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tudinal fibres which has not, I believe, been noticed by au-
thors."
In an important case I was compelled, in conjunction with
another physician, to apply the forceps under the disadvantage
of uterine inertia. After the delivery of the child, there was
no tendency to expel the placenta, but, a portion of the mass
having separated, a slight effort was made with the funis. The
placenta descended neurontin 200 mg considerably beyond the os internum, to-
gether with a quantity of the uterus, nearly the whole right
side, the left not being neurontin price comparison sensibly compressed. The cases of In-
gleby, as cited, certainly do not illustrate the general view as
to the inversion of the uterus. On the contrary, neurontin mg the four in-
stances, as recorded, give evidence of another kind of mechan- neurontin price without insurance
ism. I will now proceed to bring forward the different the-
ories which are advocated at the present day to substantiate
their view of the mechanism of inversion of the uterus by de-
pression of the fundus.
The three principal neurontin 800mg theories existing at the neurontin price streets neurontin 300 mg pain present day on
spontaneous active inversion of the uterus are those of Drs.
T. Kadford, Tyler Smith, and Duncan. It has been consid-
ered neurontin 600 mg high by some, at the present day, that the greatest progresses neurontin discounts
in all the sciences consist in the discovery and elucidation of
mechanism, and that mechanism is thought more of now than
formerly, and includes much that was supposed vital.
Dr. Radford believes that " action of the inverted part,
with want of contraction of the parts below it, is the theory of
active uterine inversion ; " that the uterine pain, diminution
of bulk, resisting feel, sudden formation, and rapid protru-
sion, convinced him of the deduction that the fundus and body
of the uterus, instead of being in a state of collaj)se or relaxa-
tion, are really in a state of constant excitement or action.
But this is not the case with the os uteri ; on the contrary,
it is soft and yielding, as we find it offers no resistance to the
coming down of the fundus, when protrusion is forthwith and
468 THE MECHANISM OF SPONTAISTEOUS
rapid. The inversion is another instance of irregular contrac-
tion, in which the fundus acts powerfully while the cervix
uteri is in a state of atony.
Dr. neurontin price Tyler Smith (" Obstetrical Transactions," 1869, vol. x.) generic neurontin available
relates two instances of inversion of the uterus and their treat-
ment. I cite these remarks, as they are later than those pub-
lished in his work on Obstetrics. Keferring to Dr. Duncan's
views on the production of inversion, he says : " I have en-
deavored to elucidate the causes of this accident, comparing it,
on the one hand, to intussusception and inversion of the intes-
tine, and on the other showing its relation to spasmodic ri-
gidity of the OS uteri during labor, to encysted placenta, the
hour-glass contraction. I have demonstrated that inversion of
the uterus is often the result of an active and not passive con-
dition of the organ. In the first stage of the act there is a
cup-like depression of the fundus uteri."
" The presence of the fundus in the middle portion of the
uterus tends to hour-glass generic neurontin manufacturers contraction, and this grasps the fun-
dus and passes it on toward and through the os uteri, and the
inversion depends on an abnormal contraction of the organ,
the OS itself neurontin discount card being at this time in a state of inertia or atony
just as it is in the second stage of labor."
Dr. M. Duncan holds that hour-glass contraction is a
disorder nearly identical in its first stage with the first stage
of spontaneous uterine active inversion. Paralysis or non-
contraction or neurontin price increase a weaker action of the other parts of the uterus,
with generic neurontin gabapentin contraction or spasm of other parts, has by many au-
thors been pointed out as contributing to an understanding generic neurontin 300mg of
the phenomena of encysted placenta. Hour-glass contraction
cannot exist unless the parts above the contraction are in a
state of inertia, unless there is a local paralysis of the uterus,
" I know no one," Dr. Duncan says, " who has to an equal ex-
tent advanced the subject of the causation neurontin 300 mg for nerve pain of active uterine in-
version."
We may simplify the different views and opinions or the-
ories respecting the mechanism of the inversion of the uterus
into neurontin prices generic generic neurontin solution the following order :
1. Inertia or functional paralysis of the uterus, with de-
pression of the fundus, preceding its complete or partial inver-
ACTIVE UTERINE INVERSIOI^. 469
sion. — Crosse, Lee, Dubois, and others. This is the opinion
generally accredited.
2. Contraction of the fundus and body, with inertia of the
cervix. Irregular contraction of the uterus. Indented or de-
pressed fundus first. — Radford.
3. Contraction of the fundus and bod}^, with inertia of the
cervix nteri. Hour-glass contraction. Irregular contraction.
Depressed or cup-like indentation first. — T. Smith.
tt. Paralysis or inertia of the fundus and body, with con-
traction of the cervix uteri. Hour-glass contraction. Fundus
depressed first. — Duncan.
6. Contraction of the fundus and body. Cervix uteri at
rest, or collapsed or inert. Regular or continuous action of
the uterus. Cervix uteri first rolled out, or doubled up, the
body following, and the fundus last. — Taylor.
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