^SJ^ 



URINARY CALCULI. 405 



ble to get it up, there is one resource left, which is ro cut down on 

 the stone through the anterior side of the vagina, or to perform va- 

 ginal lithotomy. 



924. The labia or nymphfe may have become agglutinated pos- 

 teriorly to the fecundation, and either wholly or partially close up 

 the vagina. The hymen may be hard, fibrous or cartilaginous, to 

 as to leave but a small orifice, and thus interfere ^vith the escape of 

 the child (143). Delivery is not in such cases impossible: such fee- 

 ble barriers are incapable of counterbalancing the energetic contrac- 

 tions of the uterus; but it is better to divide with an instrument those 

 parts that have to be separated, than to expose the woman to the 

 risk of ruptures and irregular lacerations whose limits cannot be pre- 

 scribed, and which might go to a dangefous extent. 



925. Where the vulvar extremity of the vagina is completely 

 obliterated, no conception could possibly have taken place by the na- 

 tural passages; but it is not uncommon to meet with bridles or par- 

 tial contractions in some part of the canal. Where these frena are 

 not very old, or very hard, they ordinarily become softened and yield 

 to the mere progress of the labor; where they resist, so far as to 

 awaken a fear of laceration of the womb, inertia, convulsions, ex- 

 haustion, or their own rupture, they should be divided by making a 

 few small incisions on their anterior edges. A woman who was in 

 labor of her third child, and who two years previously was delivered 

 by means of instruments, was brought to the hospital de Perfection- 

 nement, by M. Dubourget, after having been three days in travail: I 

 was about to apply the forceps, but was soon arrested by a large cres- 

 cent shaped bridle, which was hard, and as it were, fibro-cartilaginous 

 which was two inches above the vulva, and on the free edge of which 

 I found it necessary to make three incisions. 



926. When the vagina opens into the bladder, fecundation being 

 on that account evidently impossible, it is therefore useless to class 

 this deviation among the causes of dystocia. 



Several authors, and among others Barbaut, and still more recent- 

 ly M. Marc, have made mention of women in whom the vagina 

 opened into the rectum, who notwithstanding became pregnant, and 

 yet were delivered without any artificial aid. 



Stegmann relates the case of a girl whose vagina opened above 

 the pubis, and Morgagni speaks, after Gianella, of a case in which fe- 

 cundation nevertheless took place: in such a case it would be neces- 

 sary first to try, like the Italian accoucheur, to dilate the preternatu- 

 ral opening, and should that prove insuflacient, to make several eccen- 

 tric incisions upon the orifice, not losing sight of the proximity of 

 the peritoneum and bladder. 



