354 MATERNAL DYSTOKIA. 



— by which is meant incising the cervix, either completely or partially, in 

 one or more places — does not offer any very dangerous consequences 

 when the textures are healthy; though when they are much degenerated, 

 the operation may be followed by troublesome, if not fatal results. Nev- 

 ertheless, dilating the cervix by incision is rarely so serious for the 

 mother as the Caesarean section ; though the foetus may incur more risk, 

 as, after the cervix has been relaxed, it is often a tedious and difficult op- 

 eration to effect delivery, and strong traction may even be necessary. 

 As this measure offers a chance of saving both mother and foetus, it 

 should, as a rule, be preferred to gastro-hysterotomy ; and this preference 

 is still further warranted by the fact that the life of the mother is of more 

 value than that of the foetus, and if one must be sacrificed, it should be 

 the latter. Should the foetus happen to be dead, then there is an addi- 

 tional motive in preferring incision of the cervix. 



When the os has been considered sufficiently dilated for the introduc- 

 tion of the hand and arm into the uterus, then the foetus should be placed 

 in position for extraction — the most favorable being, of course, the verte- 

 bro-sacral, with the head and fore limbs towards the os. Should it be 

 found impossible to engage these in the passage, then more incisions 

 may be made in the cervix, and this can be done without displacing the 

 foetus. 



It is well to remember that it is very much better to dilate the os by 

 incision than by laceration, through unduly forcing the foetus into it. At 

 the same time, judicious traction should be made during the maternal 

 efforts. 



Aubry, Van Dam, and some others, have witnessed fatal haemorrhage 

 resulting from the incisions ; while metro-peritonitis has also been re- 

 ported as an equally unfortunate sequel. 



But these cases are exceptional. Those veterinary obstetrists in this 

 country and on the Continent, who have had most experience in the op- 

 eration, are unanimous in asserting that, provided certain precautions are 

 adopted in making the incisions, no such results are likely to follow. 



Donnarieix states that, in thirty years, he has performed vaginal hys- 

 terotomy in sixteen cases of schirrus, and other kinds of induration' of 

 the cervix leading to occlusion of the os uteri, and of these only one died, 

 though the cause of death was not ascertained. Recovery is the rule and 

 death the exception. 



Of course recovery must always be doubtful if the disease of the cervix 

 is of a malignant nature, as the operation and the irritation caused by the 

 extraction of the foetus will, in all probability, hasten its progress. 



In some rare instances it may be advisable to have recourse to the 

 Caesarean section at once. When, for example, labor has been severe 

 and prolonged — when some days have elapsed since parturition com- 

 menced, and the veterinary surgeon is not sent for until amateurs have 

 exhausted their efforts and the animal is sinking ; or when, from a va- 

 ginal exploration, it is ascertained that uterine or vaginal disease is so 

 extensive and advanced that the mother cannot live much longer, and the 

 foetus is alive ; then this formidable operation should be adopted without 

 delay. 



Though very many cases of induration of the cervix, with stenosis of its canal, are 

 recorded in Continental veterinary literature, yet we do not find lialf-a-dozen instances 

 in English journals. 



Of these we select the following : 



