178 BOYINE OBSTETRICS 



inal examination then reveals that the upper wall of the 

 vagina is drawn tightly over the head of the calf. 



Especially when such a case is met with for the first time, 

 it is looked upon as a most peculiar condition. The obstetri- 

 cian feels a fold, and behind it the calf, and is at a loss to 

 account for this phenomenon. But the os uteri, occupying the 

 centre of the whole, explains the situation. 



It is not always easy to diagnose the nature of an obliter- 

 ation. In some cases it is possible to enter the uterus with one 

 or two fingers, in other cases the os is so tightly shut that not 

 even a single finger can be passed. Tumors and anomalies of 

 embryonic origin are much more readily recognized. 



Prognosis. — When an obliteration is positively diagnosed 

 to be due to cicatricial tissue or cartilaginous degeneration, 

 prognosis is unfavorable. Parturition of course may take place 

 after forcibly dilating the parts, but such a procedure is always 

 dangerous. Such dangers may be greatly modified by careful 

 after treatment, which is often neglected when executed by an 

 attendant. The bloody dilatation known as liysterotomia vagin- 

 alis is described under obstetrical surgery. 



Therapeutics. — Should any doubt exist as to the diagnosis, 

 the various measures suggested under spasm of the cervix 

 uteri may be tried. It is always advisable to attempt dilating 

 the OS uteri by boring movements with the finger. This 

 requires much patience. I remember to have spent once two 

 hours before I was able to pass two fingers into the cervical 

 canal. One hour later I could pass the hand, and after two 

 more hours, working altogether five hours, extraction took place. 



The operation must be the last resource, when all other 

 means have failed. The experienced practitioner does not 

 take the kuife too quickly, but he does not hesitate to use it 

 freely when it remains the only means, after repeated futile 

 attempts to relieve the condition otherwise. 



Sequels. — The violent straining may be followed by a pro- 

 lapsus vaginae or rupture of the vaginal walls. In the course of 

 violent pains and energetic foetal movements the cervix uteri 

 may become detached. 



