HEPATIC COLIC AND NEPHRITIC come sometimes, simulate labor-pains, but the absence of Ivemorrhage from the vagina, and the intensity of the suffering, soon establish the identity of these diseases.
'threatened abortion being the condi tion present, the next point is to ascer tain whether the abortion is inevitable.
Abortion is inevitable (1) when the membranes are ruptured, (2) when the foetus is dead, or (3) when any foetal part is already engaged in the cervix (Auvard). So long as symptoms of these three conditions are not present, abor tion may not occur.
When symptoms, such as hemorrhage, have occurred, it is often difficult to determine whether abortion has really taken place, and, if so, whether it is incomplete or complete. Uterine explo ration may then become necessary.
During the first weeks of pregnancy the embryo may be so small as not to be easily found, and a positive diagnosis may not be established until, by subse quent events, continuation of pregnancy or involution of the uterus takes place.
When the foetus is dead it may remain in the uterus and the latter be thought, by the attending physician, to be empty. In some cases, even after lmnorrhages and the expulsion of portions of the secundines have taken place, the inter plored with the finger. If the tube is found ruptured, abdominal section is required; if there is simple and com plete tubal abortion into the peritoneal cavity, Douglas's pouch should be drained. When the expulsion is incom plete, or there is a tubal mole, the ovum being retained in the tube, abdominal section and removal of the tube are in dicated. Spinelli (Archivio Ital. di Ginee.. June, 1901).
Treatment.