We prefer then to choose the interval of uterine contractions. It will be a little more difficult to rupture the membranes, but the liquid will escape more slowly, there will be less chance of the prolapse of the mem bers, and of premature detachment of the placenta. Impressed by these inconveniences, Meissner has invented a curved trocar, with which he advises the induction of premature labor, to perforate the membranes at the middle part, or above the ovum, to preserve also a certain quantity of fluid, and to place the fcetus in more favorable conditions. This may be resorted to in cases of hydramnios, though the results hoped for by Meissner do not seem to have been obtained.
2d. Moment of we are unable to lay down precise rules, and from the gravity of the symptoms only can we determine the moment of intervention. In slight e,ases, wait. Tho uneasiness felt by the woman is not sufficient to endanger her life, and consequently the obstetrician should act expectantly. On the contrary, in the more serious cases, it is necessary t,o interfere, but here still the indications vary with the case. Indeed, ordinarily, hydramnios comes on in an advanced state of pregnancy, its course is slowly progressive, and it is only at certain times, that it produces serious symptoms. The obstetrician should follow the development of the disease; he will gain thus the greatest amount of time, and it is rare that he will have to interfere before the seventh or eighth month. It is, therefore, a premature delivery that he causes. While wholly protecting the interests of the mother, he regards the viability of the child, and so he should retard the moment of intervention as long as possible, to allow the pregnancy to reach as nearly as possible normal term. In acting thus, we give to the haus more chance of surviving, without compromising 'the life of the mother. If the symptoms supervene earlier, if the phenomena experienced by the mother are of a nature to endanger her life, the obstetrician need not hesitate, and he should interfere prompt ly and rapidly in her interest--we will say, also, in the interest of the ketus. In so acting, Guillemet says, rightly, we avoid for the mother excessive pain and serious conditions, which have sometimes induced death, as in the observations of Lee; and, on the other hand, we eliminate the causes of death for the infant, for, in nearly all observations, the signs of life in the infant have only disappeared when the symptoms were protracted a long time.
In cases of acute hydramnios, the procedure should be different. The rapidity with which the symptoms develop, their intensity, the serious phenomena which they cause in the mother, require an early intervention, and necessitate, not only premature labor, but, indeed, the induction of abortion. The uterus tends itself t,o expel the product of conception, and it is in these cases especially that premature contractions occur. But
these contractions are most often insufficient to determine labor, and they only augment the suffering. It is necessary, therefore, to interfere, and induce abortion without hesitation. Of course the responsibility of the obstetrician is great, and interruption of pregnancy at a time when the &Ana is not viable is always an operation not to be undertaken unless it is absolutely necessary; but we believe that in these cases to hesitate is not allowable, and that on account of the chance of the mother's death, the obstetrician should practise abortion conscientiously, which, if it end fatally to the infant, allows the mother almost every chance of recovery.
It is seen by our observation that we did not hesitate. The cure of the mother justifies our intervention, and, should we again be thrown with such a case, we should have recourse to abortion. By it, indeed, the fcetus is surely sacrificed, but the mother is almost certainly saved, and we believe that between the saving of a woman who has other children, and the saving, more or less problematical, of a ftetus subject to au the unfavorable circum stances in which it is placed by the hydramnios alone, not only is abortion authorized, but indicated; and that the obstetrician who hesitates thus to intervene in this case fails professionally, and to his own sense of duty.
Various Alterations of the Amniotic Fluid.
In dropsy of the amnion, the amniotic fluid is altered in its quantity, and in its quality as well, and these alterations are of quite different kinds. Some are compatible with the life of the fcetus; the others conduce to its death. At the beginning of pregnancy, limpid, transparent, colorless, of a density less than water, the amniotic fluid later should become unctu ous, a little thick, and especially remarkable for the presence of little whitish caseous lumps, which are similar to the sebaceous matter cover ing the body of the fcetus. Most of the foreign substances absorbed by the mother are there met with. We cite, among others, the case of Levret, who has seen the amniotic fluid whiten copper in a woman who was undergoing mercurial treatment. A case has been cited where the odor of camphor, absorbed by the mother, was noticeable. Everyone knows the case of Stoltz, who has seen a child, born living, where the amniotic fluid gave an offensive odor of putrefying tobacco; the mother worked in tobacco. The amniotic fluid may acquire irritating properties, as in the case of Naegelk, where there was found a kind of mac eration of the fcetal epidermis. The child, though born feeble, recovered perfectly, and was in perfect condition at the end of the fifth day, after shedding its epidermis.