UTERUS, DISEASES OF. INVERSION OF THE parts back and retain them during the day-time by introducing large cotton or wool tampons, or a rubber inflatable bag, and inflating it. A soft-rubber elastic ring-pessary can sometimes be intro duced by the patient every morning and removed every night. Soft-rubber pes saries should never be worn continu ously. A hard-rubber or large Albert Smith pessary can be worn continuously with great comfort in some cases. The prolapse returns when the pessary is re moved.
the prolapse is the result of lacerations during childbirth it is usually necessary to curette the en larged subinvoluted uterus, repair the laceration or amputate the enlarged cer vix, perform anterior and posterior col potomy and perineorrhaphy, as well as remove any or protruding anal folds. If the fundus uteri sinks into the hollow of the sacrum as the cervix is pushed within the pelvis, it is best to per form Alexander's operation and thus turn the fundus forward behind the pubes. When the fundus is allowed to remain in the posterior the cervix points forward and acts as a wedge to force the vulva open. In case the pa tient is at the change of life, vaginal fixa tion, or uniting the anterior wall of the uterus to the anterior vaginal wall, may be employed to accomplish the same pur pose.
In extreme cases the uterus has been removed by abdominal hysterectomy and the stumps attached to the abdominal wall. Vaginal hysterectomy supple mented by a narrowing of the vagina and perineorrhaphy has also proved suc cessful.
Panhysterocolpectomy—a new lapsus operation—consists in complete removal of the uterus and vagina, fol- the third stage lowed by operative obliteration or I ent placenta and a short columnization of the bed of the genital I are favorable to its occurrence.
6-34 529 tract. The tubes and ovaries are not disturbed, if healthy; if diseased, they are removed with the uterus and va gina. Obliteration and colinnnization of the bed of the removed uterus and vagina are effected by means of from seven to nine buried pursing sutures of chromicized catgut placed about two to two and a half centimetres apart, and running parallel to each other.
Each suture gathers the raw surfaces from the periphery in circular fashion, and draws or purses them together in the median line. It is buried by being pushed upward toward the abdomen, while the next suture is being tied be neath it. G. M. Edebohls (Medical News, June 22, 19011.
Notes of 130 cases of proeidentia uteri treated by operation. In this condition curettage is usually of but little im portance. Amputation of the cervix promotes involution of the uterus when this organ is much hypertrophied. Re section of the anterior vaginal wall serves to remove the redundanee of overstretched tissue, and thereby pre vents further descent of the uterus. The restoration of the supporting function of the perineum or sacral segment of the pelvic floor is secured by means of modi fied Emmet perineorrhaphy. Suspension of the uterus restores that organ to its position of anteflexion. Charles Y. Noble (American Medicine, Jan. 11. 1902).
Inversion of the Uterus.—Inversion signifies a turning of the corpus uteri into the cervix (partial) or through it (complete). The uterus turns inside out. It only occurs when the uterus is (1) en larged and (2) partly or completely laxed. These conditions are found in the puerperal state and during the ence of polypoid or submucous uterine tumors (usually myomas).
The CAUSES in the puerperal state are pressure upon the fundus uteri or tion upon the umbilical cord, or both, of labor. umbilical cord After a partial inversion has taken place, abdom inal pressure may complete it, or the pro jecting fundus or tumor may be caught, in the cervix and be expelled into the vagina by the contractions above it.
Symptoms and Diagnosis. — Sudden complete inversion occurring during labor is often accompanied by fatal hrernorrhage unless immediate reduction is effected. If the patient escapes death by hemorrhage, septicemia is apt to fol low later.