Of the above causes, it is apparent that certain ones are more likely to act than others in causing fcetal death. In any given case of repeated miscarriage, the greatest care is necessary to determine the possible cause.
In certain cases it may be advisable to absolutely forbid sexual inter course during gestation, the fcetal death being apparently the result of the congestion which accompanies copulation. .
As a still further cause, and likely enough not a very infrequent one, we would mention the uterus septus. This is all the more likely to be overlooked, because of the difficulty in determining the malformation, except on very careful examination. The cause of death, in this case, is the development of the fictus in a space too contracted to allow of its due expansion. Munde recently reported a case of this nature, before the New York Obstetrical Society.—Ed.] If the majority of the causes of fcetal death are absolutely beyond the accoucheur's control, it is not so in a certain number of other cases, and particularly for syphilis, all authors, excepting Despres perhaps, arguing that a careful treatment, begun during the pregnancy, can, and only can, save the child. Hence the precept of Depaul, to always follow an anti syphilitic treatment in women who abort repeatedly, without known cause, even when they do not present, nor does the father, traces of syphilis. A large number of cases have justified this treatment. We have our selves pla,inly observed a case; four abortions without known e,ause, syphilis absent in the father and mother, at least in appearance, and ab solutely denied by both. Anti-syphilitic treatment of both. Since, two
healthy infants, the elder is two years old, the younger just 9 months; neither has ever presented any symptoms. The mother has been able to nourish both.
But, when the anti-syphilitic treatment fails, have we the right to resort to premature delivery ? To us, it does not appear even doubtful; and, without hesitation, we should induce labor in the weeks which pre cede the usual death of the fcetus, not forgetting, however, that, in a good many cases, the death seems to come on more and more tardily, according as the pregnancy is renewed. Such women, who have begun by abortion, have come gradually to premature delivery, and we believe that it is in these cases especially that there is the chance of success.
[In case of habitual miscarriage not dependent on any special appre ciable cause, absolute rest in bed for weeks before the usual period of miscarriage, and for some weeks afterwards, associated with the constant administration of the chlorate of potass, and the tincture of the chloride of iron, will sometimes succeed in enabling the woman to go to term, and to give birth to a living infant Cases of the kind have been recorded by Barker, Munde, etc., and we are familiar with two instances.—Ed.]