408 DYSTOCIA. 



mentioned by Morgagni. In other cases, the falling of the womb 

 occurs during pregnancy. In both cases, provided the gestation 

 goes to its full term, it is possible for the womb, which here cannot 

 be seconded by the abdominal muscles, to deliver itself alone; but 

 it is also possible that the pains should prove to be insufficient, and 

 thenceforth prudence requires us to make use in succession of de- 

 coctions, mucilages and ointments of an emollient nature, and resort 

 to the dilatation or incision of the edges of the orifice, and afterwards 

 bring down the child's feet. 



Sennertus and Ruysch have related cases of hernia of the womb, 

 where the women have, notwithstanding, become pregnant; but every 

 consideration leads to the belief that mistake here has more than on 

 •one occasion arisen from a very decided anterior obliquity of the 

 womb. 



This kind of displacement forms, in the opinion of several authors, 

 an insurmountable obstacle to the spontaneous termination of labor; 

 so that, under such circumstances, they have thought of no better 

 counsel than that of resorting to the cesarian operation; however, 

 this last recourse will hardly be taken by a man who is fully ac- 

 quainted with the resources of the animal economy. Provided the 

 reduction be possible, the accoucheur will attempt it: in the con- 

 trary case, he should be content with recommending the horizontal 

 posture, and advising the woman not to bear down. During the 

 contractions, and even during the intervals .between them, it is pro- 

 per to press the uterus backwards, with the two hands applied to the 

 epigastrium, as if to make it re-enter the abdomen; by means of 

 these precautions, which are not even always indispensable, the os 

 uteri dilates, opens, and the labor most frequently terminates without 

 further assistance, and without danger, even in cases apparently the 

 most difficult. An accoucheur at Copenhagen was called to a woman 

 who had for a long time had a crural hysterocele, and who exhibited 

 some symptoms of pregnancy; the period of delivery arrived, the 

 surgeon had given the most unfavorable prognosis, and thought he 

 should be under the necessity of performing the operation of hyste- 

 rotomy. But nothing of the kind happened, and the labor terminated 

 spontaneously. Ruysch and Simon relate two cases of uterine 

 hernia equally remarkable; in one of them the cesarian operation 

 was performed and the woman died; in the other, nothing was done, 

 and both the mother and child were saved! 



Simple deviations of the womb may also interfere with the pro- 

 gress of parturition and require some particular care. Upon this 

 subject I ought to remark, that it is far more important than writers 

 seem to suppose, not to confuse deviations of the cervix with those 



