DYSTOKIA BY DISPLACEMENT. 287 



At a recent meeting of the Medical Society of Strasburg, M. Kopp {Gazette Medicale 

 de Strasbourg, 1875) exhibited the uterus and its appendages belonging to a Bitch upon 

 which he had operated in order to extract a foetus which was lodged in one of the uterine 

 cornua. The animal had been restless for some twenty-four hours when Kopp was 

 called in to examine it ; he found every indication of approaching pafturition, but not- 

 withstanding these, and the considerable volume of the abdomeji, tne os uteri was almost 

 closed — a circumstance which decided him to wait. During the night the Bitch gave 

 birth to a dead puppy, and on the following day the diminished distention of the abdo- 

 men enabled him to discover, beneath the skin, the presence of three fa-tuses. On inquiry, 

 he ascertained that for some time the animal had been suffering from an inguinal hernia 

 on the left side, and this information led him to adopt active measures. The skin was 

 incised over the isolated hernial sac, as far as the inguinal canal ; then, after largely 

 opening the tumor, as well as the uterine cornu it contained, he was able to remove the 

 three dead foetuses and their membranes. The prolapsed uterine portion having been 

 carefully cleansed, was closed by suture and returned to the abdominal cavity, and a 

 strong ligature placed round the sac. The inguinal canal had been widely incised ; but 

 notwithstanding this, the reduction of the uterus and its annexes offered some difficulties, 

 in consequence of the great mass of fat in and upon the broad ligaments surrounding 

 them. Every thing appeared to be going on favorably until the ninth day, when the ani- 

 mal suddenly succumbed. Death was attributed to purulent absorption, produced 

 through the agency of a small abscess on the broad ligament, which had been abraded 

 during the operation of reduction. There were no traces of metro-peritonitis, and the 

 wound in the uterus, as well as in that portion of the sac which had been ligatured, was 

 cicatrizing most satisfactorily. According to Kopp, this was an instance of intra and 

 extra-abdominal pregnancy at the same time ; and in proof of this, he pointed to the 

 narrowness of the inguinal canal, and the presence of the uterine hernia previous to im- 

 pregnation. 



Three of the foetuses were developed in the cornual hernia, and the fourth in the body 

 of the uterus. 



Pathological Anatomy. 



The pathological anatomy of uterine hernia is not without interest to 

 the obstetrist ; and as it has been studied in animals which have died during 

 attempts at parturition, or have been slaughtered after that act, the evi- 

 dence is as plentiful as it is reliable. 



According to Saint-Cyr^ the chief and essential lesion is of course to be 

 found in the abdominal parietes. The fleshy or tendinous fibres of the 

 oblique muscles may be merely separated, especially at the commence- 

 ment ; though most frequently some of them are ruptured. The great 

 rectus muscle always shows a solution of continuity, the rupture being 

 sometimes as clean and sharp as if it had been made by a knife ; though 

 at other times it is irregular and lacerated. In every case there results a 

 variable-sized opening, more or less circular, oval, or triangular, its larger 

 diameter corresponding to the axis of the animal's body \ Rodet has seen 

 an opening of this kind measure nearly twenty inches. 



The seat of the rupture varies ; sometimes the rectus muscle is perfor- 

 ated at its pubic insertion, as Favre has seen it ; in other cases it is else- 

 where, but in every instance it is inferior, posterior to the umbilicus, and 

 to the right or left of the linea alba. The latter structure is at first never 

 involved ; but when the hernia increases largely in size, it may in its turn 

 give way ; so long as it remains intact it forms a kind of cord extending 

 from the pubis to the sternum, and by partially dividing the tumor^ gives 

 it a bi-lobular appearance. 



In a few cases the tunica abdominalis resists the strain imposed on it, 

 being only extended, and in this way the hernia has another covering, in 

 addition to the skin ; but in many instances it tears like the muscles. 

 Delplanque has shown that the peritoneum may escape rupture, stretch 

 and, accompanying the descending viscera, constitute a serous tunic to 



