If the bleeding starts again every time the woman goes about her duties, the abortion may be inevitable. When the cervix is shortened and dilated so that the ovum is palpable and pieces of the decidua or ovum are expelled, the hemorrhage is more or less profuse, and especially if the bag of waters has ruptured and uterine contractions show, the abortion is deemed inevitable. In such a case the fetus may be alive, or it may be dead; and, again, conditions which show all the classic symptoms of inevitable abortion sometimes, though rarely, do not go on to abortion. It is extremely difficult, and often impossible, to tell whether an early fetus is dead or alive. A high, lasting fever sometimes kills the child; so do low blood-pressure, profuse hemorrhages, deoxidation of the blood in pneumonia, separation of the placenta, fatty degeneration of the placenta, and the severe infections--in such cases there is always strong probability that the child is dead when the abortion shows its symptoms. If the fetal tissues that appear indicate maceration, or if the discharge is fetid or purulent, the fetus is dead. Should the fetus be alive, tamponing the vagina to check the hemorrhage often separates the fetus from the uterus by the dissecting force of the blood dammed back, or in any case tamponing is almost certain to excite uterine contractions; thus there is an indirect killing of the fetus. The treatment of inevitable abortion after the fifth month differs very much from the methods used in the early months. The prime principle is, never interfere until forced to do so. When the hemorrhage is dangerously profuse, so that the woman's life is endangered (an exceptional condition), the uterine cervix and the vagina must be tamponed with sterile gauze and cotton to check the bleeding, but this is a last resort. If the fetus is alive, or probably alive, nothing short of a necessity to save the woman's life by this means justifies the use of the tampon. De Lee advises the routine use of the tampon in threatened abortion, but this doctrine is erroneous medically and altogether false morally. If the physician knows the fetus is dead, he should, of course, tampon at once to get rid of the fetus. The tampon excites uterine contractions and causes destruction of a living fetus by dissecting it loose from the uterine wall through the dammed blood. Elevation of the foot of the bed and the use of morphine will, as a rule, check the bleeding. When the woman is bleeding _to the risk of her life_, the tampon is put in to check the bleeding and so save her life. The double effect immediately following this indifferent act is on one side good, the saving of her life; on the other side evil, the killing of the fetus. The good effect is intended, the evil effect is reluctantly permitted. Such a procedure is morally licit.