406 DYSTOCIA 



Scirrhous or fibrous tumors capable of affording an obstacle to 

 delivery, and requiring serious operations, rarely occur in the vulva; 

 but chronic or acute phlegmons are met with that might be singular- 

 ly aggravated by the passage of the foetus, and it is important, there- 

 fore, that they should be very energetically treated in vt^omen who 

 are approaching their term. 



The labia are, at times, the seat of bloody tumors, of a particular 

 kind, that I have long mentioned in my lectures, which Dr. Dewees 

 also has described in the American journals, and to the consideration 

 of which I shall return when I come to treat of the accidents of par- 

 turition; for the present, I shall content myself with stating, that 

 where they are sufficiently large to interfere manifestly with the birth 

 of the child, or expose the mother to very acute suffering, I should 

 not hesitate about plunging a bistoury into them, so as to empty them 

 completely. 



927. Some women, though in other respects robust, are aflected, 

 towards the close of pregnancy, with a considerable infiltration in 

 the lower limbs, and even in the whole body. The cutaneous and 

 mucous folds of the vulva may in such cases attain to an enormous 

 size, and completely close the vagina; the termination of a labor 

 is thus rendered, of necessity, much more difficult, and above all 

 much more painful ; it cannot be dissembled, that by leaving na- 

 ture to herself here, there will be reason to fear the occurrence of 

 gangrene, or of more or less extensive lacerations; unhappily, al- 

 though threatened with such dangers, there is little that the accou- 

 cheur can do; some punctures, the application of emollient and se- 

 dative lotions, and care in relation to the disposition of the parts and 

 to the muscular efforts of the woman, afford all the materials for his 

 counsel. 



928. Inversion of the vagina may take place during pregnancy 

 and even during labor. I was called last spring, by Madame Beva- 

 let, to see a woman who had been suffering for thirty hours without 

 being delivered. The head of the fostus was quite down in the ex- 

 cavation; but the vagina, which was entirely inverted, exhibited out- 

 side of the vulva, the appearance of a fungous and livid cushion 

 larger than two fists. It was necessary to apply the forceps for the 

 delivery of the patient. 



929. Much has been said about the obliteration of the os uteri of 

 women in labor; but if it is not wholly certain, it is at least highly 

 probable that the authors who have mentioned it were misled by 

 some deviation affecting the os tincae. I have already seen so many 

 practitioners, even experienced ones, affirm that there was no os uteri 

 at all, in cases where it was merely raised up towards the sacro-ver- 



