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as a natural labor. If it requires this amount of force of forty pounds to deliver the child, and it is principally through the uterine forces it is delivered, it would appear that the same force would be necessary for inversion Sl Nitroglycerin : what amount of press- ure, then, would be required to indent the uterus when in a state of contraction ? Could the deltoid or gastrocnemii Ntg Nitroglycerin mus- cles when in powerful or strong action be depressed or in- dented ? The advocates who favor Nitroglycerin Mg tlie indentation of the fundus, either in the active or passive inversion, consider that the im- pulse of the intestines and the abdominal nisus will produce inversion. It is believed that this force or power is nearly if not quite as direct as that of the uterus itself. Joulin has, however, asserted that this force, the abdominal nisus, has no direct action, and it is probable that its actual product scarcely rises above a few pounds. Klob, while addressing his remarks to the subject of that part of the uterus which is locally par- alyzed in exceptional cases, and has been supposed to fall into the cavity of the uterus, says : " I take it to be absurd to pro- pose to regard Spray Nitroglycerin the pressure or impulse of the abdominal nisus as the cause of the sinking inward of the Nitroglycerin Sublingual paralyzed part." If this is true as so emphatically asserted by these able authori- ties, in cases of inertia, how is it possible for a contracted organ to be indented at the fundus cup-like before inver- sion ? To strengthen this point more positively. Dr. Robert Lee, on the impulsion or pressure of the intestines producing the indentation or depression of the fundus uteri, says : " On examining the bodies of women who have died soon after delivery, I never saw the uterus in such a state of uterine re- laxation or Buy Nitroglycerin inertia as to render it possible Nitroglycerin 2 for the intestines, however forcibly drawn against the fundus by the action of the abdominal muscles, as in vomiting or coughing, or strain- ing, to produce the accident." If, as I have remarked above, that activity of the fundus and body renders introcession or proi'scting inward of its walls an impossibility, how is it pos- ACTIVE UTERINE LNVERSION. 4<5 sible to believe witli Smith that a contracted fundus should become an iutrocedent body to excite the annular contraction that is spoken of by himself and Fabre, and thus become the means Iv Nitroglycerin by which the fundus should Nitroglycerin Buy pass through the cervix uteri and become inverted ? Reversely to this opinion, Duncan says, " There must be, therefore, a paralysis of the part before inversion can be begun." To fortify and illustrate this view, he falls back upon the paralyzed condition of that part of Buy Cheap Nitroglycerin the uterus where the placenta is attached. As proof of this, he refers to the testimony of Rokitansky, ISTow let us see how well this point is sustained : " This part, the paralyzed part, is forced into the cavity of the uterus, by the contraction of the surrounding tissue, so as to project in the shape of a conical tumor, and a slight indentation is noticed at the corresponding point of Sublingual Nitroglycerin the external uterine sur- face." I would remark that Fabre entertained the same view, which was first clinically shown by Rokitansky as a patholo- gical fact. Yerj few obstetricians but will admit, in some cases of tedious labor, inertia of the body and fundus of the uterus, but, in these cases of indented or depressed fundus, the uterus, after recovering from the laborious task it has gone through, regains its tone and natui'al contractility, and the inertia passes away, and no paralysis or inversion occurs. It is only a temporary functional inertia or paralysis, incident to the uterus being overtaxed. The process Rokitansky refers to is a diseased process Nitroglycerin Sl — a true paralysis of a portion of the walls of the uterus, and has no special relation to the ordinary or functional paralysis of tedious labor or adherent placenta. If this were the case, the physiological act of labor would be frequently pathological, and ISTature is not so aberrant. This morbid process is hardly ever recovered from, and I have seen the bulging in of the walls of the uterus, from this condi- tion of the uterus, Nitroglycerin Iv mistaken for polypus, and operated upon for that disease. Klob insists, and would have it Nitroglycerin Spray specially attended to, that he particularly cannot understand wherefore the paralyzed portion of the uterine walls always sinks inward into the uterus, while at the same time, in consequence of the energetic contraction of the other parts of the walls of the uterus, the cavity is reduced to small dimensions. On the L 476 Nitroglycerin Tablets THE MECHAlSnSM OF SPONTANEOUS contrary, regarding the pathological condition of the uterus where the placenta is attached, an author Nitroglycerin Cream of Great Britain holds that the placental site is thicker than the rest of the walls of the organ, and naturally projects inward — whether tiie placenta be still adlierent or detached ; therefore, the first condition is the falling in or depression of the pla- cental site of the fundus, the first degree of inversion. If the arguments of Klob and others show that, even in atony by paralysis of the placental site, it could not be projected inward, by the abdominal nisus or intestines ; how could it be, then, when the paralyzed part was thicker, except by its gravity ? Statistics, however, show that the fundus is rarely occupied by the placenta, for, out of seven hundred and thirty-seven cases as recorded by E-eid, only sixteen cases were at the fundus, while there were five hundred and sixty-five at the sides — one hundred and forty-five in the vicinity of the os, and eleven on the OS. In Buy Nitroglycerin Online the \qx\o\\s, ^ost-mortem examinations I have seen, Nitroglycerin Tablet and from several specimens which have been sent to me after sudden deatli Order Nitroglycerin from haemorrhage before delivery, the cervix was closed, and the parietes were found thin and flabby, and in some parts thicker than others. "When held up to the light, the thinner parts were translucent, but no projecting in-

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