368 MATERNAL DYSTOKIA. 



(water-bag) cannot be expelled into the vagina, even v\^hen the os uteri 

 offers no obstacle. 



An early examination is necessary, as the foetus soon perishes. An 

 incision must be made through the chorion, and the foetus extracted. 



2. Morbid Adhesion between the Fcetus and Uterus. 



Adhesion between the uterus and its contents may be due to in- 

 flammation of a portion of the mucous membrane, to hyperplasia of 

 the chorion, or to disease of the ovum or placenta, by which the two 

 latter are brought into direct contact with the interior of the organ. 

 Or it may be owing to a deficient quantity of liquor amnii when the 

 foetus begins to be formed ; for if the amnion, in the course of its 

 development, is not separated from the growing foetus by a sufficient 

 quantity of fluid, connection between them is almost certain to be 

 established either in isolated spots (Simonart's "bands"), or over a 

 wide surface. Adhesion between the amnion, chorion, and lining 

 membrane of the uterus, is then not only possible but probable, and 

 in this way the foetus is brought into a solid union with the maternal 

 organ. It can readily be understood that such an occurrence will 

 prove a very serious obstacle to birth, and greatly endanger the life of 

 the mother. 



Eainard^ furnishes us with two observations, a writer in the 

 Veterinary Journal (" Nemo ")- with another, and Naylor^ with two. 



Eainard justly remarks that veterinary surgeons should be aware 

 of the possibility of such adhesions, either with the placenta or the 

 envelopes, and, through them, with the uterus ; and that they are 

 otherwise easier recognised than those external to the uterus. 



The hand, introduced into the uterine cavity, is passed over its 

 inner surface, around the foetus, as it were : and by this means the 

 existence, seat, extent, and resistance of the adhesions will, in the 

 majority of cases, be ascertained. When the adhesions are situated 

 towards the fundus of the organ — its most distant part, and where the 

 hand cannot reach, then there will be difficulty ; but this must be 

 overcome by raising the uterus and throwing it backwards, by elevating 

 the front part of the animal's body, and lifting the abdomen by means 

 of a plank, blanket, or sack. 



Most frequently the adhesions can be broken up by the fingers ; but 

 if they are too strong, then a bistoury or other convenient instrument 

 will have to be employed. Their incision must be carefully made, and 

 the " crutch" or " repeller " (to be hereafter described) will be useful 

 in keeping the foetus away from the part where the separation is being 

 effected. The cutting should be done gradually and steadily, the point 

 of the instrument being kept at an equal distance between the foetus 

 and the mucous surface of the uterus. 



In alluding to these internal adhesions, it may be observed that 

 some very rare cases are recorded, in which parturition was opposed 

 by external adhesions between the peritoneal covering of the uterus and 

 the sac of a hernia, or neighbouring viscera. 



^ Traite Complet de la Parturition, vol. i. , p. 461. 

 - Veterinary Journal, vol. iii., p. 262. 

 3 Veter'inarian, vol. xxiii., p. 324. 



