MIDWIFERY. 



213 



Oi the tives and carminatives, or antispasmodics ; continued 

 1'rrfnani tickness, with bitter taste, by very gentle doses of calo- 

 State. me | . convulsions, by instantaneous venesection ; faint- 

 X> " "~V""" 1 *' jng fits, by cool air, application of cold water, and the 

 ue of volatiles ; annsarca depending on pregnancy, by 

 the lancet, and aperients, with mild diuretics To en- 

 ter more into the detail of the different diseases of 

 pregnancy, would swell this article beyond reasonable 

 bounds ; oor u it necessary, as the general principles 

 of treatment have been freely anil without reserve laid 

 down. It will not, however, be proper to conclude 

 part, without adverting to a mechanical disease, 

 which sometime* Uke* place between the third and 

 fourth month of pregnancy, and which is known under 

 the name of retrovenion of the womb. It may at 

 this period be produced by improper retention of the 

 urine, by which the bladder is distended, the lower 

 part of the uterus raised and brought forward, whilst 

 the upper part is turned back and thrown down be- 

 tween the vagina and rectum. Hut it is quite a mis- 

 take to suppose that retention of urine is the cole cause, 

 or, in many instances, more than a secondary one, in- 

 creasing that displacement which had begun to exist. 

 From a careful examination of the progress and symp- 

 toms of this disorder, the writer is convinced that fre- 

 quently it arise* from an undue degree of prolapsus. 

 The o* uteri is brought lower and more forward i 

 ought to be, and the fundus lie* tuck in the hollow of 

 the sacrum. The uterus enlarge* in this situation, and 

 the fundus sinks lower, whilst the o* uteri projects 

 more forward and obstruct* the urine The bladder 

 become* distended, and the retrovenion i* completed, 

 or increased thereby, if it had already taken place, by 

 the mere subsidence of the fundus and consequent ele- 

 vation of the opposite end, the uterus turning to a 

 greater or lew extent, like a beam of a balance on it* 

 axis. A moderate degree of malposition produce* in- 

 convenience, chiefly from the pressure it occasion* on 

 the orifice of the bladder, by which the urine cannot 

 be evacuated. This not only occasions the usual pain- 

 ful sensations which accompany retention of urine, but 

 very *oon excite* severe bearing-down pains, like those 

 of labour. Partly from the effect produced on the lower 

 part of the uterus by the distended bladder, but chiefly 

 by the pre**ure of the superincumbent viscera, occa- 

 sioned by the contraction of the abdominal muscle*, the 

 fundus U pressed lower, and the retrovenion rendered 

 more tompleU, and the bladder i* Mill more closed up. 

 The two prominent symptoms then of this complaint, 

 re, retention of urine, and bearing-down pains. These 

 pain* are more dependent on the state of the bladder 

 than on the position of the uterus, for they are always 

 worst when the bladder is fullet, or most irritated. 

 Last of all, if the complaint be neglected, and the 

 bladder continues unrelieved, inflammation taxes place, 

 and generally prove* fatal. < 



therefore, ought to be immediate! < the blad- 



der, by introducing the catheter; and a regular recourse 

 to this, keeping the bowel* open, and allaying irrita- 

 tion, if Decenary, by opiate*, seldom fails in curing 

 the patient. The be*t catheter to be employed i* the 

 gum one, and advantage may sometimes be derived 

 from allowing it to remain in the bladder, so a* to 

 keep it constantly empty for some time 

 been urged to replace the uterus by pressure, but tin- 

 often is not to be accomplished without much force, 

 and in some case* i* almost impracticable. No in- 

 stance ha* occurred to the writer where bad conae- 

 qucnces followed from neglecting thi* attempt, and 



therefore he is still inclined to advise the more lenient, Of the 

 though slower nimlc of trusting to the use of the ca- ******' 

 theter, rather than using force in endeavouring to re- _^-" le ^ f - 

 place the womb. At the same time, he has no objec- ""Y"" 

 tion, after the urine is drawn off, to make gentle 

 pressure upwards on the fundus uterus, with die hand 

 introduced into the vagina ; but no strong efforts to 

 are advisable, nor, in any case, ought the at- 

 tempt to be made, till the bladder be completely 

 emptied. 



CHAP. IV. 

 Of Abortion and Hemorrhage. 



When the child is expelled so prematurely as to be Of abortion 

 unfit for living, the mother is said to suffer an abor- nd hcmor- 

 tion. This is always accompanied with separation of r 

 the ovum, and contraction of the womb itself. The 

 first U production of discharge of blood, the second of 

 pains analogous to those of labour. Sometimes the se- 

 paration, and, in other caae*, the contraction, is the first 

 indication of abortion. If this event arise from any 

 exertion, fright, or any other cause operating on tin- 

 vessels, and occasioning detachment, the symptoms 

 come on unexpectedly, and in general the first is he- 

 morrhage If, however, it proceed from more latent 

 causes, influencing the vitality of the foetus itself, we 

 usually observe certain precursory signs, which shew 

 that the embryo or child i* no longer alive. The 

 morning sickne** ceaaes, the breasts become flatter or 

 fall off in sice, the abdomen feel* slack, and a sensa- 

 tion of heaviness is perceived in the lower part of it. 

 If the patient be past the time of quickening, she now 

 feel* motion no more. Any one of these signs is not 

 to be considered a* evidence that abortion is inevitable, 

 but when they are conjoined, there can be no doubt. 



If the ovum be very inconsiderable in size, the symp- 

 toms attendant on abortion are chiefly those of uterine 

 irritation, accompanied with hemorrhage, and differ 

 little from thoe of painful menorrhagia. Nothing but 

 coagula can be detected. 



1 1' the ovum be distinct, a* in the second month, we 

 have an attempt to contract, pains rrore or less regular, 

 and greater Disturbance of die abdominal viscera, and 

 not unfrequently a tendency to syncope. 



When the organisation is more complete, and the 

 ovum larger, as in the third month, we have still more 

 distinct and regular pains, accompanied with hemorr- 

 hage and sympathetic symptoms. Sometimes the wa- 

 ter i* first discharged, then the foetus, and last of all 

 the secundines ; in other cases, the membranous bag 

 come* away entire, enclosing the fu-tut, and bringing 

 along with it the furtal posture of the placenta, and part 

 of the decidua ; the rest is afterwards thrown off. 



When farther advanced, the process resemble* still 

 more nearly labour, except in being accompanied with 

 greater discharge. 



When the tVelus is expelled in abortion, it is usual 

 for the discharge to mitigate or stop for a time, then it 

 returns, and sometime* with redoubled violence, pre- 

 vious to the expulsion of the secundines. These arc 

 thrown off, at different periods, from an hour to some 

 days, but the general time i within 1 J hour*. 



The duration of the whole proces*, as well as the 

 nature and extent of the accompanying and sympa- 

 thetic effect*, vary much in different cases, and in *omc 

 a portion, or the whole of the secundines, i* so long 

 retained a* to become putrid, and produce bad con- 

 sequences. In general, abortion is not attended with 



