles may be substituted for the fingers, and continued until, as generally happens, the uterus will be found to spring out of itself upwards and forwards, “ like a bottle of india-rubber when turned inside out,” as has been aptly observed, and the womb resumes its normal condition. The operator’s hand should now be left in the uterus until, as in my case, the organ is found to contract strongly on it, when it may be withdrawn, and the case treated on those general principles applicable to all cases in which a great shock and much hemorrhage has been sustained by a parturient woman. If the inverted uterus cannot be replaced after all our efforts have been pushed as far as is possible compatibly with the safety of the patient, the uterus should be, at least, pushed up within the vagina; hemorrhage should be restrained by astringent applications; inflammation should be met by appropriate treatment; the patient’s strength supported; the state of the bladder carefully attended to; and all pressure taken off the part as far as possible by properly adjusted bandages or pessaries, as the case may be. I need not consider this subject further, as the case is now one of chronic inversion of the uterus.