It thus t,akes five pounds to cause trouble during pregnancy and child birth; but as a rule the amount varies between 10 and 60 pounds.
Usually the disease does not commence before the fifth or sixth month of pregnancy, although it occasionally appears earlier. Thus the case of Fabrice de Hilden dated from the beginning of pregnancy; those of Scarpa, Schneider, Hahn, Depaul, and Menschler, from the end of the second month; those of Martin, Pelletan, and Ganiot, from the third month; that of Bausch, Werner and Rouger from the fourth month, and that of Seulen from the fifth month.
The first symptom is the appearance of persistent vomiting, followed by general enfeeblement, and marked emaciation. But these symptoms are not constant, and much more characteristic are the pains, which are seated sometimes in the belly, sometimes in the hypogastrium, or even in the sacral, inguinal, or lumbar regions; they are usually continuous, though they may be intermittent and take on the character of uterine contrac tions. They do not appear, usually, until pregnancy has advanced to a certain point.
Then comes a rapid and exaggerated development of the abdomen, ac companied by thinning of the ut,erine parietes, and by fluctuation. This sensation of fluctuation is never seen in normal pregnancies, and has been found so pronounced as to have been mistaken for ascitic fluctuation. More often, however, there is a sensation of false fluctuation, exactly like that experienced in cases of ovarian cysts. We will return to this subject when we come to speak of diagnosis.
The abdominal development usually begins early in Dregnancy, but Joes not become very marked until after the fourth or fifth month. Al though it advances rapidly, and out of all proportion to the supposed stage of the pregnancy, it progresses evenly, and may reach an enormous development. Hence the morbid symptoms are not very intense, and it is only after the disease has existed for some time, that the women begin to suffer much. The uterus, in fa,et, does not react very energetically against the progressive liquid accumulation. Hence the relative tolerance to and benignity of the affection.
In consequence of the abdominal distension and increased intm-abdonii nal pressure, cedema appears. It may be limited to the lower limbs, or appear on different parts, such as the genitals or the abdominal wall. But its consequence may be more serious, and ascites appear. (Edema is not a constant symptom, and is absent in many well-pronounced cases.
In consequence of the great abdominal distension, other symptoms ap pear indicative of compression of the lungs: dyspncea, oppression, engorge ments of the base of the lung, cedema pulmonum, with syncopes and as phyxias, and in some cases even real hemorrhages.
Cardiac palpitation naturally ensues, and the pulse becomes small and frequent.
The urine is diminished in quantity; it is thick, reddish, and more or less'highly charged with albumin. A dysuria more or less pronounced appears at the same time; and in rare cases there may be some icterus.
Constipation is the rule. Then nervous troubles appear, vague neural gic pains, especially marked in the lower limbs.
Insomnia, with agitation and depression of spirits, may now appear; and in some rare cases psychic troubles, delirium, trismus, and even eclampsic attacks may follow.
It is a curious fact noticed by Sallinger, that in most cases there is no fever.
The extreme distsnsion of the abdomen causes thinning of the uterus, the vagina is shortened, the cervix effaced, and often partly open. The presenting part is very mobile, and ballottement is very marked.
The fcetal heart-sounds are usually feeble; they change their place, and sometimes become inaudible towards the close of pregnancy; in some cases they may never have been perceived.
The hyper-distended membranes are often ruptured too early, and pre mature labor occurs.
Finally, metrorrhagia is common during pregnancy, and occurs during labor, and especially after delivery from uterine inertia. Such are the principal symptoms of dropsy of the amnion; but we must consider some of them more in detail, especially the abdominal tumor, and the sensa tions obtained by palpation.