Page:Clinical Lectures on the Diseases of Women.djvu/11



is a subject that lies between obstetrics and gynaecology; the cases indeed that I am particularly to dwell upon were brought into "Martha" as gynaecological cases, or cases of diseases of women, more than as obstetrical cases. I do not know any subject better than this for illustrating the value or necessity of extensive knowledge with a view to good diagnosis. If you do not know of a thing, you are quite sure not to suspect it; and, in all cases of difficult diagnosis, if you do not suspect a thing you are almost certain not to find it. This remark is especially true of the subject I have to consider now.

A missed abortion is not a threatened abortion, nor is it an imperfect abortion. A threatened abortion is a very common occurrence. When a woman has a threatened abortion she suffers pain, she has bloody discharge, and the mouth of the womb may be found to open. An abortion may only get the length of being threatened; that is to say, the abortion may be averted and pregnancy may go on healthily,—even when you have been able to feel, through the neck of the womb, the ovum as it hangs in the cavity of the body of the uterus. I have known also two cases in which a considerable piece of decidua was separated and discharged