Thisis most likely to occur in delicate females, and in those who are debilitated by disease. The contractions are very feeble, and, as the nurses saydo not tell; the mouth of the womb dilates but slowly, and the head descends with difficulty into the passage.
In many cases in fact the labor is so tedious, from this cause, that the female becomes completely worn out, and finally sinks, while the child is exposed to the greatest hazard from the delay.
It is in these cases that the patient's strength needs supporting, and that stimulants may be useful. A little wine, or brandy and water, will often rouse the failing energies, and bring on a series of strong contractions that will end the labor at once.
The most usual resort however is to the drug calledErgot, orSecale Cornutum, a fungus growth which is sometimes found on ears of rye. This possesses the peculiar property of exciting the womb to contract, the same as an emetic excites the stomach to vomit, and it seldom fails in its effect; but still there are many objections to its use. It not unfrequently causesdelirium, great restlessness, and anxiety, sickness, headache, and convulsions, or complete prostration, from which the female may be long in recovering. It is also supposed by some tobe not altogether free from danger to the child. If however no other means were known of making the womb contract, in such cases, all the probable evils should be risked, because the labormustbe completed at all hazards; but other meansareknown, which succeed even more certainly than ergot, and without any danger. The application ofGalvanism, explained in my "Neuropathy," and "Practical Facts," will almost invariably cause the womb to contract, and speedily bring the labor to a safe termination, without the slightest risk or inconvenience, to either mother or child. Simple friction over the abdomen will also succeed in many cases, and gently rubbing the mouth of the womb with the finger in others. These simple means should therefore always be used in preference to the ergot, but in case they cannot be resorted to, or fail, the drug must be administered, and I will therefore explain the manner in which this is done. When gathered the ergot is in large irregular lumps, and should be so kept. When wanted for use a single drachm should be finely powdered, and divided into three parts; one of these parts to be taken first in a glass of sugar and water, and the others at intervals of ten minutes, unless the effects of the first are very powerful. It is often thrown from the stomach however even in still smaller quantities, and is then given, by some, as an injection by the rectum, in which mode it seems more powerful, so that a smaller dose is sufficient.
Great caution should always be observed in using this powerful drug, as it will sometimes act so energetically as toburst the womb; or expel the child so suddenly as to lacerate the perineum and other parts. The contractions produced by it are different from the natural ones, being almost constant, without anyinterval, and gradually increasing in force. They usually come on in about ten or fifteen minutes after the last dose, and continue about an hour and a half. Some practitioners depend almost altogether on the ergot, in every protracted case, and even use it to bring onpremature labor, when that is required. Thus M. P. Dubois was once called to a dwarf, whom he delivered with instruments, the first time, but with great difficulty and risk. The next time she became pregnant he determined to bring on premature labor, and accordingly he administered ergot, when she was abouteight monthsgone. This brought on natural labor, and she was delivered without difficulty. M. Chailly says he believes it will bring on uterine contraction at any time, and that he has never known it to fail. I consider however that there is always more or less risk in its use, and I should certainly prefer any of the other means, particularlyGalvanism.
It is of the first importance however to be certain, before usingany forcing means whatever, that there is nophysical impediment. If the pelvis should be deformed or small, if the child's head should be unusually large, or dropsical, or if the soft parts of the mother should be undilated and rigid, the most serious consequences must ensue from violent uterine contractions. In like manner if the presentation be unfavorable, particularly if it be one of the trunk, the danger is equally great. In every case the passage of the child must bephysically possible, before it is attempted to force it away. A neglect of this rule has frequently led to fatal results. The ergot has been given and the uterus forced to contract, while the pelvis was too small for the child to pass through; and the consequence has beenrupture ofthe uterus, or complete exhaustion, with death to both mother and infant. In other cases the delivery has resulted so suddenly, from the violence of the expulsive efforts, that the vagina and perineum have been lacerated in the most shocking manner.
The ergot is also especially dangerous to very nervous women, or to those who are disposed to congestion, apoplexy, or inflammation.
