196 The Philippine Journal of Science lan 



occurred too late to be of any avail, as the period between the 

 admission to the hospital and the time of the abortion was an 

 average of thirty-one hours for the fatal cases and twenty-two 

 hours for those who recovered. The retardation of the abortion 

 in the fatal cases naturally caused the delivery to take place at 

 a time when the patient's condition was at the weakest, when 

 more toxins had been absorbed from the dead foetus, and when 

 the energy expended in the process was sufficient completely to 

 exhaust the mother. This was strikingly illustrated in a number 

 of cases in which the last effort, voluntary and involuntary, made 

 by the patient in this world was to rid herself of her dead foetus. 

 Further the percentage of mortality for the mother observed in 

 favor of the cases that did not abort is in itself a proof that this 

 class of cases was of a milder form, that the mother was not 

 absorbing any toxins from a dead foetus to aggravate her already 

 serious condition, and that the energy not expended in delivering 

 a foetus was reserved for the recovery of herself. 



The fact that the mortality for the mother is increased pro- 

 portionately to the term of the pregnancy, as seen in Table II, 

 agrees with a similar statement made by Schutz.(l6) The mor- 

 tality of the mothers (60 per cent) aborting foetuses ranging 

 from the fourth to the ninth month is greater than for the period 

 before the fourth month (44 per cent) . The larger the foetus, 

 the greater the tax required by the mother in its expulsion, thus 

 lengthening the process of the delivery. The more fully devel- 

 oped placental circulation and the firmer attachment of the 

 placenta during the latter months of pregnancy facilitate the 

 absorption of toxin originating in the dead foetus before its sep- 

 aration occurs, thus rendering more unfavorable the mother's 

 prognosis. 



The mortality of 50 per cent for the mother for the total of 

 the second month of pregnancy (Table II) brings to one's mind 

 the idea of toxsemia of pregnancy so frequently seen in early 

 pregnancies in general, causing the cholera patient a graver prog- 

 nosis, while those of the ninth month, being so near term, cause 

 no additional strain on the mother, as convincingly seen in the 

 resulting mortality of only 33 per cent in 10 cases. It was in 

 this group of cases that a child was born alive to be discharged 

 from the hospital with its mother. 



From the foregoing it is evident that abortions are very fre- 

 quent in cholera patients, that the mortality is very much higher 

 in the pregnant cases, and also that the foetuses are nearly all 

 stillborn. The question arises. What kills the foetus? 



