802 MATERNAL DYSTOKIA. 



It will also be discovered that the tumour does not adhere to the 

 abdominal parietes, and that it may be reduced by taxis. 



But it may be necessary to ascertain the presentation and position of 

 the foetus, and if it cannot be born, what the nature of the obstacle is 

 which prevents delivery. In such a case vaginal exploration must 

 be resorted to ; by it we may learn that the os is not dilated from 

 one of several causes to be hereafter discussed ; or the non-dilatation 

 may be due to the uterine contractions not pressing the foBtal mass 

 directly against the cervix, in consequence of the altered direction of 

 the uterus, or the margin of the hernial opening strangulating the foetus 

 and hindering its advance. These obstacles must be combated by 

 appropriate measures. 



In consequence of the foetus lying so far below the pubis, the hand 

 introduced through the os cannot feel it, even when the whole length 

 of the arm is inserted ; in which case, if the animal is standing, the 

 abdomen may be raised by means of a sheet or blanket, so as to bring 

 the foetus within reach. If the animal is recumbent and cannot rise, 

 then it should be placed on its back and secured in that position, the 

 croup being raised by bundles of straw. The tumour may then be ex- 

 amined by external palpation, as well as by rectal and vaginal explora- 

 tion, and the position of the foetus determined. 



As a rule, the position is never quite normal. In the most favour- 

 able cases, the head is found to be directed backwards and near 

 to the pubis — sometimes partly in the pelvis, with the face upwards 

 and slightly forwards ; the fore feet being more or less doubled back 

 against the body, which lies deep in the tumour, and the buttocks 

 resting on the mammae of the mother— the foetus being altogether, in 

 the recumbent female, in the position of a sitting dog. 



The state of the borders of the hernial orifice should be carefully 

 ascertained, and their rigidity and tension, together with the degree 

 of constriction they exercise on the body of the foetus, noted. This 

 important examination should be made before any traction is exercised 

 on the foetus ; for on the information so obtained will depend the 

 choice of means to effect delivery. 



With the Bitch uterine hernia is frequently most difficult to diagnose, 

 and errors are far from infrequent ; the most common mistake is fixing 

 on the tumour as a cancerous mass. But mammary tumours are very 

 different to that of hernia ; they are generally nodulated, very hard, and 

 the skin is closely adherent to them ; whereas the uterine hernia has 

 not the fluctuation of a cyst or abscess, neither has it the resistance of 

 a carcinoma, fibroma, or adenoma, while the skin covering it is smooth, 

 supple, perfectly natural, without ulceration, discoloration, and other 

 signs which mark the presence of mammary enlargements. The 

 uterine tumour can also be reduced by taxis or manipulation, while the 

 fissure in the abdominal wall can be felt. This, together with the fact 

 that it is only developed rapidly after impregnation, and without any 

 local or general inflammatory symptoms, or disturbance of the general 

 health, should settle the question. 



However, should any doubt yet remain, or if it is desired to ascertain 

 the exact state of affairs, a more careful examination will be necessary, 

 it being always borne in mind that this hernia in the Bitch appears in 

 different regions. Vaginal exploration cannot be resorted to with this 

 animal, because of the smallness of the pelvis — unless the Bitch is a 

 large one, and then the fingers are too short to explore to any depth. 