Among the special causes which often paralyze the action of the womb, may be mentioned a full habit of body, great distention of the uterus from accumulations of fluid, and extreme thickness of the membranes. In some cases in fact, the membranes will be so strong that the most violent contractions fail to break them, and the uterus completely exhausts itself to no purpose. It is in such cases as these, when the mouth of the womb is fully dilated, that the accoucheur should rupture the membranes artificially. This is usually done with the finger nail by pinching them. Some practitioners however use a pointed instrument, or a sharp quill; but there is always more or less danger of injuring the child or the mother by such means. The best time for breaking them is during a strong pain, when they are fully distended. The mere scratching, or pushing on them will frequently suffice. I have known cases however in which they were so strong that an instrument was actually necessary to open them.
The death of the infant also seems sometimes to check uterine contraction, though probably not from the mere circumstance of its being dead, but because the womb suffers from the same morbid cause which produced its death.
Any strong moral impression may also produce the same state of things. Thus in some females thewomb will instantly cease its contractions, and the labor be arrested, fromfright, or from strong repugnance to somebody, or something, in the room. Instances have been known of women being so alarmed on first seeing the accoucheur, or so displeased because he was not the one they wished, that the uterine efforts immediately ceased, and could not be again brought on for a long time. The presence of some person who is a subject of dislike may also have a very prejudicial effect, and if this is known they should be immediately removed. Dr. Merriman tells us of a female who was seized with a fit, from which she died, simply from seeing a strange doctor enter the room.
Whatever may be the cause which paralyzes the action of the womb we should endeavor, if possible, to discover and remove it. If however it be beyond our reach, the patient's strength must be supported as much as possible, and the simplest means of exciting the contractions tried first; if these fail the more powerful ones must be tried, always preferring the safest. Finally, if all fail, the hand must be introduced into the womb, the child turned, and brought away by the feet; or the forceps must be used if absolutely necessary.
Sometimes the mouth of the womb or other soft parts, will not give way, but remain obstinately rigid, so as to render the continued expulsive efforts of the womb of no avail. If this state continues too long the parts become swollen, hot, and dry, and extremely painful, so that the slightest touch causesacute suffering. The abdomen also becomes exquisitely tender, fever sets in, with cold sweats, the head begins to wander, the features express great anxiety and suffering, and the voice alters so that it can scarcely be recognized. These symptoms will sometimes be established, and become rapidly worse in a remarkably short time, so that the patient will appear to pass suddenly from a condition of comparative ease and safety to one of extreme peril and suffering. The child also suffers in an equal degree, the continued pressure upon its head having a most injurious effect. The bones overlap to a great distance, the scalp is engorged with fluid, and all its blood-vessels are ready to burst; the brain is severely compressed; the circulation in it is suspended, and apoplexy frequently ensues. Even when one of these protracted cases eventually terminates without immediate mischief, there is much subsequent evil to be feared. The bruised parts frequently slough away, so that fistulas are formed, and the whole remain so permanently weak that they can never afterwards retain their places.
The most usual resort in these cases of obstinate rigidity isblood-letting. This frequently induces relaxation immediately, and also checks the tendency to inflammation and fever. In many cases however, if not in all, it may be dispensed with, and should always be so if possible. Very frequently it produces as much evil as good, by alarming the patient, and by creating a debility which cannot afterwards be removed. Simple warmfomentationswill often make the rigid parts give way; and so will lubricating them with soothing ointment, or better still anointing them with theExtract of Belladonna. This frequently acts like a charm, and opens the rigid ostincæ in a few minutes. Injections of thin starch and laudanum are also excellent, and may be advantageously administered before applying the Belladonna. TheGalvanic Batterymay also be employed, it having induced relaxation in many cases, when all other means failed; as will be seen by the cases quoted in "Practical Facts."
If the labor really does progress though slowly, it is generally best to have patience and let it take its course. If however the patient is likely to sink before it is completed, or if it is at a stand still, and cannot be accelerated, artificial delivery may be necessary. It is seldom however that all of the above mentioned means fail.
