364 MATERNAL DYSTOKIA. 



Pathological Anatomy. 



The lesions found after death are generally alluded to as "fibrous 

 degeneration," " scirrhus," or " cancer " of the cervix ; and it is usually 

 mentioned that this part was " hard and like cartilage," " creaking under 

 the knife like cutting an unripe apple or turnip " ; or that there was 

 " schirrus " or " cancer," " nodular and hard like cartilage.'' 



Macgillivray states that when the contraction of the os uteri is the 

 result of prior disease, it will generally be found of a hard fibroid nature ; 

 while, on the other hand, where the contracted parts are soft and very 

 much thickened, acute disease will commonly be found accompanying 

 the stricture. " In hard stricture, the transverse rugae or folds appear 

 generally to be transformed into a compact, unyielding fibro-cartilaginous 

 material ; in one very serious case I found six of these hardened unyield- 

 ing transverse rugae or folds between the os tincce and os internum. In 

 soft stricture, without any actual disease being present, the contraction 

 is generally confined to the os and the vaginal portion of the cervix 

 uteri. In cases of complicated stricture, or, in other words, stricture 

 accompanied by some active disease, it will often be found that the 

 stricture is merely the concomitant eilect of the disease, and such 

 causative disease will almost invariably prove to be either ulcerative, 

 schirrous, really cancerous, or fungous in its nature. . . . Deposits of a 

 fibrinous nature are only too common in patients of rheumatic constitu- 

 tion." 



Treatment. 



The condition of the cervix uteri being ascertained, there should be 

 no delay in resorting to active measures, as it is impossible for delivery 

 to be effected, in the great majority of cases, without such interfei-ence. 

 Here the necessity for a correct diagnosis is, as we have already urged, 

 of the greatest moment ; for if the obstacle to birth is only rigidity or 

 spasm of the uterus, this can generally be overcome by mild measures 

 and without risk or injury to the animal ; whereas, in induration these 

 measures would be ineffective, and valuable time must be lost in trying 

 them. 



Delivery, in induration of the cervix, must be effected by one of two 

 serious operations. This must be eitlier vagiiial-hystcrotomy or (jastro- 

 liysterotomy. We shall again allude to and describe these, in speaking 

 of obstetrical operations. 



It may only be necessary in this place to say that vaginal hysterotomy 

 — 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. 

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

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

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

 operation 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 prefer- 

 ence 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 additional motive in preferring incision of the cervix. 



