G. H. Kidd, discussing the diagnosis between dropsy of the amnion and ovarian cysts, says: " The encysted liquid may be a distended blad der, a dropsy of the amnion, an ovarian cyst, or a pregnancy complicated by an ovarian cyst. The absence of urine on catheterism, disposes of the first; the state of the nipples, and the presence of a floating body in the abdomen, shows the presence of a fcetus; while with ovarian cysts, the uterus can always be felt in the true pelvis." Both Boddy and Hiod punc tured, in cases of hydmmnion, believing them to be ovarian cysts, and Kill did the same, and delivered the woman of twins, in a case of hydrain nion, which he took to be pregnancy complicated with ovarian cyst. De paul, in connection with his case of extra-uterine peritoneal pregnancy with hydramnion, says: " This is a rare, if not unique example, of dropsy of the amnion, complicating an extra-uterine pregnancy. The size of the abdomen prevented palpation of the fcetal parts, and there was a tense, rounded, and fluctuating pouch instead of the ordinary lumpy tumor. The cervix was in its usual place, which is rare in extra-uterine pregnancy. The patent orifice permitted me to reach the fundus uteri with my finger; but, instead of enlightening me, it simply made me sus pect an obliteration of the internal os." There remains to be considered the diagnosis from the hydatid mole. It seems impossible to mistake hydramnion for it. The only symptom sometimes found in the vesicular mole, that is analogous to any sign of dropsy of the amnion, is the rapid development of the abdomen, and its want of proportion to the stage of pregnancy. But the constant presence of alternating losses of reddish and watery fluid, the hemorrhage which always accompanies, precedes, or follows the termination of the disease, and the occasional passage of vesicles, should suffice to remove all doubts.
Pathological Anatomy.—Most authors regard hydramnion as a disease of the fcetus or its membranes, and it is there that we should look for the cause of the affection. But in some cases the examination of these has been neglected; and in as many more it has been made without finding anything. In a third set of cases, lesions have been found, but they were not characteristic. Three varieties of lesion seem, however, to be specially constant: lst. Those of a supposedly inflammatory nature. 2d. Fcetal malformations. 3d. Lesions of the uterus, or tumors of various kinds. • lst. Lesions of an iuflammatory Nature.—These have usually con sisted in thickening of the membranes, with more or less marked capillary injection, a varying red color, and false membranes, either on the sur face of the amnion, or on the foAal surface, and in the thickness of the pls.centa.
Thus Dubois and Desormeanx: thickening and hypertrophy of both placenta, which were united.
Godefroy: membranous plaques upon the internal surface of the pla centa and the membranes.
Oulmont: infiltration of edges of the placenta, and cedema of the cord.
Prt.vost: one placenta and two amniotic cavities for three fcetuses, the two amnii being enclosed in a common covering. One cord was (ede
matous.
011ivier (d'Angers): thickening of the membranes, which were white and opaque, like parchment. Injected vessels.
Mercier: the same changes, with a species of false membrane. Sen tex: same, placenta livid.
Robert Lee: placenta soft in parts, and dark in color, looking like the lung in cases of pulmonary apoplexy.
Toogood: adhesions of placenta. Atthill: same.
D'Outrepont: cartilaginous and hepatic degeneration of the placental tissue.
Hildebrandt: fibro-myxoma of placenta.
Hunter: hypertrophy of placenta.
Valenta: maternal and fcetal syphilis.
SkIdiot: emphysema of Lotus.
Lee, Obs. I.: Real ascites, malformations of lungs. Obs. VI.: Foetal ascites.
Bourgarel: Foetal ascites. Pemphigus. Onyxia, congested placenta. Liegener, Obs. XII.: Cord soft and short. Obs. XIV.: Cord very cedematous; pemplugus; liver much developed.
2d. Monstrosities.—Pietro Lusana: anencephalus.
Siebold: hydrocephalus. Cystic degeneration of kidneys.
Battson: hydrocephalus. Infiltration of skin and subcutaneous cellu lar tissue. Anchylosis of articulations of lumds and feet. Cystic degen eration of the cord.
Thomas: exaggerated development of the head.
Jungmann: premature ossification of the head.
Lumpe: 'umbilical hernia into cord. Hypertrophy of the skin of the head. Club-foot.
Zacharias, Lawrence, and West: encephalocele.
Griffith: tumor covered with the normal scalp, filled with liquid and cerebral debris.
Werner: thin cord with bands. Double hair-lip. Absence of left lung. Billielen: hydrothorax.
Liischner: double monstrosity. One child normal, the other atrophied. Adhesions of both lungs.
Frankenhauser: obliteration of the urethm; (edema of cord and fcetus. Hildebrandt: hydatid mole.
Bausch, Werner, Parien: faults in the cord. Placental atrophy. Lee: hydrocephalus.
Dill: anencephalus.
Liegener: double hare-lip.
Gueniot (GuiHemet): anencephalus.
Polaillon (Guillemet): clubbed hands, _mperfomte anus.
Pinard: two cases of anencephalus.
3d. Tumors.—Keating: tbterine fibroid. Ganiot: same.
Neuschler: uterine tumor.
Pfannkucla: carcinoma uteri.
These are the chief changes; and we shall see tnat it is especially in the acute cases of hydramnion that the lesions considered inflammatory have been noticed.
The liquor amnii itself is generally normal; a few authors have found it fetid, and reddish or greenish in color.
We, therefore, conclude that pathological anatomy gives us no certain data; for all the above lesions have often been found in cases in which there was not the least trace of dropsy of the amnion.
Prognosis.—Most authorities consider dropsy of the amnion a serious complication for the fcetus, while it rarely compromises the health or life of the mother. This, however, is only true up to a certain point. In the slowly progressive form, but little discomfort is experienced by the woman; but in acute hydramnion the distress is very great indeed, and the prognosis for the mother much more grave. We may, in this respect, divide dropsy of the amnion into three degrees.