Sometimes the womb is so much inclined in a particular direction that its mouth does not present to the middle of the passage. Thus it may lean over so much to the right side that the mouth may open against the left wall of the Pelvis; or it may lean to the left side, or to the front. In all these cases the expulsion of the child may be totally prevented, because it is forced against the walls of the passage instead of down its axis.
Obliquity is sometimes righted spontaneously, but more frequently it requires the interference of art. The mode of rendering assistance is to support the womb on the side to which it falls, particularly during the pains, so that its mouth may be directed towards the middle of the passage.
Falling of the womb may retard labor, but is not likely to make it more than usually difficult, nor dangerous. It is requisite, however to bear in mind that the head of the child may, by this displacement, be found in the vagina, and even at the vulva, before it has passed through the mouth of the womb, because the neck itself is already in the passage. The head may therefore be felt low down, and the accoucheur may think the labor will soon be completed, when in reality it has scarcely begun. In such cases it merely requires patience andnon-interference.
In my work onthe Diseases of Women, will be found many curious cases of pregnancy and delivery, occurring during partial or complete prolapsus uteri; and also much information regarding obliquity, and other similar derangements.
These constitute by far the most serious obstacles to delivery, and are most to be dreaded. In treating upon them it will be first necessary to explain the chief kinds of deformities, and the cause from which they arise, after which it can be shown how they interfere with the progress of labor, and how they can be best remedied.
Deformities of the pelvis may either be congenital, or they may be produced by certain diseases in after life, and also by bad physical education. The principal causes however are two diseases,Rachitis, orRickets, andMalacosteon, called alsoMollites Ossium, or softening of the bones. Rachitis usually attacks children somewhere between nine months and twoyears of age, and produces a variety of well marked symptoms; such as large head and belly, protrusion of the breast-bone, flattening of the ribs, emaciation of the limbs, and various deformities of the bones. The patient may recover from the disease, but the deformity of the bones often remains, and therefore no female should become pregnant, who has had rickets, till the shape and dimensions of her pelvis are known, or it may cost her life.
Malacosteon or softening of the bones, may come on at any period of life, and frequently occurs without any serious constitutional disturbance. It consists in a gradual absorption from the bones of all their solid matter, so that they become soft, and may be bent or twisted like horn. Sometimes this state will be reached very soon, but at other times the disease progresses very slowly. The causes of it are unknown, and it is incurable. I have seen a patient who could bend the bone of her legnearly double, as if it were a piece of rope.
In my work on the Diseases of Woman, I have spoken upon various other causes which may deform the bones in young females, such as wearing corsets, improper attitudes in sitting, and want of sufficientunconstrainedexertion of the body in the open air.
The deformities may be of various kinds, and may either alter the general appearance and the walk, or may not be discoverable except on examination. Sometimes the pelvis istoo large, so that the womb and other parts are continually falling down into its cavity, but this is very rarely seen; more frequently it is either too small, or irregular in its form.
In all cases where the irregularity in form, or diminution in size, is such as to prevent the passageof the child an operation becomes necessary, either upon the mother or her infant, and great danger is consequently incurred by both.
It is therefore the duty of every mother, if she has the slightest suspicion that her daughter is deformed, though it may not be apparent, to have her examined before she is allowed to marry.Many have lost their lives for want of this precaution.Severe blows or falls in early life may also create a pelvic deformity, and this, as a possible consequence of such accidents, should always be borne in mind. The means by which the form and size of the pelvis are ascertained, as before stated, are simple, and such as need not in any way be feared.
To enumerate all the varieties of deformed pelvis, as described by different authors, is unnecessary, and would not be useful here. I shall therefore only refer to them generally. Sometimes the pelvis is regular enough in its form, but singularly small altogether, not larger perhaps than that of a child eight or nine years of age. More frequently, however one part only is small, while the others are full sized, or the different parts are not in a proper position in regard to each other. Thus sometimes the pubic bones will be flattened backward, near to the sacrum, so as to narrow the antero posterior diameter of the upper strait; at other times one of the sides will be flattened towards the other, as if crushed in, and thus diminish all the diameters; and at other times one side will sink down lower than the other, and thus effect similar changes in another way.
