The etiology is obscure. In Virchow's case there was a syphilitic his tory, but in the other cases there was none. In some of the cases it seems that the lesion was only the result of an endometritis, of an irritation of the mucous membmne, preceding pregnancy. The changes in the cho rion, as those of the fo3tus, are only secondary. Speigelberg, even, rather considers this alteration secondary.
3. Catarrhal Endometritis.—Hydrorrhffla.
The opinion, entertained to-day by the German authors Schroeder, Spie gelberg and Braiin, is that chronic inflammation of the decidua may, aside from cellular proliferation, produce an abnormal secretion called hydrorrhcea gravidarum. But this opinion is not yet accepted by all authors, and Stapfer, after reviewing and discussing all the opinions, con cludes that there are, perhaps, two forms of hydrorrhcea, the traumatic and the catarrhal. His work is the most recent and complete. We bor row, from it, the following description.
The aqueous discharges during pregnancy have been considered, now as uterine dropsy, now as dropsy of the membranes, now as premature rupture of the membranes, and have been described, under the titles false waters, hydrorrhcea and metrorrhcea. Several hypotheses have been sug gested regarding the seat, the source and the nature of the liquid.
Seat.—I Bettoeen llu3 Uterine Walls and the Mentbranes.—A case of Daclos, quoted by Basset, seems conclusive. Here two full sacs and one empty one were found, as well as the channel le,ading from the latter to the os, and this in a woman who, three weeks before, had suddenly lost a glassful of liquid, and had, subsequently, had a discharge, drop by drop. This is the anatomical explanation of the clinical fact reported by Naegelt and Geil. A secretion occurs and accumulates. The membranes are detached, progressively, as far as the os, and at this moment, probably owing to a painless uterine contraction, the pocket is suddenly emptied. In this case there has been found, on the internal surface of the uterus, an opaque, whitish plaque. Is this the first or the second degree of the catarrhal endometritis of Schroeder, Spiegelberg and Braun ? IL The Water collected between the Membranes.—According to Mattti,
in two out of three cases the amnion is separated from the chorion by liquid, not only in the early weeks, but even up to the end of gestation. He has called this space, thus filled with liquid, the pocket, the amnio chorial sac. According to others., this pocket only accidentally exists in cases of hydrorrhcea. But Naegelt, Basset and Chassinat have denied the existence of this sac, and shown that, even in hydrorrhce,a, there is complet,e adhesion of the membranes. Duclos had already reported that in his case. Geil overturned this opinion, and maintained that all the water escaping from the uterus during pregnancy or immediately after labor, comes from the space separating the concavity of the uterus from the convexity of the chorion. Stapfer states that, in a case seen by him, at the moment when he was palpating, some liquid escaped which could only come from the internal surface of the uterus, for the cervix was not dilated, and, during labor, two pockets were successively formed and ruptured by Stapfer. The membranes were intact. In a case of Bat bedat, however, the chorion and amnion were entirely separated On one side, and incompletely on the other. The amnion on its external sur face, and the chorion on its internal surface, were covered by a slight plastic exudation, such as is seen in pleurisy. That seems to prove that Naegele and Geil were too positive. Duges stated that the liquid accu mulated in the cavity of the allantois! ! ! The older writers held that the liquid gathered between the two decidtue. In these cases, hydrorrlicea occurred in the first weeks of pregnancy. The two decidute do not, in deed, become united until after the third month.
The water collects in an hydatid.
/V. The water collects in a cyst.
V. The collection occurs in a supernumerary ovum.
These three opinions do not admit of discussion, so that only three opinions remain: 1. The hydrorrhcea of the first weeks (Tarnier) occurs in the cavity of the hydroperion. The liquid collects between the decia reflexa and the decidua vera. 2. The hydrorrhcea of the last months is due to an accumulation of liquid between the decidua and the chorion.