(c) Fatty Moles.—Death of the fœtus and fatty degeneration of the placenta, or fatty degeneration of the placenta and death of the fœtus, produces this variety of mole. A withered fœtus with a mass of fatty placenta are expelled.
3. Is it merely the Coats of the Uterus, and unconnected with Pregnancy?—Fleshy masses may be expelled from the womb, which may not be the result of sexual intercourse. The description just given of true moles will, it is hoped, assist in forming a correct diagnosis. Considerable care will be required, for the honour of the woman accused depends upon the opinion given as to the nature of the substances submitted for examination. It must also not be forgotten that moles may be retained for many months in the uterus and be then expelled. The knowledge of this fact may rebut an accusation of infidelity against a wife. Polypi may be discharged from the womb; the presence of a pedicle will point to their true character. All substances expelled from the uterus should be carefully washed in water, and all clots removed. The examination of the woman may also help in the formation of the diagnosis. The absence of the signs of defloration or of recent delivery will be in her favour.
2. Examination of a Woman stated to have aborted.—This subject may be divided under two heads—(1) Has the woman been recently delivered? (2) What were the means used to procure the abortion?
It is by no means easy to answer the question whether an alleged abortion has really taken place or not. The signs of recent delivery are in most cases absent, for the woman can better hide her condition during the earlier than during the later months of utero-gestation; consequently suspicion may not have been aroused against her for some weeks or months after the event. The history of the case, with other attendant circumstances—milk in the breasts, change in the colour of the areola round the nipples, severe flooding, absence of the hymen, injuries to the os uteri, transverse condition of the os uteri in contradistinction to its circular form after delivery, &c.—will, in most cases, assist in forming a correct diagnosis; but it must be again repeated that few of the signs applicable to delivery at the full time are here available.
In all doubtful cases—
1. Examine into the general and present state of the health of the woman.
2. Find out if there are any reasons which would occasion a pretext to use drugs which are not usually given to women during pregnancy.
3. Learn if menstruation is regular and easy, or if the woman is in the habitual use of emmenagogues, for, if so accustomed, she may have used them ignorant of pregnancy.
4. If a woman ascribes her abortion to a fall, to an accident, or to violence used against her, carefully examine into the nature of these.
5. Examine into the general causes of abortion, and also inspect the expelled substances.