3. The accumulation is between the chorion and the amnion.
Origin of the The Liquid comes from the Amniotic Cavity by and Pinard have shown that this transudatiou of amniotic liquid is possible at a certsin stage of labor under the influ ence of the pains. Is the same true of pregnancy ? Stapfer does not think so, for the anatomical conditions are not the same.
II. The Liquid conum from the Uterine is the view of Naegelt. and Geil, who have seen these escapes of water persisting after labor, as well as of Chassinat, Chailly and Mackenzie. It is the classical opinion. But does the liquid come from the glands or from the vessels? 1. The Liquid conies frctn the is the opinion of Hegar and of Retzius, who have seen hypertrophied glands on the membranes of the ova of two women who had had hydrorrhcea. The decidua vera is an organ of secretion, and hydrorrhcea is a hypersecretion. This is the catar rhal endometritis of Spiegelberg, Schroeder and Braun.
2. The Liquld comes from the The liquid is serous and es capes from the capillary vessels, torn by the separation of a part of the membranes of the ovum. This is the opinion of Chassinat and of Depaul, but the separation of the membranes is not explained. b. The Liquid comes from the believes that the fluid is not pure lymph, but that other liquids from the vascular capillaries or the amniotic cavity are mixed with the lymph.
III. The Liquid comes from the Amniotic Cavity, whence it escapes through a Tear in the Membranes, above th.e Uterine Orifice.—The only cases are those of Ingleby, Biesing and Graef. In all the others the membranes were intact.
Nature of the Liquid. —This is very little understood. Chassinat found it thin, limpid, transparent and viscid from albumin. He found no odor of spermatic fluid. The color is not always yellowish. In a case which we reported to Stapfer, the liquid had a slight spermatic odor, was not viscid, was but slightly turbid and contained no vernix caseosa. Boiling caused slight turbidity but not nitric acid; hence there was no albumin. In Gomes' case the fluid was not albuminous, but was markedly acid and con tained much epithelial detritus. After evaporation, crystals of chloride of sodium were found, but no nitrate of urea. With a little hydrochloric a,cid, no uric acid formed even after twelve hours. A little ammonia caused crystals of ammonio-magnesic phosphate to appear at once in the field of the microscope.
affection is rare. Stapfer could only collect seventy
cases. It has been particularly seen in multiparce, and appears at inde terminate periods. It, however, seems more frequent in the last two months.
hydrorrhosa has the following symptoms: A woman after the sixth month suddenly loses, at different intervals, a jet of trans parent,colorless liquid, slightly tinging the linen, making it stiff, like ascitic fluid, giving a more or less abundant albuminous precipitate, and fol lowed by an oozing more or less marked and prolonged. All this happens without prodromal symptoms and without painful uterine contractions. Labor occurs at term, and the fcetus is healthy. The membranes are intact, adherent, opaque in one, two or three places.
Local hydrorthwa begins suddenly, without known cause, at night. At other times, the abdomen becomes distended before the discharge, the patient feels tired; then painful uterine contractions follow; a jet of liquid escapes from the vulva; the pain ceases at once, and the abdomen subsides. Geil disputes this preliminary increase in the size of the abdomen noticed by Hegar and Chaasinat. Generally the escape of the liquid is sudden, but sometimes there is simple oozing. Some times there is a single discharge, or there may be a repetition which may become ne, riodical. The quantity of liquid varies from ono to twenty ounces. Naegele has seen the discharge continue thirteen weeks. In some rare eases the liquid has been colored by blood, and sometimes a slight sanguinolent discharge has preceded the aqueous one. There are no constitutional symptoms.
depends on the source of the liquids. The only avail able symptoms are: The repetition of the discharge, the non-appearance of abortion, the existence of a catarrhal metritis at the time of conception. In one case we observed an effacement of the cervix, coincident with an escape of liquid, which lasted four days. Then the flow ceased, but the cervix remained obliterated, and the labor took place after sixteen days, twenty days after the accident,. The bag of waters formed and broke spontaneously, while the membranes and placenta showed nothing par ticular. Another sign is the presence, in the liquid, of debris of vernix caseosa, which shows the presence of amniotic liquid.
Prognosis. —This is good, neither pregnancy nor health being compro mised.
consists in keeping the patients quiet and watching uterine contractions, if they occur.