Page:Clinical Lectures on the Diseases of Women.djvu/19

Rh pears in the breasts; hæmorrhages from the uterus may occur, or they may not. If the liquor amnii is not discharged it is absorbed, and the contents of the uterus either macerate or become mummified. If the membranes remain entire, the process undergone by the uterine contents is that of mummification. It is only when germs are admitted, and generally after rupture of the bag of membranes, that putrefaction and maceration take place, and the more or less complete dissolution of the ovum. If the uterus has been felt, the remarkable observation may be made, that a woman going on apparently in pregnancy has the uterus steadily diminishing in size, instead of getting bigger; and at last, and almost invariably (not invariably), before the full term of pregnancy, counting from the commencement of it, would have been reached, the ovum is expelled. The expulsion is frequently unexpected. When it is expelled, you have a mass in a state of mummification, nearly dry, of a dirty-brown colour; and the fœtus and membranes are concealed, being rolled up in the placenta, which is too firm to be compressed, and embraces the whole ovum. Such ova I have had sent to me more than once by practitioners, saying truly that the fœtus appeared rolled up neatly in the membranes and the placenta as in a parcel. That was exactly the case in this instance. In this preparation you will see that the placenta and membranes have been opened up to show the fœtus inside. In our case the edges of the placenta met over the fœtus, embracing it entirely, rolling it up in a parcel-like form. I will now read to you the case.

S. K., aged thirty-one, married eight years, has had four children (the last two years ago), no miscarriages. Had not menstruated for five months when a bloody discharge began. After this had continued for three weeks she became an out-patient under Dr. Godson. She was ordered ergot and strychnine, and the discharge ceased. But it soon recommenced, and