Page:Clinical Lectures on the Diseases of Women.djvu/13

Rh or maternal membranes. Sometimes the fœtus comes away alone, without even the ovuline membranes. Sometimes the ovum comes away, and the maternal membranes or decidua imperfectly. Sometimes only a bit of the placenta is left, as in the case that I am to relate.

Imperfect miscarriage is a dangerous thing, frequently in consequence of the very serious and recurrent bleedings that result from it. It not very rarely leads to death from mere putrid intoxication or sapræmia, or from septicæmia, or from pyæmia, just as happens after delivery at the full time. This is especially liable to occur if the miscarriage has come on in consequence of extensive endometritis such as is found in pregnancies occurring during typhoid fever. Imperfect miscarriage is also often disastrous by inducing endometritis, generally purulent endometritis, and this frequently in connection with putrefaction of the parts left behind.

The case of imperfect miscarriage which I am about to read is in every respect remarkable, and illustrates the subject admirably. M.C., aged thirty-eight, married for sixteen years, has had six children, the last two years ago. On March 11—that is, eight months ago—she miscarried with a three-months' fœtus. The placenta did not come away till three weeks afterwards. Subsequent history shows that the whole placenta did not come away even then. For a fortnight before, and for six weeks after the miscarriage, she had considerable bloody discharges. Since then losses of blood have occurred occasionally. She is feeble and anæmic, but otherwise healthy. Nothing abnormal, except suprapubic dulness, discovered on examination of the hypogastrium. Digital examination per vaginam finds the cervix uteri largely patulous, greatly hypertrophied, but not softened as in pregnancy. Through the speculum it is observed to be anæmic or pale in colour, and to have on its inner surface slight abrasions. The vagina contains some