This Plate represents a case which occurred in the practice of Dr. Ramsbotham, and which terminated favorably. The polypus had a very long neck, and was forced _out of the external opening_ by the child, which was then born with ease. I once saw a case myself, in which the labor was completely arrested by a large hard tumor about the middle of the Vagina; it could not be moved, and delivery was evidently impossible while it remained. In consultation it was decided to cut it out, as there seemed but little circulation of blood in it, and its situation was favorable for the operation. This was accordingly done with but little trouble, and the child was born without difficulty in about twenty minutes after. The mother perfectly recovered. [Illustration: 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.