Excerpt from The American Gynecological and Obstetrical Journal, Vol. 16: January-June, 1900
A few remarks now as to the causation, diagnosis and treatment. And first let me say that I do not believe that it is ever possible for the uterus to contract itself inside out; the accident, in my opinion, can only occur through the organ being pulled inside out from below by means of the cord or a heavy polypus, or by being pushed inside out from above by the hand. Moreover, I have never thought it possible for the accident to happen in a puerperal case, if the uterus is firmly contracted. In most of the reports I have read the patient had been profoundly anaesthetized and the uterus completely relaxed when the cord was pulled upon, either unintentionally by being wound around the child's head, or intentionally 'while trying to remove the placenta. It would be well to remember this whenever we interfere instrumentally, and for this reason we should rather employ Crede's method of ex pression than to make too strong traction on the cord. In no case should we do the latter when there is absolutely no contraction of the uterus. The diagnosis would appear to be difficult, for some of the greatest authorities have confessed that they have removed the uterus thinking that it was a polypus, and others that they had removed a polypus under the impression that it was the inverted uterus. One of our members told us on his return from a visit to England that he had seen the immortal Lawson Tait take off the inverted uterus with the ecraseur, and it was only when he found the ovaries and tubes inside of it that he discovered that it was the inverted uterus. In my case there was very little difficulty, for the fact that it was attached above to the vagina was sufficient to eliminate both placenta and polypus. Moreover the openings of the tubes could be distinctly seen and the decidua could be peeled off in strips which would not have been the case with a tumor.
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