For our own part we must confess, that, although we have seen this
application tried repeatedly, it has never produced the desired effects,
but has invariably brought on very troublesome and distressing symptoms,
such as sickness, faintness, headach, vertigo, &c.
There is a condition of the os uteri which is occasionally met with, and
which presents a degree of rigidity which we have never seen except where
there have been adhesions and callous cicatrices from former injuries. It
has nothing of the thin edge put strongly on the stretch during the pains;
but it is thick and firm, presenting nothing of the elastic cushiony
softness of the os uteri in a favourable state for dilatation; it dilates
to about an inch across, tolerably regularly, and without much apparent
difficulty, but no efforts of the uterus can dilate it farther. We have
already alluded to two extreme cases of this when speaking of ruptured
uterus, and where in each instance the os uteri entirely separated from
the uterus and came away. Whether there is something peculiar in the
structure of the part which renders it thus undilatable, or whether it
required even still more powerful measures than those employed, is not
very easy to decide.
_Edges of the os uteri adherent._--_Cicatrices_, &c. A serious impediment
to the passage of the child may be produced by adhesions of the sides of
the os uteri to each other; by hard callous cicatrices resulting from
ulcerations, lacerations, &c. in former labours; by abnormal bands, or
bridles, as they have been called; and by tumours and other morbid
growths. Where the structure of the os uteri has been much injured by
previous injuries of this character, the resistance will probably be so
great as to require artificial dilatation with the knife. Generally
speaking, however, the whole circle of the uterine opening is not
involved, portions still remaining of natural structure, and, therefore,
capable of dilatation. On examination, it feels irregular both in shape
and hardness; a part being soft, cushiony, yielding, and forming the
segment of a well-defined circle, the rest of it uneven, knobby, and hard,
being evidently puckered up by cicatrisation.
In many cases, these callous contractions give way more or less when the
head begins to press powerfully against them; but even where this is not
the case, the healthy portion of the os uteri is so dilatable as to yield
sufficiently. It would be difficult to estimate how far an os uteri in
this state, with perhaps, not more than half, or even a third, of its
circle in a healthy condition is capable of dilating. But from cases which
have come under our own observation, and others which have been recorded
by authors in whom we place the greatest reliance, we are quite confident
that with proper treatment a sufficient degree of dilatation can be
effected without resorting to artificial means.
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