By referring to the description of the perfect pelvis, given in the early part of the work, the nature of these changes will be readily understood, particularly if the plates given there are compared with those given here.
PLATE XL.Represents thestandardform, with which the rest must be compared.PLATE XLI.Represents a pelvis which resembles that of the male in its form, and is therefore calledmasculine. It is deeper, and less capacious altogether than the standard one. This form is occasionally met with in females of a peculiar general conformation, and temperament, approaching that of the other sex. It is not a sufficient deviation from the natural form to create any great difficulty, though it may cause delay.
PLATE XL.
Represents thestandardform, with which the rest must be compared.
PLATE XLI.
Represents a pelvis which resembles that of the male in its form, and is therefore calledmasculine. It is deeper, and less capacious altogether than the standard one. This form is occasionally met with in females of a peculiar general conformation, and temperament, approaching that of the other sex. It is not a sufficient deviation from the natural form to create any great difficulty, though it may cause delay.
standard form of the PelvisPlate XL.Represents thestandardform of the Pelvis.Masculine PelvisPlate XLI.Masculine Pelvis.
standard form of the Pelvis
Plate XL.Represents thestandardform of the Pelvis.
Plate XL.
Represents thestandardform of the Pelvis.
Masculine Pelvis
Plate XLI.Masculine Pelvis.
Plate XLI.
Masculine Pelvis.
PLATE XLII.Represents the peculiar deformity most frequently produced byMollites Ossium. The different parts are stretched out as it were, and crushed inwards toward each other. The size of each strait is diminished in nearly every diameter, and the whole form is very unfavorable to delivery. This is sometimes called acordiformpelvis. Observe the difference between it and the standard one.PLATE XLIII.This is called anOvatePelvis. It appears as if it had been crushed by a heavy weight, from above downward, the sacrum being depressed below the plane of the pubes. In this case the antero posterior diameter of the upper strait is so much lessened that the two halves appear nearly separated, and form almost a figure of eight (8).
PLATE XLII.
Represents the peculiar deformity most frequently produced byMollites Ossium. The different parts are stretched out as it were, and crushed inwards toward each other. The size of each strait is diminished in nearly every diameter, and the whole form is very unfavorable to delivery. This is sometimes called acordiformpelvis. Observe the difference between it and the standard one.
PLATE XLIII.
This is called anOvatePelvis. It appears as if it had been crushed by a heavy weight, from above downward, the sacrum being depressed below the plane of the pubes. In this case the antero posterior diameter of the upper strait is so much lessened that the two halves appear nearly separated, and form almost a figure of eight (8).
Mollites Ossium deformityPlate XLII.Represents the peculiar deformity most frequently produced byMollites Ossium.Ovate PelvisPlate XLIII.This is called anOvatePelvis.
Mollites Ossium deformity
Plate XLII.Represents the peculiar deformity most frequently produced byMollites Ossium.
Plate XLII.
Represents the peculiar deformity most frequently produced byMollites Ossium.
Ovate Pelvis
Plate XLIII.This is called anOvatePelvis.
Plate XLIII.
This is called anOvatePelvis.
PLATE XLIV.This is another kind of deformity, in which one side is sunk down below the other, while both are twisted as it were round the sacrum.PLATE XLV.This is a section of a Pelvis to show the effect of a corroding disease of another kind. The whole of this is such a mass of disease and deformity as to preclude any particular description.
PLATE XLIV.
This is another kind of deformity, in which one side is sunk down below the other, while both are twisted as it were round the sacrum.
PLATE XLV.
This is a section of a Pelvis to show the effect of a corroding disease of another kind. The whole of this is such a mass of disease and deformity as to preclude any particular description.
another deformityPlate XLIV.This is another deformity, in which one side is sunk below the other, and both twisted round the sacrum.corroding diseasePlate XLV.The effect of corroding disease.
another deformity
Plate XLIV.This is another deformity, in which one side is sunk below the other, and both twisted round the sacrum.
Plate XLIV.
This is another deformity, in which one side is sunk below the other, and both twisted round the sacrum.
corroding disease
Plate XLV.The effect of corroding disease.
