Plate XLVIII.
Case of Polypus.
TUMORS EXTERNALLY.
Sometimes tumors exist externally, on the lips, or in the Vulva, but as they seldom offer much obstruction, and are easily detected and managed, but little need be said about them. They should always however be attended to, if discovered, before labor comes on, or better still before pregnancy.
In some instances the veins around the Vulva become much enlarged, and resemble tumors, and sometimes even impede delivery. It is usual then to open them, and let out the blood, but not till the head is sufficiently low to press upon it and prevent dangerous bleeding.
OBSTRUCTIONS IN THE VAGINA, AND NARROWNESS OR OBSTINATE RESISTANCE OF THE VULVA AND PERINEUM.
The Vagina may be partly closed by its sides growing together, or it may be united by bands and membranes stretching across; and these obstructions may be sufficient to impede or prevent delivery. Most usually they give way, and are gradually broken down by the pressure of the child's head; but if they prove too strong, after waiting a reasonable time, they must be cut through. Cases have even been known in which the hymen has been found perfect at delivery, and even offered considerable resistance, so as to necessitate its being cut through before the child could be born. In such cases this membrane is unusually strong, and conception occurs without its being broken.
When the perineum or Vulva remains rigid and hard, so that the opening cannot be enlarged sufficiently for the child to pass, it may also be necessary to operate with the knife. But this should never be done till after every means of relaxation has been tried, and the head has been kept back as long as prudent. It is however, always better to open a passage than to let one be torn, because it may be made in the most favorable place. When the perineum is allowed to be torn, the most serious consequences often ensue, and the patient is made a miserable sufferer for life. The Vagina and Rectum may be torn into one, or the power of retaining the contents of the intestine, or bladder, may be for ever lost. When an incision is made none of these evils follow; the wound speedily heals, and in a little time no trace of it can be seen. It has even been necessary to cut the neck of the Womb, when it would not open, to prevent the organ from being ruptured; and this has been done with perfect safety. A celebrated practitioner in this city had to perform such an operation very recently, on a female who had injured herself, and made the mouth of the Womb grow together, by violent attempts to produce abortion. The delivery took place with comparative ease, and no unpleasant results whatever followed, either to the mother or the child.