Page:Clinical Lectures on the Diseases of Women.djvu/20

10 she came into the hospital. Examination now discovered a dilated heart with a mitral regurgitant murmur. There was dulness above the pubes for an inch, but nothing abnormal could be felt. Digital examination per vaginam discovered the brim of the pelvis occupied by a moderately hard mass, with which the cervix, which is patulous, is connected by continuity. The uterine probe passes easily into the uterus three inches and a half. The uterus is mobile, not tender, and forms the mass occupying the pelvic brim. About six hours after this use of the probe, which was withdrawn untinted by blood, pains began. After about eight hours of pains a mass as big as an orange was expelled. Very little hæmorrhage accompanied and followed the birth, of the mass. The patient rapidly recovered. The mass was found to consist of the entire ovum in a state of decomposition; except the liquor amnii, of which there was not a trace. The whole presented a dirty-brown colour, somewhat like that of decolorised blood. The decidua and other membranes were rolled tightly around the fœtus, the edges of the placenta meeting over it. The fœtus was of the size of about two months' growth. On the fœtal surface the placenta was covered with rounded projecting masses of various sizes, as of a field bean, or of a hazel-nut. They were beneath the chorion, and were formed of blood-clot in various stages of decolorisation.

This is as perfect a case of missed abortion as you could desire to see. The length of detention, after the death of the fœtus, is five months; the woman then began to feel herself ill because she began to bleed. Observe, in this case, that the membranes remained entire; therefore there was no putrefaction. The whole ovum was in a state of decomposition. Here I cannot avoid pointing out a common mistake in obstetrical writing. Some of the best books on obstetrics divide all children and abortions into living or putrid. That is a very great mistake. Dead