Plate XLV.
The effect of corroding disease.
Curvature of the spine sometimes affects the pelvis, when low down, and therefore if any female is affected with it she should not marry before being examined. Several diseases and lesions of the hip-joint, and of the thigh, may also do the same, and should therefore be suspected.
In the great majority of cases, deformities of the pelvis remain unknown, till the period of delivery, and all that can be then done is to combat in the best possible way the difficulties they create. It is evident that the amount of difficulty depends entirely on the disproportion between the head of the child, and the passage through which it has to be born. If the head be large and the passage small the difficulty will be greatest, but if the head be small it may pass through the pelvis though under its average size. The development of the head cannot be ascertained however, before birth, except when it is unusually large from dropsy, and it is therefore always assumed to be of an average development, and the pelvis is compared accordingly.
The kind of assistance required in these cases depends chiefly on the measure of the pelvic diameters, though it may be modified somewhat by other considerations.
When the smallest diameter of the pelvis measures fromthree inches and a half to three inches, it is customary to leave the expulsion of the fœtus to nature, and it is generally effected, though slowly and with difficulty. If however the patient becomes exhausted, or the head be unusually large, the forceps are generally used after waiting five or six hours. In these cases the head often becomes firmly fixed in the upper strait, so that great force is needed to dislodge it. The upper part passes through, owing tothe overlapping of the bones, and the scalp then bulges out like a large tumor, from being engorged with blood and serum, but the lower being more unyielding remains behind. It is therefore impossible for the head to move either way, as it is formed like a figure 8, and held by the narrow part, as will be seen by the following plate.
PLATE XLVI.head fixed at the upper straitThis Plate represents the head fixed, or impacted, at the upper strait of a narrow pelvis.
PLATE XLVI.
PLATE XLVI.
head fixed at the upper strait
This Plate represents the head fixed, or impacted, at the upper strait of a narrow pelvis.
This Plate represents the head fixed, or impacted, at the upper strait of a narrow pelvis.
When the smallest diameter is not more than fromthree inches to two and a half, the birth is sometimes effected by nature, but with extreme difficulty. The accoucheur waits four or five hours, as in the former case, and then if no progress is made he applies the forceps, using great care in doing so. If the extraction is found impossible, with reasonable force, the head must be opened and made smaller, eventhough the child be living, because it is more proper to sacrifice it than to risk the life of the mother. In a case like this however, no one person would like to decide, unless in a great emergency; there should always be a consultation if possible.
Adwarf, named Lepratt, who used to perform at the theatres, was delivered with the forceps by M. Dubois, though the pelvis only measuredthree inches. She perfectly recovered, though the child was born dead: it was of fair average size.
It is contended by some that the delivery may be effected, under peculiarly favorable circumstances, when the passage measures only two and a half inches, and at all events the effort should be made; but for the sake of the mother such cases should not be left long, as the chance is so small, and the risk of delay so great. When the passage islessthan two and a half inches, spontaneous or artificial delivery is allowed to be impossible, and the only alternatives then are to dismember the child or open the mother. Which of these should be done depends on circumstances. Whenever the childcanbe brought away by the natural passages, though it be piecemeal, it always is so brought, unless the danger to the mother be greater than by the cesarian operation, in which case that operation is resorted to. By means of an instrument called theCephalotribe, which crushes the head, the child may be brought away, unless very large, when the pelvis only measurestwo inches. When the passage isless than two inches, the only resort is to the cesarean operation, which sometimes succeeds, and saves both mother and child, though more frequently the mother sinks.
