The intestine shares in the general derangement. Usually there is a more or less obstinate constipation, sometimes interrupted by a diarrInea which may persist for several days.
The vaginal touch, which apparently should give us definite infornta tion, and does so in certain cases, is insufficient in others.
The marked. cedema of the external genitals interferes with the intro duction of the finger, and limits the field of exploration. The changes in the cervix are sometimes difficult to appreciate at three months. At the fundus vaginEe, we feel only a more or less elastic mass, which might as well belong to an ovarian cyst as to a uterus distended by one or seve ral ftetuses. The fcetus cannot be reached, nor can the change from the neck to the inferior portion of the uterus be appreciated by the finger. The only thing that we can be sure of is that the uterus is fixed and the cervix but little developed. Rectal touch did not, in our second case, give us any more exact information. The vital importance of a precise diagnosis for the woman, is, however, easily appreciable. Happily, in most cases, the diagnosis of pregnancy has been nutde beforehand, and the field of error is thus limited.
Thus acute dropsy of the amnion differs in its symptoms and its course from the slower form, and it is liable to cause errors of diagnosis, which may have most serious consequences for the patient. For energetic treatment will not only relieve them, but will remove the threatening dangers; while they will surely succumb if the disease be left to its own . course.
Happily, nature herself sometimes effects a cure by means of premature labor; but in only too many cases the contractile power of the uterus is much impaired by the distension; and then the obstetrician tnust inter fere, and, by perforating the membranes, bring on the labor.
diagnosis of dropsy of the amnion presents several points for examination: 1st. The recognition of pregnancy; 2d. The de termination whether it is single or twin; 3d. The recognition of dropsy of the amnion, and its differentiation from hydrorrhcea, ascites, the vesi cular mole, and ovarian cysts; 4th. The determination of the cause and
the nature of the dropsy.
lst. The Recognition of is sometimes difficult in norinal cases, and it is not astonishing that it should be more so in cases complicated with hydramnion. In ordinary pregnancies we have, besides the probable signs, only active ftetal movement, the fcetal heart-beat, and ballottement as positive evidences of pregnancy. The first of these, active fcetal motion may easily, in dropsy of the amnion, escape the notice both of the mother and of the accoucheur. Lost, so to speak, in the liquor amnii, the movements of the child are not transmitted to the abdominal walls. Then, the ketus being so moveable, its heart-beat, as we have seen, is not constant at any one point even when alive; and when it is dead, both this and the preceding sign fail entirely.
Luckily, it is not the same with ballottement, which, in cases of hydram Mon, assumes a capital importance. It is in fact more readily per ceived than usual, whether practised by the abdominal or by the vaginal method. But even ballottement may sometimes be absent, and then it is only by a careful consideration of the ensemble of the symptoms that a conclusion e,an be reached. Usually, however, ballottement is easily appreciated, and by that aign, with fluctuation, the diagnosis must be established.
2d. The Determiration between twin Pregnancy and Dropsy of the Amnion.—Both cases give us exaggerated abdominal enlargement; but in twin pregnancy there is hyper-enlargement from the beginning of preg nancy, while in hydramnion the first months of pregnancy pass normally, and the rapid and excessive distension comes only later.
In twin pregnancy, also, the peculiar shape of the abdomen, with its increased transverse diameter, and the presence of similar fcetal parts on opposite sides of the abdomen, are peculiar. In some cases the belly ap pears to be divided into two lobes by a vertical furrow, especially on top, and the shape is characteristic.