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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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