PREMATURE EXPULSION OF THE FCETUS. 47 



experiences a sense of uneasiness, languor, pain in the back and 

 lower part of the abdomen, accompanied by pains of an expulsive 

 character, and often with hemorrhage. When the ovum itself is 

 ruptured, there is a discharge of water from the vagina, greater or 

 less, according to the age of the foetus, followed afterwards by pain 

 and discharge of blood. 



Sometimes the ovum is discharged with little or no pain, at others 

 the pains are described as being more severe than those of labour at 

 the full term. 



Treatment. — There are two points to Ke observed in the treatment 

 of these accidents"; firsts If possible, to prevent the expulsion of the 

 foetus, and enable the woman to complete her pregnancy ; secondly^ 

 Where this is hopeless, to shorten the process as much as possible, 

 and prevent further hemorrhage. 



As we cannot be certain in the first instance, whether the child is 

 dead, or not, it behooves us to act under the supposition of its life, 

 knowing that if the vital relation between the ovum and the uterus is 

 compromised it will be discharged. 



The 'preventive treatment will consist in moderate bloodletting if 

 the patient be plethoric and the pulse full and bounding, rest in a 

 strictly horizontal posture^ on a hard bed, lightly covered with clothes, 

 and in a cool room, cold wet napkins to the vulva, abstinence from 

 stimulants, anodyne enemata, and if necessary, the internal use of 

 astringents, such as infusion of rose leaves, elixir vitriol, alum, ace- 

 tate of lead and opium, &c. 



If these means fail, and the hemorrhage continues, whilst the 

 ovum is not expelled, there is little or no chance of preventing mis- 

 carriage ; our endeavours must be directed to the suppression of the 

 discharge, knowing it will generally cease as soon as the womb is 

 emptied. The best agent we possess under these circumstances, is 

 the tatnpon^ or plug. This should never be used, however, if inter- 

 nal hemorrhage can take place to such an extent as to destroy 

 life; in other words, not if the uterus be empty, and the patient far 

 advanced in pregnancy. It may be used with safety and advantage, 

 if the uterus be filled with its natural contents, or be only slightly 

 distensible, even though empty. For this purpose some recommend 

 a sponge steeped in vinegar, others a silk handkerchief, others, 

 again, small, square pieces of linen pressed into the vagina till that 

 cavity is entirely filled, the whole being retained in its place by a T 

 bandage, or the hand of an assistant. It should be allowed to remain 

 in situ, from six to twelve, or even twenty-four hours, the patient 

 being still in a horizontal position, and, the bladder, if necessary, 

 relieved by the catheter. When withdrawn, the ovum, or fragments 

 of it, will generally be found adherent to its upper part, along with a 

 coagulum. 



The tampon, it will be remembered, is not to be used under any 

 circumstances where there is a hope of saving the pregnancy. 



