308 MATERNAL DYSTOKIA. 



expulsive efforts, prove that some obstacle to delivery must be present. 

 Consequently, vaginal exploration is resorted to, and when the hand is 

 passed into that canal it reaches a kind of imperforate cul-de-sac, at the 

 bottom of which is a large round tumour into which no opening can be 

 found. This tumour is the lower face of the uterus, which, pressed 

 against the corresponding wall of the vagina, projects into the pelvic 

 inlet. Eaising the hand towards the sacrum, the os will be discovered 

 much removed from its normal position, and situated above and in front 

 of the uterine tumour just alluded to. 



Sometimes the os is completely closed, in other cases it may be more 

 or less dilated. When in the latter condition, there is frequently formed 

 at this point a kind of membraneous transverse fold, raised in the form 

 of a valve, which has been compared to a fleshy band analogous to 

 that which forms the sacculations of the large intestine ; this band is 

 stretched across the lower part of the os, and it has to be surmounted 

 before the hand can touch the foetus. The latter is lodged in a kind of 

 pouch or excavation situated beneath the band, and constitutes the 

 tumour met with at first at the bottom of the vagina. 



The more or less vertical position of the foetus should also serve as a 

 guide. 



Complications. 



To Saint-Cyr, Garreau, and Schaack, we are indebted for our descrip- 

 tion of the condition we have been describing, and to the two latter are 

 also due the knowledge we possess of certain complications which are 

 worthy of notice. 



Garreau has found the cervix in this uterine deviation thickened, 

 indurated, and the os closed. Delivery was impossible, and the foetus 

 remained for three months in the uterus without causing any great in- 

 convenience to the Cow. At the end of this period the Calf was ex- 

 tracted by Caesarian section, and with perfect success ; as the Cow 

 quite recovered, and w^as sold at a good price eight months afterwards. 



In one of the cases described by Schaack, the foetus was in the 

 vertebro-sacral position, and the limbs and head having been secured 

 by cords, delivery was accomplished by strong traction. In a quarter 

 of an hour afterwards, however, the Cow lay down, trembled all over, 

 the muscles of the limbs and the eyes contracted in a convulsive manner, 

 and death rapidly ensued. 



At the autopsy, which was made six hours after death, a quantity 

 of blood, in the form of a large clot, was found in the abdomen, and the 

 textures about the pubis were infiltrated with that fluid. The uterus 

 had resumed its ordinary form , and its mucous membrane was intact ; 

 but at the inferior part of the organ there was a large triangular tear, 

 about six inches long and four wide ; and it was noted that this lacera- 

 tion had caused the rupture of two good-sized arteries, which of course 

 led to the haemorrhage that caused death so rapidly. 



Indications. 



The indications for treatment in this deviation are simple ; raise the 

 fundus of the uterus, lower the cervix, and bring the os in line with 

 the vagina. When this is accomplished, the uterine contractions will 

 act directly on the cervix, and if this is healthy, dilatation of the os will 

 soon take place ; then the foetus, pushed towards the vagina, instead of 

 against the sacrum, will enter the passage, from which a little judicious 



