2d. Signs perceived by the of the established by different trials, is the absolutely certain sign, especially if the obstetrician has clearly perceived them previously. Vire think this is almost the only sign, for those of palpation seem to us more hypothetical than real, more theoretical than truly practical.
If the accoucheur has previously examined the patient during fcetal life, it may be easy to reach a diagnosis of its death, but the conditions are very different when he sees the woman only after the death of the fcetus. Then, vaginal touch and palpation give us no information. Stoltz has noted a sign, a sound isochronous with the mother's pulse, a species of crackling, which he attributes to the decomposition of the liquor amnii. This sign is, however, not invariably present.
[In one case under our observation, where the woman carried a dead five months fcetus for a period of four months, this crackling was very apparent, but we can hardly say that it was isochronous with the mother's pulse. In other instances, however,we have failed to hear the sign. To us, the most characteristic physical sign of fcetal death is a flabbiness of the uterus, instead of resiliency and compressibility, on the bi-manual pal pation, associated, of course, with the decrease in abdominal distension, and collapsing of the mammte.—Ed.] What now may be the appearance of the fcetus after its retention in the uterus? Lempereur, Sentex and Ruge, have described the changes well, and we copy their classification: "According to the stage of fcetal life at which it has succumbed, we find: 1. Dissolution; 2. Mummification; 13. Maceration; 4. Putrefaction; 5. Peculiar alterations, and of doubtful nature.
" Dissolution is apt to occur during the first two months of fcetal life. The liquor amnii then appears more or less milky, in a state of emulsion, so to speak. The placenta may continue to develop, and finally be con verted into one or another form of mole." Mummification.—Dessication.—" At the second period of intm-uterine life is a particular change, entirely distinct in form from those which precede or which follow. The embryo, endowed with a greater force of resistance, provided with an osseous frame, frail and incomplete, it is true, but nevertheless solid, composed of newly organized. elements, which
already have a fixed texture, does not liquefy; it preserves its first form, except its volume, which suffers a proportional reduction. This is mummification, withering, emaciation, contraction, drying up of the anthors. The tissues, yet soft, are condensed under the influence of this prolonged maceration in a saline fluid; they diminish in volume, reduced to a thinner layer, in a word, shrivelled up. The color also changes very rapidly; it becomes dull, gray, yellowish, tarnished, and as if cachectic, contrasting clearly with the normal color, a brilliant dark rose." Sentex adds to this description that the quantity of sanguinolent serum exuded. in the different serous cavities is very small, very dark, and the rose color of the eye-humors hardly marked. The liquor amnii in the first degrees of change exists still, but it ends by disappearing, leaving on the embryo a dull grayish sediment, analogous to the deposit of overflowed water. The actual drying up may be retarded, in proportion as the fluid medium remains. The embryo undergoes, at the same time with emaciation, a sort of shortening; besides, it is already very small at the time of its death.
To this change, in cases of multiple pregnancy, is added. another, namely, flattening. One of the foatuses dying at this time, and the other continuing to develop, the dead fcetus, beaten down, is flattened like a ginger-bread image. It is found at delivery joined to the placenta of the sound twin, and contained in a little isolated pouch, as we have had occa sion to observe in a clinical case. This is the fcetus compressa of the, Germans.
3d. Maceration. —This is by far the most frequent Of the alterations, and the most varied in its forms. It differs essentially from putrefaction, in that the decomposition proceeds slowly, without production of gas, with out odor, without green cadaveric tinge, and never invblves the mother in those formidable consequences to which true putrefaction exposes her.