The sliape of the abdomen is peculiar. In the place of a distinct pro tuberance surmounted by a depression, the belly is evenly swollen, es pecially in front, while the lateral portions appear to be depressed.
In some cases Guillemet has noticed peculiar deformities. Thus he has seen the uterine volume so considerable, that the upper part of the abdomen projected in front of the sternum, and the sides of the abdomen swollen out with a deep cleft in the middle, so that it resembled the heart in a pack of cards. We may notice in addition a supra,-pubic cedema, often considerable, and finally, that this form of belly remains the same, what ever be the position taken by the woman.
There is a large area of dull percussion, sometimes occupying almost the whole abdomen, and tympanitic intestinal percussion can only be found at the sides, where a sonorous and fixed percussion note will be found when the distension is large.
Palpation gives different results according to the intensity of the dis ease and the time at which it is practised.
At the beginning, the uterus is readily appreciable to the hand through the soft abdominal walls. Later, they not only become harder, but the distended uterus is so intimately applied in some cases to the abdominal walls, that it is only to be distinguished from it by its faint contractions. The abdominal walls are sometimes very cedematous, sometimes thinned out and very white and pale; or the skin may be covered with reddish or bluish blotches, and appear ready to break. In the first case the sense of fluctuation, and the perception of the fcetal part, will be nearly or quite imperceptible to the touch; in the other case, fluctuation may be so distinctly perceived that the fluid appears to be contained in the peri toneal cavity.
Fluctuation may be absent entirely. (Chereau.) It is the same pre cisely with the recognition of fcetal parts. Sometimes ballottement is very easy, and sometimes it is very difficult to obtain. Besides the diffi culties created by the distension of the abdominal wall, the distension of the uterus itself is of great importance; and when the dilatation of the organ is great, and the fcetus is small, it is often difficult to feel it, and to appreciate its presence. Twin pregnancies, and death, which alters the density and firmness of the fcetus, increase these difficulties. The same things apply to the vaginal touch. It is true that, in most cases, vaginal ballottement is very easily obtained; but in some cases it cannot be gotten at all. The finger feels a soft mass filling the vagina, or an eluatic and hyper-distended pouch, but no presenting part is appreciable.
Finally, the exaggerated sensibility of the abdominal walls, which are sometimes so tender, that patients can hardly bear the weight of their clothes, is an obstacle to palpation; and the cedema and tenderness of the genitals make a vaginal examination so painful, and the senaations are so incomplete, that the perception of the fcetal parts, if not impossible, is extremely difficult. The other symptoms we will find more marked in the acute form of dropsy of the amnion.
Besides this, which we may call the classical form of the malady, and which is relatively common, there is another, which is much rarer, and of which we have only been able to collect twenty-one cases, two of which we ourselves have seen.
Nevertheless, we believe that we can justify our division of the rapid cases from those that we call the classical onds. One prime fact confronts us; and that is that, while in the ordinary form the dropsy takes several months to attain its maximum, in the other it takes only from a few days to three weeks at the utmost for the belly to be enormously swollen, and for symptoms so grave to appear that the life of the woman, as well as that of the product of conception, may be compromised. For while, in the first instance, the uterus has time to accustom itself to the distension, in the second case it is suddenly invaded by the enormous liquid accumu, lation, and reacts against it And here we meet a second difference. While in the classical hydramnion fever is so exceptional that Sallinger only found it recorded in two out of the eighty-one cases he collected, it is the invariable rule in the second class, and gives the disease an inflammatory appearance. Acceleration of the pulse, and increase of the temperature, have never been absent in a case of acute dropsy of the amnion. (See observations of Charpentier, Cerne, Sentex, etc.) • Authors have, therefore, sought to attribute acute hydramnion to in flammation of the membrane& Besides these distinctive points there is a third; in acute dropsy the symptom of vomiting assumes an exceptional intensity and gravity. In the two cases that we have seen, it was so severe that the patients could eat nothing at all. The vomit is at first composed of food, then of mucus and bile; very great abdominal pains, with a feeling of heat and burning, . accompany it, and reduce the patient to a condition of most alarming debility.