366 MATERNAL LYSTOKIA. 



Symptoms. 



These 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 v^ith a round, 

 smooth, and tense, but fluctuating tumour at a variable distance from 

 the vulva, or even between its labia ; the foetus can be felt through this 

 tumour, and this might lead to the supposition that this is the " water- 

 bag." But on passing the hand to the base of the tumour, instead of 

 finding the borders of the os — as we should do if it were 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 

 tumour— which is the posterior segment of the uterus pushed into the 

 vaginal canal. On the surface of this tumour 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 afforded, 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 labour 

 pains and the other indications of parturition subside, the dead foetus 

 is gradually desiccated as the fluids surrounding it become absorbed, 

 and the parent does not appear at all amiss, its condition being per- 

 haps only accidentally 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 anomaly, perhaps, with which it might be 

 confounded is deviation of the uterus, in which the cervix maybe 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 super- 

 ficial fibrinous bands or membranes. For the latter, 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 ruptured 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 production of cicatricial tissue or other morbid alteration, then it 

 will be necessary to incise it as for induration, and in the way to be 

 hereafter described. 



But if the OS is obliterated and the cervix cannot be found, then the 

 portion of the uterus which protrudes into the vagina must be incised, 

 and the foetus removed by this artificial opening. With this object, 

 Hubert recommends a convex bistoury, the blade of which is covered 



