330 



MATERNAL DYSTOKIA. 



pushed in front of the pelvic inlet, and the parts of the foetus which pre- 

 sent be immediately brought therein : so that the tumor may be kept out 

 of the track of the latter. 



Should the growth be of the nature of a kyst or abscess, merely punc- 

 turing it by means of a bistoury, scalpel, or trocar, will evacuate its fluid 

 contents, when it will collapse and birth be rendered possible. 



When it is a pediculated tumor like a polypus, it may be got rid of at 

 once by extirpation, if the pedicle is easily accessible. To this end the 

 pedicle may be simply ait through ; but this measure, though the most 

 expeditious, is not always the best ; as there may ensue internal haemor- 

 rhage, which will be all the more troublesome as haemostatic agents are 

 difficult of application to the wound. 



The pedicle may certainly be ligatured, either in mass or partially 

 previous to extirpation, in order to obviate the disadvantages attending 

 simple excision. This means has been successfully employed, and 

 though perhaps a longer and more difficult operation, it is to be preferred 

 when possible. 



Saint-Cyr recommends, before all other measures, linear ecrase?ndnt, 

 should Chassaignac's or any other ecraseur be available. This ecrascme7it 

 should be no more difficult than simple excision, and so far as haemorrhage 

 is concerned, it is as safe as the ligature, while its consequences are 

 much more trifling. Cartwright has most successfully removed a vaginal 

 tumor by the ecraseur. 



When the base of the tumor is very small, and has but a slender attach- 

 ment to the textures from which it springs, and when, in addition, it is 

 beyond the application of a ligature or the use of the ecraseur, it may be 

 torn off, or removed by the finger-nail. 



The most difficult tumors for treatment are those which are hard and 

 sessile, and to which the foregoing measures are not applicable. It some- 

 times happens, however, that these formations have only a very loose 

 connection with the subjacent tissues, and it is often possible to remove 

 them either wholly or in part, by making incisions through them, and 

 enucleating the divided portions by means of the fingers. 



It is rare that these neoplasms developed in the labia of the vulva 

 offer any obstacle to birth ; should they chance to do so, however, it is 

 easy to remove them by means of the scalpel or bistoury. If the subse- 

 quent oedema of the labia has not disappeared when parturition com- 

 mences, and if it hinders exploration by the hand, or the expulsion of 

 the foetus, it may be combated by scarifications. These, however, should 

 only be made during parturition. 



There may occur cases, nevertheless, in which, either from the nature, 

 mode of attachment, or situation of these tumors, their removal is not 

 possible, and birth cannot be effected. In such cases it will be for the 

 obstetrist to decide whether he will have recourse to embryotomy or the 

 Caesarean section : this decision being arrived at after duly weighing all 

 the circumstances and facts relating to them. 



Having completed these general considerations on utero-vaginal tumors 

 as a cause of dystokia, and offered the above indications in the way of 

 treatment, we will now proceed to notice each class of these formations, 

 in so far as they have been recognized as obstacles to parturition in 

 animals. 



