Finally, the following occasional causes have been noticed: Extreme youth, or, on the contmry, extreme age; the predisposition of certain women who menstruate very abundantly; acute diseases which affect the circulation, and the respiration; the eruptive fevers; pneumonia; cholera; typhus; the diatheses and cachexias (among which latter, syphilis is the most prominent), and, filially, syncope, gravido-ca disc troubles, trauma tisms, or, in one word, all the causes of abortion.
lst. Influence upon the Mother.—All authors agree that whatever the lesion, it exerts no influence upon the mother. The sanguineous effusions may possibly, it is true, compromise her health, and exceptionally endan ger her life; but, as a general rule, she suffers from nothing more than a more or less pronounced state of malaise, which has only a passing influ ence upon the material health. According as the disease is more or less intense, and according as it has or has not accidental complications, the mother suffers more or less; but the placental malady seems to have hardly any pathological influence upon her.
2d. Influence of Placental Lesions upon the Foetus.—Ilere, on the con trary, all authorities agree as to the direct influence of the lesion. How can it be otherwise ? The placenta is the essential organ of Retal devel opment; through it all its functions of nutrition and assimilation are ac complished; through it it respires and is nourished, and from it draws the elements necessary for its development. Is it not natural that the ftptus should suffer when it is affected with disease ? We may con clude with Dubois: "If a portion of the placenta still preserves its struc ture and its functions, the Artus will not only continue to live, but its nutrition will suffer little or nothing. On the other hand, if it does not die, it will be born feeble, thin, and wizened. If the placental disease is progressive, it will cause, in spite of our efforts, a gradual enfeeblement of the fcetal movements and heart-beats, until both stop completely; and the mother and the accoucheur, not unfrequently, help on the agony and death of the fcetus in these unfortunate cases." 3d. Influence of Diseases of the Reins upon the Placental Lesion.—Is it not possible for the state of health or the life or death of the fcetus to react upon the disease of the placenta ? We are entirely dependent upon hypoth esis for an answer. It is true that placental cedema, atrophy, and hyper trophy, appear to be lesions which are peculiarly prone to follow death of tho foetus; but we know nothing certain about iL If we could recognize and diagnosticate disease in the fcetus, we might obtain more precise data. The
only thing that we can determine, and that but rarely, is the condition of the heart-beat, that is to say, the life or death of the foetus. It is only after the beginning of the second half of pregnancy that even this is possible, and the first cause of the death of the fretus escapes us. One fact only can be appreciated at the time of the death of the ketus, and that is the almost constant tendency to abortion which follows that accident. But how often do we not see this accident occur without there being either in the placenta, the membranes, or the fcetus, anything to explain the death, and we are forced to ascribe it to general causes, to diatheses. Even when we find a placental lesion, is the placenta diseased because the fcetus is dead? or has the fcetus died because the plaoenta is abnormal ? The question is still entirely unanswered.
John Bremmer has studied the pathological altemtions of the pla centa, in connection with their influence upon the course of labor. He claims that placental alterations cause, by contiguity, a state of torpor and debility of the uterus, which manifests itself at the time of labor, by a more or less marked paralysis of the organ. Certain symptoms during pregnancy enable us to foretell this condition; these are a pale, thin, and pining facies, flaccid breasts, loss of flesh, frequent pains in the back and in the uterus, but above all, a continuous and unbearable state of malaise, lasting day aud night, and often resisting even narcotics; a soft or com pressible pulse, and a slight lowering of the uterus. At the time of labor, its slowness and difficulty, in women who have had other easy deliveries, are markedly in contrast with the continuous and severe pains, and soft ness and facidity of the 08. The child it born feeble and almost asphyxi ated; or it may be covered with livid blotches. Others again, though born at term, are only half the average weight of new-born infants; they may live a few days.
The amount of alteration in the placenta does not appear to bear any direct relation to the infant's condition as regards life or death.
Finally, the escape of meconium, if not always a sign of the death of the fcetus, indicates a state of such great weakness that relaxation of the sphincters has occurred. Nevertheless, the diagnosis is only certain after the expulsion of the placenta. The cord looks dirty, and the vessels are yellowish green in color; the placenta exhales a fcetid odor, and may be smaller than usual, but its texture seems to be but little changed.