Every variety of malformation has been found with dropsy of the am: nion, from hydrocephalus and spina bifida, to anencephalus, harelip, clubbed feet and hands, double monstrosities, etc. Internal deformities, malformations of the heart, imperforate genital organs, etc., have also been noted.
And if some of these malformations, such as an imperforate urethra, will explain hydramnion, the others will not do so, and we must return to the opinion of Burns, who said: " Dropsy of the amnion is a disease of the egg, and not of the mother; the fcetus is often deformed, and the affection must be considered as a species of monstrous conception." As to syphilis, Bums, in 1839, had already proved that hydramnion might occur with syphilis of the father or the mother. Fournier has recently again called attention to this relationship, as have Bourgarel, Preel, De paul, Ganiot, Charpentier, Sallinger, etc.
In some cases of hydramnion with syphilis, the fcetus shows indubitable marks of the disease; but in others neither fcetus, placenta, nor mem branes showed the least sign, and we are compelled to admit the effi ciency of the maternal influence. To these three main facts--twin preg nancies, fcetal malformations, and syphilis--we must add lesions of the ovum and membranes of various kinds.
In the four cases of syphilis we observed in two years of clinical ser vice, there was but a single case of dropsy of the amnion. The woman had dropsy of the amnion in 1875, has since had two healthy children while under specific treatment, and is at the present moment enceinte for the fourth time, and shows a small amount of amniotic dropsy.
The anomalies of the cord may cause a stasis in the venous circuldtion of the placent% Hildebrandt has noticed the connection between these anomalies and the hydatid mole; indeed the hydatid mole is often accompanied by a large amount of liquor amnii.
Among these anomalies of the cord, SaRinger notices: Extreme thin ness; exaggerated torsion; cystic degeneration; stenosis of the umbilical vein; rings of the cord.
There may be also cartilaginous and hepatic degeneration of the placen tal tissue, fibro-myxoma of the placenta; atrophy of the placenta; hyper trophy of the placenta ; abnormality of the hepatic circulation. On the
side of the mother there may be hydrcemia, tumors, especially fibroids, and carcinoma uteri.
As to the membranes themselves, they may be the seat of a multitude of inflammatory and other lesions, concerning which we have recorded a number of observations in our Memoire.
'Finally, Gervis decided that the liquor amnii ca,me from the amnion, and its excessive accumulation was due to serous extravasation. In most cases we can detect either: 1st. Inflammation of the amnion; 2d. A hy pertrophic and morbid decidua, the amnion remaining healthy; the fcetus is compromised, and abortion is imminent; 3d. Dyscrasias of the mater nal blood, such as cause serous transudations in other parts of the body.
Symptoms.—By dropsy of the amnion, we mean a disease in which the amniotic cavity contains an abnormally large amount of fluid. It may exist alone, or be accompanied by other dropsies, as ascites (Sc,arpa); and it shows itself in two forms, sufficiently distinct, though not very sharply divided from one another. One is the slower, classical form; the other. more acute, has been described by Oulmont and Jacquemier. The symptoms are different enough to justify expectant treatment in the one case, and to call for active interference in the other. Let us first de scribe the symptoms of the ordinary classical dropsy of the amnion.
Gassner has found that there is, 011 the average, This quantity is doubled in twin pregnancies. The figures, of course, are not by any means exact. Gassner also found that, in general, the amount of liquor amnii increased proportionately with the weight of fcetus and placenta. The amount of fluid present with hydramnion is very variable. Sallinger has collected the following cases: Schneider, 60 pounds, 24 pints; O. Reilly, 48 pounds, with 20 pounds of ascitic fluid; Hansen, over two buckets full; G. de Gorregues Griffit.h, 40 pounds; Battson, 32 pints; Haerlin, 30 pounds; Blink, more than a bucket full; PeRatan, 21 pounds; Werner, 15 pounds; Rouger, 15 pounds; Mattin, 14 pounds; Ridder, 14 pounds; Ramsbotham, 15 pounds, with 25 to 30 pounds of ascitic fluid; Valenta, 5 pounds; Fabrice de Hilden, 27 pounds; Sallinger, 30 pounds.