Alimentation becomes almost impossible; milk, bouillon, alcohol, noth ing can be retained; the woman loses flesh with extreme rapidity, and the contrast between the volume of the stomach and that of other parts of the body is very striking. The shrivelled face, the hollow eyes, bril liant with fever, and the pinched and tightly dravrn lips, sufficiently in dicate the serious condition of the sick woman.
At the same time, the pains are characteristic in their extreme inten sity; occupying the entire abdomen, they shoot down into the loins and thighs. They cease neither day nor night, depriving the patient of all sleep, and are exacerbated by movement on her part. The dorsal position does not ease her, and she can neither stand nor sit; she lies crouched in bed, in the most curious positions, writhing occasionally under exacer bations of the pain. She weeps and sighs, piteously demands relief, and cries out inarticulately. Treatment is useless; neither quinine nor opium, nor chloroform, nor chloral, nor morphine injections are of avail. The pains keep the patient in a perpetual state of agitation; the fever and the pain increase continuously as the belly is distended. Deprived of sleep, and with a constant fever, with frequent vomitings and exacerbations of pain, the woman soon sinks into a state of profound exhaustion, and cries loudly for the relief which it seems impossible to give her.
The abdominal distension increases continuously. Although it attains an enormous size in a few days, it grows steadily though more slowly after the first outburst, until it reaches proportions that are frightful. Espe cially is this the case in twin pregnancies. (Edema of the abdominal walls, especially marked above the pubis, where the skin forms a kind of sac, adds to the distress, and, causing swelling of the labia majora and minont, interferes with micturition. The urine itself is scanty, dark in color, and turbid, and contains a variable quantity of albumin.
Usually, after a certain time, the patient feels other abdominal pains, which, from their intermittent character, are readily recognized by mill tipane as uterine contractions. Although not a constant phenomena, this is, as we shall see, of great value in diagnosis.
The abdomen has now assumed the form that we have described in the more ordinary variety of hydramnion; but palpation is almost impractica ble from the pain it causes the woman. Where it can be employed, it
does not give ns the same results as regards ballottement and fluctuation as it does in the other cases.
If the abdomen is very cedematous, palpation is useless. If it is not cedematous, we feel the utems as a thin-walled mass, which gives to the finger an elastic sensation, but no feeling of fluctuation, exactly as an ex tremely distended ovarian cyst would do. It is in vain that we search the mass for foetal parts. Percussion and auscultation give only negative re sults, and, if we have not studied the disease from the beginning of preg nancy, we are liable to make grave errors in diagnosis. As to volume, the abdomen may take on enormous dimensions. In our second case, at 5-1 months, the abdomen meltsured 52.8 inches.
In some cases, as in this one, the abdomen permits a special sensation to be perceived, which enables us to establish the diagnosis, though seve ral examinations are necessary for the purpose. Thus, at our first visit, the uniformly distended abdomen allowed us only to feel, in the right iliac region, a hard and specially painful point, which gave the sensation of a thick-walled multilocular ovarian cyst. At the second examination, made two days later, on gently palpating the abdomen, which had in the mean time increased f of an inch in circumference, we first found again the same sensation. But on palpating in the right iliac region, we found the sensation of hardness to increase under the pressure, diminishing markedly as it was relaxed. At the same time, this hard point seemed to increase in extent, and, prolonging itself towards the upper part of the abdomen, gained the epigitstric depression by a curved track; and on placing the left hand on the epigastrium, it W118 plainly felt to become harder. Then the abdomen appeared to change a little in shape; it gradually became more prominent in front, the lateral portions becoming depressed. This sensa tion of a contracting organ could be given by nothing but the uterus, and decided the diagnosis. It is easy to understand the importance of this sign, which of course will be more difficult to appreciate where dropsy of the amnion is complicated with ascites.