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The first proposition or theory has no relation to my sub- ject, and I shall not therefore touch upon it. It is the last theories I shall address myself to — Eadford's, Smith's, and Duncan's. The views and opinions of Radford and Smith, as it will be noticed, are more nearly allied in what is the generic for nexium some instances to is there a generic nexium each other. The observations of Smith are also in some instances nearly the same as Duncan's, though Duncan considers the fundus as paralyzed, or in a state of inertia, while Smith con- siders it contracted. To examine these views clinically, I will quote a case from Radford and Smith. Dr. Duncan gives no case. " I was requested to meet Mr. Dick in consultation with a patient in her first labor. The patient was confined on the lap of a female friend, and was delivered in that position. " After the child had cried, and the placental foetal circula- tion had ceased, the funis was divided. It was of the ordinary length, and did not encircle the neck. The patient was now put to bed. I placed my hand on tlie abdomen, and found the uterus hard, and rather larger than usual. I now took the fimis in the left hand, and gently stretched it, and passed the finger of the right hand into the vagina to examine for the placenta, but was not nexium 40 mg generic able to feel it. While I made the inquiry, Mr. Dick placed his hand rather suddenly upon the 470 THE MECHANISM OF SPONTAIs'EOUS belly; a strong forcing what is generic for nexium pain came on, and the woman ex- claimed : ' Oil ! the nexium dosage 80 mg after-birth is coming ! ' The placenta was now rapidly advancing, and in a moment it 'passed through the os externa. I then discovered it was not the pla- centa alone, but the uterus, constituting generic form of nexium an extreme degree of partial inversion. TJie protrusion was sudden and forcible, and was attended by a bearing-down effort. The uterus was returned easily, and the hand carried into the cavity. The os uteri grasped the wrist, assuring me that regular action was in operation." " I was summoned by my friend Dr. W. Bryant to assist him in a case of tedious labor for inertia. After consultation, we determined on delivery by the forceps. After chloroform, we delivered her of a living when does nexium go generic child. "While she was still in- sensible, a few seconds only after the birth of the child, I placed my hand on the lower part of the abdomen to 80 mg nexium ascertain if the uterus contracted properly. At this time, the vulva was uncovered, and a slight amount of haemorrhage was taking place. While my hand was on the hard and contracted uterus, I felt the rounded mass disappear ; it seemed to subside into the pelvis. At the same instant, a mass presented at the ostium vagina, and was quickly expelled. Our first thought was of twins, but we soon saw that it was the inverted uterus, with the placenta attached. The placenta was carefully peeled oif, and we found but little difficulty in returning the organ through the os uteri. JSTo time what is the generic name for nexium had been allowed for firm con- traction of the OS upon the extended organ. There was no traction on the cord," These are typical cases of the spontaneous active inversion of the uterus, and many cases could be adduced from a large number to show that active contraction existed in the body and fundus before the inversion took place. It is admitted by Kadford and Smith that, generic for nexium 40 mg after the delivery of the child, the uterus was hard and well contracted and felt as a round body above the pubes. There was no paralysis or inertia in these cases ; no cup-like indentation or depression is spoken of as having shown itself, or generic equivalent of nexium felt by the hand. The inversion was sudden a,nd quick, through the contraction of the uterus. In cases of this nature, we cannot but appreciate the fact that ACTIVE UTEEITiE INVERSIOIS^ 471 activity of tlie whole organ, body and cervix, would render in- version impossible. As the contraction of the fundus was evi- dent to tlie hand, firm and round, the generic name for nexium lower part of the uterus body and cervix must have been relaxed, or in a state of in- ertia, to admit of the generic brand for nexium inversion. On this single point, I will quote one of the prominent authors who advocates the de- pressed fundus in inversion first, to present his own question in answer to the cases I have cited fi"om Radford and Smith : " Will any one therefore claim that the commencement of the process of inversion is in the spot actively contracted ? " It is clear that Hadfbrd and Smith certainly do, as well as others. If so, then I would ask. Can the muscular action of the walls of the uterus indent or drive any part of its structure into the cavity ? I am not now speaking or referring to any part of the uterus affected with paralysis at this time. I take it that no regular or irregular action of the fundus of the uterus could produce introcession does nexium have a generic of a part of the parietes of the body. As these points will be conceded and is there a generic for nexium have been generic version of nexium by the advocates of the indentation of the fundus first by contraction, or inertia, or paralysis order nexium samples of the fundus and body of the uterus, then there must be some other method or mechan- ism to be recognized, to account for the production of inversion in cases of active when will nexium become generic contraction of the body and fundus of the uterus. As illustrating this point more than I have, and before I advance to an explanation for the reason I buy generic nexium entertain an oppo- site opinion to the generally-received one, I will give a clini- cal instance of the spontaneous active reinversion or replace- ment of the uterus, of recent date and of unquestionable authority.

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