PARTURITION. 
700 
ably wedged in confequence of an accumulation of faeces, 
it then becomes neceflary to open the head. 
Extreme rigidity of the external parts is one of the 
moft frequent caufes of obftrufHon which depends on the 
date of the loft parts. It takes place, in a greater or lefs 
degree, in the greateft number of women who lie in for 
the firft time : and generally in all women who are con- 
fiderably advanced in life before they have children. It 
is feldotn that the reiiftance oppofed by the external parts 
is fo very great as to prove an invincible obftacle to la¬ 
bour. But, on many occalions, the long-continued 
prefl'ure of the child on thofe parts produces the moft dif- 
agreeable confequences, as inflammation of all thefe 
parts and of the bladder. Inflammation in thofe parts 
is always dangerous, for there feems to be a remarkable 
tendency to gangrene. Cafes are on record where the 
whole parts have Houghed off, and where the refturn, 
vagina, and bladder, have formed one canal. Perhaps 
death is much preferable to life under fuch circumftances. 
Copious blood-letting, and the liberal ufe of forne unc¬ 
tuous application, with time and patience, in general 
overcome the rigidity of the external parts. Placing the 
patient over the fleam of hot water was formerly re¬ 
commended in fuch cafes ; but this pra&ice is now ex¬ 
ploded. 
Disorders of the Uterus. 
It is a curious fad!, not only that conception fome- 
times takes place when there is a tumour within the 
womb, but al(b that pregnancy goes on to the full pe¬ 
riod. When this has happened, the tumour has been 
pudied down before the infant, and has filled up the 
paflages. If this obftacle be afcertained at an early pe¬ 
riod of the labour, which it muft be if the pradlitioner 
be in any ordinary degree fkilful and attentive, the tu¬ 
mour may be pufiied back, and the feet of the child may 
be brought down. 
The following Angular cafe of an excrefcence on the 
os uteri, is ftated by Dr. Denman, vol. ii. p. 65. “In 
June 1770, I was delired to fee a patient in the eighth 
month of her pregnancy, who in the preceding night had 
a profufe hemorrhage. Her couhtertance fliowed the ef- 
fedls of the great lofs of blood file had fuftained ; and, 
from the reprefentation of the cafe given me by the gen¬ 
tleman who was firft called in, I concluded that the pla¬ 
centa was fixed over the os uteri. On examination I felt 
a very large flefliy tumour at the extremity of the vagina, 
representing and nearly equalling in fize the placenta, 
which I judged it to be. Had this been the cafe, there 
could not be a doubt of the propriety and neceflity of de¬ 
livering the patient fpeedily ; and u'ith that intention I 
palled my finger round the tumour, to difcover the ftate 
of the os uteri. But this I could not find ; and, on a more 
accurate examination, I was convinced that this tumour 
was an excrefcence growing from the os uteri, with a 
very extended and broad bafis. I then concluded that 
the patient was not with child, notwithftanding the dif- 
tenfion of the abdomen, but that file laboured under 
fome difeafe which refembled pregnancy, and that the 
hemorrhage was the confequence of the difeafe. A mo¬ 
tion which was very evidently perceived when I applied 
my hand to the abdomen, did not prevail with me to 
alter this opinion. 
“ It was of all others a cafe in which a confultation was 
defirable, both to decide upon the difeafe, and the mea- 
fures which it might be neceflary to purfue ; and feveral 
gentlemen of eminence were called in. That fhe was 
actually pregnant, was afterwards proved to the fatis- 
faftion of every one ; and it was then concluded, that 
fuch means fliould be ufed as might prevent or leflen the 
hemorrhage, and that we fliould wait and fee what ef¬ 
forts might be naturally made for accomplifliing the de¬ 
livery. 
“No very urgent fymptom occurred till the latter end 
of July, when the hemorrhage returned in a very alarm- 
3 
ing way, and it was thought neceflary that the patient 
fliould be delivered. There was not a poflibility of ex¬ 
tirpating the tumour, and yet it was of fuch a fize as 
to prevent the child from being born in any other way 
than by leflening the head. This was performed; but, 
after many attempts to extract the child, the patient 
was fo exhaufted, that it became neceflary to leave her to 
her repofe, and, very foon after our leaving her, (lie ex¬ 
pired. 
“ We were permitted to examine the body. There 
was no appearance of difeafe in any of the abdominal vif- 
cera, or on the external furface of the uterus, which 
was of its regular form ; and, when a large oval piece 
was taken out of the anterior part, the child, which had 
no marks of putrefaction, was foundin a natural pofition. 
A11 incifion was made on each fide of the cervix to the 
vagina, and then a large cauliflower excrefcence was 
found growing to the whole anterior part of the os uteri. 
The placenta adhered with its whole furface; fo that 
the blood which file had loft muft have been wholly dif- 
charged from the tumour. Were fuch a cafe again to oc¬ 
cur, there could be no doubt refpefting the propriety of 
fixing a ligature round the neck of the tumour.” 
In two cafes, where a great thickening and induration 
of the neck and mouth of the womb, approaching to the 
nature of fchirrofity, had taken place previous to con¬ 
ception, the natural action of the uterus, though after a 
very confiderable time indeed, aflifted by copious blood¬ 
letting, eventually overcame the refiltance. One of the 
patients died ten months after, with all the fymptoms of 
real cancer uteri. The other was reftored to perfeft: 
health after lying-in. 
Dr. Denman has recorded (vol. ii. p. 73.) two cafes, 
where the enlarged ovarium impeded the progrefs of the 
child. In the one cafe the head of the infant was 
opened, and the delivery completed by the crotchet; 
but the patient died at the diftance of three weeks. In 
the oth.er, a trocar was paflfed into the tumour, and a 
living child was born. The patient recovered from her 
lying-in; but died hectic at the end of fix months. In 
fuch cafes, the ovary may be pufiied back, if the circum- 
ftance be difcovered early enough. 
References to fixteen other cafes of this kind may be 
found in the 10th' volume of the Medico-Chirurgica! 
TranfaiStions. Thefe tumours have been of various fizes 
and degrees of firmnefs. 'Sometimes they have contained 
only a thin fluid; fometimes the contents have been of 
the confiftence of honey; and fometimes there has been 
fatty matter, intermixed with long hair and teeth. 
Whenever fuch tumours have been detefted during 
labour, much doubt has generally been entertained re- 
fpe&ing their nature and the proper mode of manage¬ 
ment. On fome occafions the medical attendants have 
not thought it right to take any immediate ftep towards 
accelerating the delivery, becaufe the patient was not 
confidered to be in immediate danger; and it was hoped 
that the tumour would prove fufficiently compreflible to 
allow the child to pafs, when ftrong pains fliould come 
on. And, where the tumour was not very large nor very 
firm, this method has been fuccefsful. Some have taught, 
that, in fuch cafes, there fliould be no delay in employ¬ 
ing the perforator; confidering it more advifable to fa- 
crifice at once the life of the child, than to hazard that 
of the mother. If, by this facrifice of the child’s life, the 
mother’s could be always enfured, the pradlice might be 
defenfible ; but, unfortunately, it has happened, that 
in three cafes out of five, in which the perforator was 
employed, the mother did not recover; and in one of 
the other cafes the mother’s recovery was very incom¬ 
plete. Sometimes with the view of preferving the child, 
or from fome other reafon, the operation of turning has 
been undertaken; but this does not appear to have 
been a fuccefsful mode of pra&ice, either to the mothers 
or the infants. Sometimes the tumours have been opened 
with the view of diminifiiing their bulk j but in feveral 
in fiances 
