TUMORS. 407 



tebral angle, that it seems to me very easy to refer a great majority 

 of the cases of supposed obliteration of the os uteri to this mistake 

 alone. It is evident that nothing less than some severe disease, some 

 acute inflammation, could thus close up the mouth of the womb, be- 

 twixt the fecundation and the term of gestation; but in that case the 

 parts would necessarily be affected with concomitant alterations of 

 structure, sufficient to remove all doubts; the anamnestic signs would 

 have attracted attention precedently, and abortion could rarely fail to 

 take place. 



However, if authentic examples be wanting of complete oblitera- 

 tion at the period of labor, we at least possess several instances of 

 coarctation, partial or total induration, and still more numerous ones 

 of stricture in some other portion of the os uteri. 



Were the canal closed by a spongy or polypous mass, like those 

 met with by Denman and M. Evrat, we should wait for its descent 

 into the vagina, to attempt its extraction, after which we should pro- 

 ceed as in any other case of parturition. 



930. A scirrhous induration, of partial extent, might require no 

 particular assistance. In a case mentioned by M. Desormeaux, the 

 whole dilatation took place at the expense of only two-thirds of the 

 circumference of the orifice, and the escape of the ovum was scarcely 

 retarded; but if the whole of the cervix uteri were involved, either at 

 its vaginal extremity, or at a point near the cavity of the uterus, the 

 vaginal-cesarian operation would be indicated, it being well understood 

 that a forced dilatation with the fingers or the speculum, either could 

 not be attempted, or had been vainly tried. 



931. A fibrous tumor, a scirrhus, a polypus, cicatrices, an ulcer, 

 an abscess in the substance of the womb, or even upon its internal 

 substance, would also require particular precautions, provided it were 

 possible to ascertain their existence. In the first place, the diseased 

 point does not in general partake in the extension of the organ during 

 pregnancy, or does not contract again after delivery; in the next 

 place, it deranges or interrupts the contractions daring labor, and in 

 that way favors the occurrence of convulsions, laceration of the womb, 

 hemorrhage, inertia, and general exhaustion. In order, therefore, to 

 protect the woman as far as possible from such dangers, it would be 

 necessary to extract the child, without waiting too long, either by the 

 hand or with instruments. 



932. Labor is also sometimes rendered very difficult, and even 

 wholly impossible, by means of displacements and deviations of die 

 womb. 



There are instances of complete prolapsus which did not prevent 

 the woman from being fecundated ; witness the peasant woman 



