MORBID ALTERATIONS IN THE GENITAL ORGANS. 357 



Causes. 



This occlusion may be due to agglutination of walls of the os, the for- 

 mation of fibrinous membranes or bands, the development of cicatricial 

 tissue from wound or injuries sustained in previous pregnancies, etc. 



Symptoms. 



The symptoms are, of course, the usual external symptoms of retarded 

 parturition. Internally, the hand, on being introduced into the vagina 

 and pushed towards the cervix, comes in contact with a round, smooth, 

 and tense but fluctuating tumor at a variable distance from the vulva, or 

 even between its labia ; the foetus can be felt through this tumor, and 

 this might lead to the supposition that this is the " water-bag." But on 

 passing the hand to the base of the tumor, instead of finding the bor- 

 ders of the OS — as we should do if it was the foetal membranes — there 

 is discovered a circular furrow, one side of which is the extremity of the 

 vagina, and the other is continuous with the tumor — which is the pos- 

 terior segment of the uterus pushed into the vaginal canal. On the sur- 

 face of this tumor may be found a small imperforate depression ; in 

 other instances there is a kind of prominent ring, like the top of the neck 

 of a bottle, but without an opening ; this is the cervix. In other cases 

 no trace of the cervix or os can be distinguished. 



Results. 



If relief is not aflEorded, the mother may die from exhaustion or rupture 

 of the uterus ; or a rupture may occur through which the foetus and its 

 membranes will pass, and the mother survive for a longer or shorter 

 period, constituting a case of extra-uterine pregnancy. Or neither of these 

 results may happen, but after a certain time the labor pains and the 

 other indications of parturitipn subside, the dead foetus is gradually 

 dessicated as the fluids surrounding it become absorbed, and the animal 

 does not appear at all amiss ; its condition being perhaps only accident- 

 ally discovered, either when it dies or is killed long afterwards, or when 

 the remains of the foetus begin to be expelled in a vicarious manner. 



Diagnosis. 



The diagnosis of this condition must be based on the signs just alluded 

 to. The only other anomal}^ perhaps, with which it might be confounded 

 is deviation of the uterus, in which the cervix may be tilted up towards 

 the vertebro-sacral angle, even almost beyond the reach of the hand. 

 The position of the cervix and os tincae should be the guide in diagnosis. 



Treatment. 



As in induration of the cervix, so in atresia delivery must be effected 

 by incision, or puncture if the os is found to be obstructed by superficial 

 fibrinous bands or membranes. For the latter object, the extremity of the 

 finger or a metal catheter may suffice, the pressure being gradual and 

 the movement semi-rotatory. The bands may, in rare instances, be rup- 

 tured by means of the finger-nails or divided by scissors. If, however, 

 the resistance is too great, and the os is closed either through the produc- 

 tion of cicatricial tissue or other morbid alteration, then it will be neces- 

 sary to incise it as for induration, and in the way to be hereafter described. 



