Ruge and Sentex have described the changes in these fcotuses, to whom Martin has given the name of " fcetus sanguinolentus" from its peculiar red-brown appearance, in which respect German authors follow him. In France, such fcetuses are called simply macerated (feetugmaceres.) The shape of the cadaver is peculiar, being flattened out, 118 it were, in the thorax, while the abdomen projects like that of a frog. The bones have all softened to such an extent that the fcetus collapses, so to speak. The epidermis is readily detachable, and is covered with bulhe. The cel lular tissue is edematous and colored reddish. The Aetna is so stipple that it is often expelled doubled in two. The internal organs are simi larly changed. The serous cavities are full of bloody fluid. The uterus and the lungs are, of all organs, the least altered. There is no odor to the fcetus of a nauseating nature. It is simply stale and disagreeable.
According to both Lempereur and Sentex, the alterations are divisible into periods, the changes being the greater the more delayed the reten tion. Sentex has followed these changes day by day, as it were.
[Readers especially interested are referred to the original articles of Sentex and Lempereur, where the details, as regards gross and histological appearances, are strikingly minute.—Ed.] Lempereur, who admits the prolongation of pregnancy beyond term, says that, in such cases, the fcetus may present the following alterations: 1. Maceration, general breaking up of the fo3tus, and expulsion of all the debri$ either at a menstrual period, or during a subsequent preg nancy, or delivery. 2. Putrefaction, if air g-ains access to the uterus. 3. Dessication. 4. Ossification, petrification. 5. Saponification.
As for the ketal adnexa, fibrinous masses are found in the vessels of the cord, or else simply liquid blood or recent coagula. The cord is swollen, of a color like that of the fcetus. The placenta presents, on the maternal surface, a number of smooth-walled cavities, containing yellow purulent masses. Its color, and that of the membranes may be of an earthy-brown.
There is nothing unusual about the expulsion of the fo3tus. Out of 77 macerated syphilitic fcetnses observed by Ruge, 35 presented by the ver tex, 24 by the pelvis; there were 8 transverse presentations, 6 of which turned spontaneously. Two points we have noticed particularly. One being that the membranes ruptured slowly, or required to be ruptured; they seemed to have spread considerably. The entire ovum is expelled more frequently than when the fa,tus is living. On the other hand, the labor proceeds more slowly, the uterine contractions are feeble.
Are these alterations due to syphilis, or is maceration simply a post-mor tem clutnge present as well in nou-syphilitic infants ? •Ruge's researches are absolutely conclusive. According to him, 78 out of 94 dead macerated fcetuses are syphilitic, but it is not this disease which causes the macera tion, and induces the alterations, and the proof of this assertion rests on the fact that fcetuses absolutely not syphilitic are born macerated, and presenting identic,ally similar changes; and further, in that syphilis is char acterized rather by the presence of peritonitis, and hypertrophy of the liver, spleen, lungs, and, above all, the bones, and these changes we do not find in macerated fcetuses. Maceration, therefore, is caused by post
mortem changes.
Pritrefaction.—This is the decomposition established spontaneously, under certain conditions, in organs deprived of life. It causes pro duction of new substances, especially vapors and very fetid gases. This decomposition only occurs when air has penetrated after the rupture of the membranes. The decomposition goes on very rapidly, the time con ditions essential to fermentation being present in the uterus, that is, air, heat, humidity.
The changes affect the whole fcetus at once, and are, as it were, instan taneous. At the outset, there is infiltration of all the superficial cellular tissue with gas, whence more or less generalized emphysema, and marked crepitation on palpation. At times the gases accumulate in the uterus, and are expelled with a loud report. These gases are poisonous to the mother. She is seized with fever, chills, hiccough, vomiting, and may shortly die if we do not extract the fcetus. The odor is awful, but the fcetal epidermis is never covered with bulla3, as in maceration.
Cadaveric this exist in the fo3tus at the time of birth? Casper says that he has never observed it in the ketus before term, al though it has been noted in maternity hospitals; and that, in those born at term, it is of very short duration. Taylor has seen one case; Tourdes saw it, at Strasburg, in twins of five months; he affirms that it may occur in the uterus itself, and he says that in those cases where it was not noted, this was because the duration was slight.
In England, cadaveric rigidity is admitted by Grigg, Young, Parkin son, but denied by Thompson. Bailly grants it, and has always found it. Dagincourt, who, to the other observations, adds two cases of Budin's, and one personal, says that muscular rigidity is due to coagulation of the myosin, under the influence of the post-mortem acid reaction of the muscles. The fcetal muscle does not differ in composition from that of the adult, and, therefore, may be presumed to act similarly under similar conditions.
The question cannot as yet be answered. The two hypotheses, cadaveric rigidity, and cadaveric spasms, have each weighty arguments in their favor. Are the cases of Thompson and of Bailly analogous to those to which Taylor has given the name of spasm ? We believe, with Pinard and Dagincourt, in a true cadaveric rigidity, for, as Pinard justly says, in case of convulsions, we do not observe flexion, but extension of the limbs, and in all the cases cited of cadaveric rigidity, the fcetus has been in a state of flexion.