There is one form of alteration which is much more frequent—that which is due to the presence of meconium in the liquor amnii. Nor mally, in cases of breech presentation, the meconium gives to the fluid a green tinge, more or less pronounced according to the quantity that has been mixed. In some cases the fluid is thin; in others it is much thick ened and sticky; and if one does not consider the escape of the greenish fluid as evidence of the death of the fcetus, as the older obstetricians thought, it indicates at least an action on this little being, by compression of the cord or otherwise, prolonged labor, etc. However, this sign is noi certain, and it is not rare to see the child born alive after abundant escape of very dark liquor amnii. One can say, in a general way, that the de gree of intensity of these changes, and the greater or lesser fluidity, are proportional with the perfect health of the fcetus, though the fcetus may be born alive with very thick and fetid liquor amnii. Auscultation only can decide as to the beating of the heart; its perfect regularity and nor mal force has completely reassured us in a case where at first one might have some fear.
Concerning the alterations which are consecutive to the death of the fcetus, Lempereur describes three degrees. In the first, thore is a solu tion of the fcetus; in the second, a mummification; in the third, macera tion; the other alterations are only produced after the escape of the fluid, and after the entrance of air into the sac. To these time periods, differ ent states of the amniotic fluid correspond.
In the first (solution), the fluid is no longer clear, transparent, limpia and pale yellow, but sometimes simply dirty and thickened, sometimes milky, like an emulsion, according to the quantity of organic elements dissolved. This fact is mentioned by the older obstetricians, as Mauri 'man, Puzos, Bischoff, Martin, and others.
In the second (mummification), the liquid is diminished, still thicker, granular, purulent, or rather, as if mixed with a clayey earth. At a more advanced degree it disappears, leaving on the embryo a grayish oily sediment analogous to the deposit of overflowed water.
In the third (maceration), the liquid is altered according to the state of the fcetus. This period is characterized by the cedematous infiltration of the fcetal tissue with a bloody serum, complete inbibition of the soft parts-with their softening and shrinking, and raising of the epidermis in phlyctenulte, in vast blisters. It is this escaped liquid which gives to the liquor amnii its special characteristics. It is thin, red and bloody, more or less thick. With this condition of the fluid the fcetus is dead. This is
verified by clinical observation. These changes, however, are not always found in cases of fcetal death.
Lempereur has noted many cases, where on rupture of the membranes, a clear and quite transparent liquid escaped. This is duo t,o the fact that. at the moment of rupture, the indite are intact, and it proves that the liquid which they contain alters the amniotic fluid after their rupture.
Amu iot ic Cords.
These amniotic bands are not as rare as might be supposed, for Klotz was able, in 1869, to collect 34 cases. Montgomery, who had already ob served them, considered them as organized lymph; Simpson, as the result of local inflammation of the skin of the fcetus; Simonart, as due to ulcer ation of the skin of the fa.tus, and to inflammation of the amnion; Gurlt, as prolongations, not detached, from the skin of the fo3tus; Scanzoni, as exudations from the internal surface of the uterus, and penetrating across the amnion; G. Braun considers them as the folds of the amnion. Very probably they are not inflammatory products, but adhesions, partly meta morphosed, of the amnion to the fcetus. Spiegelberg proclaims that they should be considered as due, sometimes, to a very early inflammation of the amnion having induc,ed an adhesion to the skin of the fcetus; some times, more rarely, as an arrest of development, an abnormal fold of the amnion, but he rightly remarks that, up to the present time, no one has discovered vessels in the amnion, hence its inflammation is more than problematical, and he supposes, with Brailn, that they are due to abnormal folds of the amnion, or to an incomplete or too late separation from the foetus, produced by an unknown cause, perhaps by insufficient or tardy secretion of the liquor amnii. As a consequence, arrest of development, semetimes fissures in the fcetus, the liquor amnii developing and distend ing the amniotic sac. These adhering points are lengthened in bands, which, by the constriction they exercise on the fcetus, cause malforma tions and spontaneous amputations. One sometimes finds the fcetus thus malformed, and at points corresponding to the constriction, free ends, detached bands, or sometimes only cicatrices. Finally the bands may be suspended free in the amniotic sac. According to Braiin, when the am niotic fluid is produced tardily, the amnion is torn, while the chorion re mains intact. 'Under the influence of the fcetal movements the amnion becomes rolled around the cord, and induces thus, by compression, the death of the fcetus. (Fig.23.) Finally, these amniotic folds may be pro duced after the death of the fcetus by diminution of the liquor amnii.