Page:Clinical Lectures on the Diseases of Women.djvu/18

 In some respects missed miscarriage or missed abortion is even more important than missed labour ; for, in a case of missed abortion, the history of the woman and her size may- have led either to no suspicion of pregnancy having com- menced, or to suspicion which may have been dissipated by the further history of the case. In a case of missed abortion or missed miscarriage the important element of suspicion as to the real condition may not have come into the mind either of the patient or her physician. Mistake is then extremely liable to occur. This is not so likely in missed labour ; for in that condition the woman's size will almost certainly have made her aware that she is in an advanced state of pregnancy ; and her friends will also know it. I told you that missed labour may be a subject of great medico- legal importance. The same is true, and even more so, of missed abortion or missed miscarriage. Take the case that I am going to read, where a woman passed a foetus of about two months at the end of a pregnancy (if you so miscalled it) which lasted for five months. If, in such a case, the practitioner, without sufficient care, were to tell the husband that his wife had had a two-months child, you can easily understand that his natural rejoinder might be, " That cannot be my child, for I have been away from home five months " Such unfortunate misapprehensions have happened, and the occurrence shows the importance of counting the term of a woman's pregnancy, not up to the time when the foetus is discharged, but back to the time when it died. If this is kept in mind, the practitioner, in the imaginary case that I have given, will not make the mistake of leading the hus- band to think that the foetus just born could not have been begotten by him. It is sufficient to allude to this, the medico-legal importance of it is so plain.

Now, when a woman has a missed miscarriage or a missed abortion, what is the course of events ? The foetus dies ; the symptoms of pregnancy are arrested ; milk sometimes ap-