404 DYSTOCIA. 



the pelvis may be higher than the breast, and all the muscles in a 

 state of relaxation; then by means of tlie hand or fingers, we at- 

 tempt to push the tumor out of the passage; finally, when all at- 

 tempts at reduction have proved to be fruitless, it may become indis- 

 pensably necessary to extract the tumor by making incisions through 

 the vagina or rectum, or even to have recourse to the cesarean 

 operation. 



921. Sarcomatous, scrofulous, fibrous or other tumors that are 

 situated in the cellular tissue of the pelvis, and that cannot be dis- 

 placed, are much more dangerous than the foregoing ones; by resist- 

 ing the head of the child, they expose the Avomb and other organs con- 

 tained within the excavation to contusions, perforations and lacerations 

 that it is not always an easy matter to prevent; they also induce iner- 

 tia and exhaustion, and pretty frequently excite hemorrhagies, con- 

 vulsions, or various kinds of inflammations. 



922. Those of the recto-vaginal septum are, most generally, sim- 

 ple encysted tumors; this at least seems to result from the observa- 

 tions of Plenck, of M. Pelletan, and a case recently noticed by M. 

 Roux at La Charite at Paris. The woman has sometimes succeed- 

 ed in expelling them, either through the anus or through a laceration 

 in the perineum. In some cases they have been ruptured by the 

 muscular eftbrls, and that without any ill consequences, when the 

 fluid they contained was permitted to escape into the rectum, the 

 vagina, or even to be effiised in the surrounding cellular tissue. But 

 they may also end in abscess, gangrene, or a mortal peritonitis, if the 

 laceration extends into the peritoneum. It is, therefore, most pru- 

 dent to empty them or extract them as soon as they are ascertain- 

 ed to be capable of hindering the escape of the foetus, or rendering 

 it dangerous. In such cases, it is not always an easy matter to dis- 

 tinguish an hydatid or encysted tumor from such as are solid; but, as 

 has been pointed out by M. Desormeaux, a puncture with a small 

 trocar will suffice to remove all doubts upon the subject. 



923. Calculi in the bladder. It is evident that a large stone 

 might, during labor, become situated directly behind the pubis, so 

 as to shorten the antero-posterior diameter of the pelvis. But a stone 

 being violently pressed from above downwards, by the child's head, 

 would almost necessarily give rise to contusion or laceration of the 

 bladder or of the recto-vaginal septum, as well as the pain that would 

 ensue thereupon. It would be easy, at the commencement of labor 

 to push the stone upwards, and retain it above the symphysis pubis, 

 until the head could get below it. Should the practitioner arrive late, 

 and find the stone coming down before the head, he should, notwith- 

 standing, endeavor to raise it above the strait. AVhere it is impossi- 



