In this condition an ounce of prevention is worth many pounds of cure. Do not hurry the third stage of labor; wait for the spontaneous delivery of the placenta, do not puss on the cord or press the uterus in any fashion that might produce an indentation.

The title of this paper should more accurately have been Acute Inversion of the Uterus, as referring to that type of inversion that occurs at or shortly after labor. The condition may best be described as a turning of the uterus inside out and upside down. It is the rarest of all uterine displacements.

The chief underlying cause is uterine inertia; the inversion most commonly commences at the placental site, where the uterine tissue is softer, more vascular and lacking in tone. Granted a relaxed and atonic uterine musculature there are two factors which appear to have some bearing on the development of inversion; these are: (a) Improper or over-enthusiastic Crede expression of the placenta; (b) Traction on the cord. It must be borne in mind, however, that these are purely secondary, and in a great many case no cause except a relaxed and weakened condition of the uterus, such as might be brought about by prolonged chloroform anaesthesia, prolonged labor, twins, hydramnios, etc., can be held responsible.

The mechanics of inversion are indefinite, but it is generally accepted that once any portion of the relaxed uterine wall becomes depressed, the area about it regains its tone and strives to expel the still inactive zone as though it were a foreign body. This process continues until the uterus has turned itself partly or completely inside out.

The diagnosis of the condition is usually simple. The absence of the fundus within the abdomen, sudden or gradually developing condition of shock, and alarming haemorrhage, are signs not be mistaken.

In this condition an ounce of prevention is worth many pounds of cure. Do not hurry the third stage of labor; wait for the spontaneous delivery of the placenta, do not puss on the cord or press the uterus in any fashion that might produce an indentation.

If you should be so unfortunate as to find yourself confronted by such a condition, replace the uterus at once by pressure applied between the fundus and the cervix, provided the patient is not in a condition of deep shock. This procedure must be carried out under anaesthesia. Packing the uterus and vagina with iodoform gauze, to be removed at the end of twenty-four hours, is to be recommended.

If shock and haemorrhage are too alarming, the mass in the vagina should be compressed bimanually, the vagina packed, and the patient transfused at the earliest possible moment. Reduction of the inversion may be carried on next day when the shock has been overcome.

When the tumult and the shouting dies, you will have time to look around for a suitable remedy.

On March 22 of this year, Mrs. B. was delivered of a male child, weight 9 lbs. Pregnancy had been uneventful, except that she went two weeks over term and judging by the size of the uterus there was a moderate degree of hydramnios. Labor pains started, continued fitfully, and stopped, on several occasions before the final date of delivery.

There was a very slight laceration at the mucocutaneous junction which was repaired while waiting for the placenta. The placenta was delivered following slight Crede manipulation, and moderate traction on the cord. Following the expulsion of the placenta came a most terrific haemorrhage. After a few moments spent vainly trying to stem the torrent, the obstetrician mounted a stool and with his first compressed the aorta against the body of one of the lumbar vertebrae, and maintained this position until expert help arrived.

It is a long story. Mrs. B. was transfused twice within the next twelve hours. She was moribund when the second transfusion was started but her vitality kindled quickly under the influence of the new blood. The uterus was then replaced and packed. A third transfusion was given the next day, by which time she had started on her long slow climb to convalescence.

I will not weary you with all the details of the next ten weeks.

Homoeopathy played its part in overcoming complications, and today Mrs. B. is able to walk a few steps.



DR. ALMFELT: I dont do obstetrics nowadays and havent in years, and the years I was doing it we had no hospital facilities. I was a country doctor in northern Wisconsin, and I remember one day I had three cases and the last case I came to the baby had been born for about an hour or two, and there was someone there acting as nurse, and she had cut the umbilical cord and tied the babys end, but not the mothers, so when I got there she had been bleeding all that time, and she was absolutely dried of blood. She was yellow in her face, had no pulse, and as near as I could see, there wasnt much life left in this woman.

I had nothing to do with except what I carried with me, and that meant only the ordinary things. The placenta was still in the uterus. I could deliver it manually and after that was done, still the uterus remained large and flabby and open and continued to bleed. There wasnt much haemorrhage then because it was all practically bled dry. I tried various remedies like Ipecac and such things and I thought perhaps there was a little reaction for a minute or so, but the patient threw down the bed covers and her hands were as cold as ice, and yet she wanted air.

Now, in Kents lecture on Secale, that was the particular leading symptom, so I said to myself, “That is Secale.” I got out a powder of 200, and in five minutes she turned on her side and that was the last of the bleeding, and she was well inside of the ordinary time, only two weeks.

I want to mention this to you men who are doing obstetrics today to show you that if you know how to select the proper remedy, it will work and work quickly, better than anything else I have seen.

DR. CAMPBELL: I gave a remedy as soon as I got a chance. I gave her Carbo veg. first. By the time I got there her shock was gradually developing. She was pretty cold and I gave her Carbo veg. before she had a transfusion. She was bled out if ever anyone was. The blood came out just like out of a hydrant.

DR. FIELD: Did you carry her through the particular case from the time of presentation, or give any remedies?.

DR. CAMPBELL: Yes. There were particular conditions arose that I dealt with, and for her uterine inertia it seemed to me that with her labor coming and pains, I should give her Kali sulph., but up to the time the placenta was delivered, there was apparently nothing wrong with her. She was in good shape.

DR. BALDWIN: Did you ever give her China?.

DR. CAMPBELL: The day following, and that was after her second transfusion.

DR. FIELD: This is a sincere question, with no reflection: Do you believe that if a different prescription was prescribed, that would have been a different story to be told? I mean I want to get your reaction towards homoeopathy.

DR. CAMPBELL: I really do not know. If she had had a different remedy, possibly not. Perhaps if I hadnt pulled quite so hard on the cord – but it wasnt a hard pull – I never do it. I remember before the condition I put my hand on the fundus and said to the attending nurse, “That is a peculiar shape. It is a sharp ridge instead of a full, rounded fundus”. It never occurred to me that condition was developing, and that was before there was any traction on the cord whatsoever, and the books say that the uterine inertia is the prime factor in producing that condition. The placenta, either by pulling on the cord or improper handling, has less tone than the rest of the uterus.

It is impossible for me to answer your question, Doctor. I prescribed as best I could.

D M Campbell