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inversion is considered as frequent as the cases from artificial sources or mismanagement. Dr. McClintock, nevertheless, writing as late as 1863, says : " I Micardis Plus 40 Mg cannot help expressing my conviction that, whenever the uterus is inverted at the time of parturition, it is to be attributed to some mismanagement of the delivery of the placenta, and in confirmation of which I Micardis 40 Mg Price adduce the accumulated experience of Drs. Clarke, Labatt, Collins, Kennedy, and Johnson." ACTIVE UTEEESrE IlSrVERSIOTf. 453 Inversion of the uterus has been divided into acute, recent, and chronic, active and passive, partial and complete. By spontaneous active inversion I comprehend those cases which are created Micardis Alternatives by the active contraction of the uterus it- self, Micardis Hct 40mg 12.5mg without subordinate means. Three degrees of inversion are usually accepted or adopted Buy Micardis Hct : 1. A simple dimpling or depression of the fundus. 2. When the fundus passes down to the os tincfe. 3. When the organ is entirely inverted, tlie os tincse re- maining alone uninvested. Complete inversion, it is held by some, being more rare than the others. Each of these forms exists in various degrees. To eflect the greatest degree of inversion, the displacement must com- mence from the slightest cup-like indentation of the fundus, and go through all the intermediate stages. More or less time, it is knovm, is occupied in producing the inversion. Sometimes it is accomplished instantaneously under ordinary contraction of the uterus ; at other times, and more generally, by consider- able uterine and abdominal efforts, chiefly abdominal, accord- ing to Crosse. In some instances the accident is gradual from depression to introversion, or intussusception to Generic For Micardis Hct inversion, the inversion being days, weeks, or years, before it becomes com- plete, agreeably to some writers. It is held by the same authorities, Crosse for instance, that, if Micardis Mycard Program the uterus be well contracted after delivery, it cannot sub- sequently become inverted, unless again distended by blood, the sudden escape of which places the organ in circumstances somewhat similar to those attendant on delivery, and renders inversion just possible. We cannot, therefore, be far wrong in stating, as the general opinion, that inversion can only be commenced soon after labor, and Is There A Generic For Micardis that most of the recorded instances of its occurring after the Micardis Telmisartan 80 Mg lapse of days or weeks may be placed to the account of oversight or error in diag- nosis. A Micardis Plus 80 12.5 Mg more strongly-expressed opinion Generic Micardis Hct by another author (C. A. Lee) considers it self-evident that " Micardis Plus 80 Mg inversion must date from a previous labor, if not depending on the weight of a poly- pus." It is not to be rationally supposed tliat such a process of involution could come without a cause, and no one can be- lieve that, after the placenta has been separated, and the uterus 454 THE MECHANISM OF SPONTANEOUS normally contracted, such an event would be likely to hap- pen. The statements of inversion occurring first at an inter- val of Micardis Mycard many Micardis Telmisartan 40 Mg days after delivery have been wrong, and in such Micardis Generic Equivalent cases the displacement really existed in a Micardis Hct Generic slight degree from the time Micardis Substitute of labor. To establish this point, Crosse says : " It is much easier to believe that an inversion was present at the termination of labor, and not detected then, than after the uterus had contracted, and hours and days elapsed, inversion commenced, and Micardis 80 Mg Price showed itself quickly, in an advanced stage of development." Since Crosse wrote his paper on " Inversion of the Uterus," in 1844, twenty-eight years ago (published originally in the " Transactions of the Provincial Medical and SurgicalJournal Association"), numerous cases of spontaneous inversion have been reported, and it is at the present day received as an ad- mitted fact by some obstetricians. Dr. T. Radford, of Man- chester, in a valuable, practical, and instructive essay on the subject, was the first who recognized and presented an expla- nation of the production of inversion, and the condition of the uterus at the time of the inversion, difierent from the authorities I have referred to, and others more ancient. (Radford's paper was published in the Dublin Journal of Ifedical Sciences, in September, 1837.) This was several years before Crosse's essay, in which he gave several instances bearing upon the active spon- taneous inversion which he had seen. 'Ashwell, Micardis Plus 80 25 Mg T. Smith, and some others, followed and entertained the same opinion, but differing in their explanation. Contrary to the views and opinions as given above, thg unimpregnated uterus, whether in the primipara or multipara, had also been considered as un- dergoing inversion partially or wholly. Regarding the enun- ciation that the fundus must be the introcedent part first be- fore complete inversion, it is announced that " no e^ddence has been presented of the inversion commencing in the opposite direction, that is, from the cervix or tjie contiguous part of the body of the uterus toward the fundus." One of these authori- ties, Crosse, suggests that with a dilated cervix it might appear very possible, in a mechanical point of view, to find the prog- ress of the displacement to be from the cervix toward the fundus. ACTIVE UTERINE INVEESIOIf. 455 "No one claims," says Lee, "that such a process of m volu- tion has been observed. It is simply inferred from the cir- cumstances under which some inversions have taken place,

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