Vol. 60, 1909 - University of North Carolina at Chapel Hill

ORIGINAL COMMUNICATIONS. 375
)f them are, often insures for the patient a menstrual function. The return of the
.ife of invalidism. The fetals parts, in event menses is indicative of fetal death. The
3f the survival of the individual, may ulcer- rectum may be irritable and pulsation can
ite into the bladder or intestines or through often be elicited by vaginal palpation, The
:he abdominal wall. The presence of a most typical system is metrorrhagia coinciiead
fetus acting as a foreign body will dent with the symptoms of pregnancy tn its
nost naturally bring about numerous adhe- early stages. If associated with this there
jions with the varying results that follow is a discharge of decidual tissue one should
n their train. The sac containing a living expect extra uterine fetation.
)r dead fetus is apt to rupture sooner or False labor may be premature happening
ater. The woman may succumb at once at the seventh or eighth month but usually
rom severe hemorrhage or d-e later from makes its appearance at term, rarely after-
;he anaemia produced by successive hemor- wards. At that time the patient has interhages.
If the ruptured cyst contains a mittent pains analogous to true labor pains,
lead or petrified fetus death from peritonitis The cervix does not become obliterated but
s almost certain to follow. It is quite pos- dilates sufficiently for the entrance of one
jible at the end of a primary or secondary or two fingers. After the decidua is expellibdominal
pregnancy for rupture of the cyst ed the pain ceases and does not return unmd
escape of the fetus to take place with- less there has been a rupture of the fetal
JUt provoking either hemorrhage or peri- sac. The signs of labor will disappear and
onitis. The final fate of the dead fetus is milk will come in the breasts.
luite variable. If death occurs duiing the The symptoms of rupture are sudden and
irst inoiitlis the fetus may be completely severe pain radiating over the abdomen,
ibsorljed. At a later jieriod this disappear- rapid, weak pulse, air hunger shock and
ince cannot take place. Suppuration and other concomitants of hemorrhage. There
Darlial liciuefaclion, conversion into adipo- is at>l to be nausea, hiccough and extreme
:ere, muniificatiou or calcareous infiltration tenderness of the abdominal walls. The
jvhh the formation of a lithopaedion may escape of the fetus from the tube without
esult. The cyst may especially in old cases much loss of blood is marked by severe pain
ilcerate or rupture through the abdominal referable usually to the side, tenderness of
.vail, into tlie intestine, vagina, bladder, the abdomen and often a temperature rise.
iterus or by various channels. The great- The rupture may be spontaneous or provok-
;st number the first named channel and the ed by some slight trauma,
emainder following in the order named. Physical Diagnosis.—The os and cervix
The symptoms are divided into those are often soft and either firmly confined by
common to all varieties and those peculiar adhesions or pushed entirely out of their
;o individual varieties. Of the first class natural position by the rapidly enlarging
ire the reflex symptoms that belong to all cyst. Fetal pulsations may be felt through
lormal pregnancies. The nausea and vom- the vaginal wall and the fetus can at times
ting are commonly severe and begin usually be outlined in the same way. There are
:arly in pregnancy. Two symptoms spe- two tumors, one of which is usually situated
:ifically point to extrauterine gestation. io the right or left of the median line. A
rhey are the bloody discharge and the ab- sulcus between the adventitious body and
iominal pains which are as a rule colicky the cervix can be made out. In some cases
ind sharp, they start from the region of the the fetus is palpable through the abdominal
(umor and radiate downwards and out- wall. On manual examination of a cyst
frards. These pains may be in about the containing a dead fetus of considerable size
ijrst and second month aud last throughout crepitation of the bones may be obtained,
breguancy. The acme of their severity is The uterus remains stationary in size after
^bout each menstrual period and there may the fourth month. Fetal heart sounds and
pe an intermission of entire freedom from movements are discernable after the fifth
Ihem between the periods. During these month.
Utacksof pain the abdomen may be swollen Diag/tosis.—The diagnosis is nearly alind
tender to the touch. The pulse is ac- ways difficult and cannot be made with cer-
:elierated but there is no temperature rise, tainty during the first period. At that time
rhe bloody disciiarge from the uterus occurs the diagnosis of probability constitutes an
in a majority of cases. This .phenomenon ample reason for surgical interference. It
8 usually accompanied by pain and the ex- may be taken for ovarian cysts, fibroid tu-
Julsioii of the decidual membrane. This mors, several forms of salpingitis and hemiischarge
is due to rupture of the decidua, atocele. It may possibly be differentiated
s sero-purulent, coffee colored or red and from the.se by the history, the malposition
nay be apparently so profuse as to call for of the uterus and by the disturbances of
he tamponade. In the primary abdominal pregnancy. In the second period of pregype
there may be no disturbance of the nancy diagnosis is not so difficult but it is