The necessity for all these frightful operations is now much less than formerly,and may be done awaywith altogether. This important fact should be known universally, and also the means to be resorted to. In the first place, every young female should be examined, before marriage, by a competent person, if there be the slightest reason to suspect deformity; and in case the deformity is found to exist, the consequences if she becomes pregnant, must be laid before her. If, after being told this, shewill marry, or has already done so, the means ofavoiding conceptionshould be placed at her disposal, so that she may not be made, of necessity, a helpless victim. These means need not be described here, though I have no hesitation in referring to them. When I know that thelife, orlife-long health, of a female, depends on her not becoming pregnant, I consider it my duty to put such means at her disposal, if she desires it. In many instances I have known females suffer, several times, the most frightful tortures, merely to bring into the world the mangled fragments of a dismembered child, with the greatest risk to their own lives; and in others I have known them in constant dread of becoming pregnant, because they were conscious it would be their death warrant. In such cases I leave it tohumanity, andcommon sense, as to whether such information should be withheld?Icould not reconcile it with my notions ofdutyto withhold it.
In case pregnancy has occurred before the deformity is discovered, and it is then found that afull grownchild cannot be born, premature delivery must be brought on; or, in other words, the Uterus must be made to expel the child before the full term, while it is yet small enough to pass through the Pelvis. This operation is of course only allowable when needed to preserve life, or to escape great suffering and danger. It must always be decidedupon by the medical man, and performed by him, so that a description of it is uncalled for here. In Europe it is quite common, and nothing has tended so much to do away with those disgusting and horrid operations, on mother and child, which were formerly absolutely necessary in cases of deformity. If it is found at the first delivery of a female, or before, that she cannot bear a living child at full term, artificial delivery is accomplished atsevenoreightmonths, thus avoiding all the danger to the mother, andfrequently preserving the child. In the case of thedwarfbefore referred to, when she became pregnant the second time, M. Dubois brought on premature delivery, and the child wasborn alive, with but little difficulty. According to statistics it appears that, when artificial premature delivery has been induced, inone hundred and sixty-one casesonlyeight mothershave died, and all butforty-sixof the infants were born alive. Of the whole number of childrenseventy-threecontinued to live; and of the eight mothers five died from other causes, leaving butthreewhose death resulted from the operation. Now when the fearful number of deaths from instruments, and other operations, necessary at full term, is recollected, the advantage of this practice will be evident. In the Cesarian operation for instance, which is often the only remaining resort, butonefemale out ofsixrecovers.
The delivery should be postponed as long as possible, so as to give the best chance for the child living. This must of course be decided upon after the size of the pelvis is ascertained. Seven months is the earliest time at which the fœtus is viable, and it is much better left till eight, if the size of the parts will allow of its birth then. In case they are sosmall that it cannot be born even at seven months, we have our choice, as M. Chailly remarks,between the dreadful Cesarian operation at full term, and producing early miscarriage.
M. Dubois seems to recommend premature delivery in nearly all cases, if the smallest diameter isunder three inches; because, as he remarks, spontaneous delivery atfull termis then a very rare exception, and the danger and suffering to the mother is so great. He also recommends it when there are tumors, and even when the female is afflicted with any acute disease. Of course it is always necessary, before operating, to be sure that the child is alive.
I knew a lady myself who had given birth, at full term, tosevenchildren, all of which were torn from her with instruments,dead, owing to the smallness of the pelvis. When pregnant with theeighth, premature delivery was brought on, at my suggestion, at aboutseven months and a half. The fœtus was born with comparative ease, andlived. But for this operation she probably would never have been blessed with a living child at all. Since then she has avoided conception.
Tumors of various kinds are met with, both in the bones of the pelvis and attached to the soft parts. They frequently offer the most serious impediments to delivery, and baffle the skill of the most experienced obstetricians. In fact they differ so much in their structure, their size, and their situation, that but few general directions can be given as to their management. In every case where one exists pregnancyshould never occur, if possible to be prevented, before it is removed; for though it may cause no inconvenience at other times, yet during delivery it may necessitate very serious operations, or even cause death. Some of these tumors are mere vesicles, or bags, filled with fluid, and may be punctured and their contents let out, so as to make them less. Others are more or less solid but moveable, and may often be supported above the upper strait till after the child is born. When they are so large as to block up the passage, and are either fixed or cannot be carried up into the Womb, there is often no other choice than to either cut them out or open the child's head; the practice being determined by the circumstances of the case. In some instances the bladder itself, distended with urine, has impeded delivery, and been mistaken for a tumor; and in other instances stones in the bladder have caused the same error.
