Uterine rotation : its clinical importance in pregnancy and labour / by James Haig Ferguson.

  • Ferguson, James Haig, 1862-1934.
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: Uterine rotation : its clinical importance in pregnancy and labour / by James Haig Ferguson. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    subject.” On the other hand, I quite admit that examination of the living subject is, of course, always liable to error, and one can never claim for it absolute accuracy, owing to the impossibility of getting directly at the uterus, and the varying degrees of skill of different examiners. Of this, however, I am sure, that rotation of the uterus, especially in the third stage of labour and immediately post-partum, can be better observed clinically than after death ; and owing to the special facilities existing then, one can claim for one’s clinical examination a very fair degree of accuracy, perhaps greater than under any other circumstances. Rotation is to a great extent a vital property of the uterus; it tends to disappear when muscular contraction ceases, and to become undone by post-mortem gravitation. The greater the muscular contraction and retraction, the more marked (cceteris paribus) is the rotation. Such vital processes are apt to be overlooked in the conclusions which are drawn from the examination of frozen sections alone, and consequently the results of patient anatomical work often lose much of their practical importance. Take as an illustration the position of the apex-beat of the heart. If one were guided by post-mortem evidence alone, one would be led consider- ably astray. One would imagine it to be produced, as Vierordt shows, by the tip of the right ventricle, and to be further from the middle line than it is; whereas, as a result of a movement of rotation occurring during each systole, the apex of the left ventricle comes to the front and impinges on the chest-wall at a spot nearer the middle line. The minute and careful descriptions of post-mortem frozen sections are interesting enough in their way, and have no doubt done a great deal to open up and elucidate much that is of import- ance as regards the relationships of parts which are more or less rigid or incarcerated, and whose position is not much affected by death, and post-mortem changes, especially and notably,—for example, advanced pregnancy, the two first stages of labour, and certain cases of extra-uterine gestation. They are, however, of no practical value whatever in alone determining the exact position of a freely movable organ, such as the body and fundus of the uterus, which even in life is affected by every movement of the body, and whose attitude, especially after labour, is to a great extent dependent on muscular vitality and tonicity. Especially does this hold good in the determination of the position of the unimpregnated uterus, the uterus in early pregnancy, and the uterus in the third stage of labour and post- partum. For in these circumstances the uterus is freely movable, not being unduly large, and consequently comparatively little influenced by outside pressure apart from the general abdominal pressure. Webster found that in all his cases the walls of the uterus were