A specimen of one of these tumors is represented in Plate XLVII, and one of a Polypus in Plate XLVIII.
PLATE XLVII.This represents an Ovarian Tumor, which has descended before the head of the child, and completely blocked up the passage. The delivery, it will be seen, is utterly impossible in such a case, unless the Tumor can either be pushed away, or reduced in size.
PLATE XLVII.
This represents an Ovarian Tumor, which has descended before the head of the child, and completely blocked up the passage. The delivery, it will be seen, is utterly impossible in such a case, unless the Tumor can either be pushed away, or reduced in size.
Case of TumorPlate XLVII.Case of Tumor.
Case of Tumor
Plate XLVII.Case of Tumor.
Plate XLVII.
Case of Tumor.
PLATE XLVIII.This Plate represents a case which occurred in the practice of Dr. Ramsbotham, and which terminated favorably. The polypus had a very long neck, and was forcedout of the external openingby the child, which was then born with ease. I once saw a case myself, in which the labor was completely arrested by a large hard tumor about the middle of the Vagina; it could not be moved, and delivery was evidently impossible while it remained. In consultation it was decided to cut it out, as there seemed but little circulation of blood in it, and its situation was favorable for the operation. This was accordingly done with but little trouble, and the child was born without difficulty in about twenty minutes after. The mother perfectly recovered.
PLATE XLVIII.
This Plate represents a case which occurred in the practice of Dr. Ramsbotham, and which terminated favorably. The polypus had a very long neck, and was forcedout of the external openingby the child, which was then born with ease. I once saw a case myself, in which the labor was completely arrested by a large hard tumor about the middle of the Vagina; it could not be moved, and delivery was evidently impossible while it remained. In consultation it was decided to cut it out, as there seemed but little circulation of blood in it, and its situation was favorable for the operation. This was accordingly done with but little trouble, and the child was born without difficulty in about twenty minutes after. The mother perfectly recovered.
Case of PolypusPlate XLVIII.Case of Polypus.
Case of Polypus
Plate XLVIII.Case of Polypus.
Plate XLVIII.
Case of Polypus.
Sometimes tumors exist externally, on the lips, or in the Vulva, but as they seldom offer much obstruction, and are easily detected and managed, but little need be said about them. They should always however be attended to, if discovered, before labor comes on, or better still before pregnancy.
In some instances the veins around the Vulva become much enlarged, and resemble tumors, and sometimes even impede delivery. It is usual then to open them, and let out the blood, but not till the head is sufficiently low to press upon it and prevent dangerous bleeding.
The Vagina may be partly closed by its sides growing together, or it may be united by bands and membranes stretching across; and these obstructions may be sufficient to impede or prevent delivery. Most usually they give way, and are gradually broken down by the pressure of the child's head; but if they prove too strong, after waiting a reasonable time, they must be cut through. Cases have even been known in which thehymenhas been found perfect at delivery, and even offered considerable resistance, so as to necessitate its being cut through before the child could be born. In such cases this membrane is unusually strong, and conception occurs without its being broken.
When the perineum or Vulva remains rigid and hard, so that the opening cannot be enlarged sufficientlyfor the child to pass, it may also be necessary to operate with the knife. But this should never be done till after every means of relaxation has been tried, and the head has been kept back as long as prudent. It is however, always better to open a passage than to let one betorn, because it may be made in the most favorable place. When the perineum is allowed to be torn, the most serious consequences often ensue, and the patient is made a miserable sufferer for life. The Vagina and Rectum may be torn into one, or the power of retaining the contents of the intestine, or bladder, may be for ever lost. When an incision is made none of these evils follow; the wound speedily heals, and in a little time no trace of it can be seen. It has even been necessaryto cut the neck of the Womb, when it would not open, to prevent the organ from being ruptured; and this has been done with perfect safety. A celebrated practitioner in this city had to perform such an operation very recently, on a female who had injured herself, and made the mouth of the Womb grow together, by violent attempts to produce abortion. The delivery took place with comparative ease, and no unpleasant results whatever followed, either to the mother or the child.