24-1 



JM I D W I F E R Y. 



Of the 



danger, if the constitution be not previously ruined, 

 or ^ e P at ' ent much sunk ; but repeated miscarriages 

 ultimately impair the health, and predispose to other 

 diseases. Nor is the process itself altogether void of 

 danger. Very lately, the author was consulted respect- 

 ing a lady who had suffered a miscarriage in the second 

 month, and who, when he saw her, was just expiring 

 from hemorrhage, although she had been carefully and 

 zealously attended by two intelligent gentlemen from 

 the first. 



A predisposition may be given to abortion by that 

 imperfection which takes place in the uterus in ad- 

 vanced life. Repeated miscarriages also not only oc- 

 casion a debility in the womb, but also, by the power 

 of habit, give a tendency to injurious changes and ac- 

 tions about the snme time in future pregnancies. Ge- 

 neral or local debility, produced in any way, has also a 

 predisposing effect, and this is particularly the case when 

 there is a relative plethora, or greater quantity of blood 

 circulating in the vessels than their debilitated condi- 

 tion can sustain. An absolute plethora is another fre- 

 quent predisposing cause, and is generally combined 

 with an hemorrhagic disposition. Excessive irritability 

 of the uterine system, or of the body altogether, ren- 

 ders abortion very apt to occur, and the same holds 

 true of undue sympathy between the uterus and other 

 organs. Some conditions of the ovum itself, too ob- 

 scure to be detected, or which, either from the minute- 

 ness of the part, or destruction of organization which 

 takes place, cannot be observed, must also be includ- 

 ed. Delicacy of the membranes, excessive quantity of 

 liquor amnii, diseased cord, or placenta, are amongst 

 the number of causes. The exciting causes are numer- 

 ous, and vary in different individuals. One of the most 

 certain is the death of the child, arising from affec- 

 tions or changes peculiar to itself, or from disorders 

 and affections of the mother, such as sudden and se- 

 vere cramp in the stomach or bowels. Passions of the 

 mind have much influence on the uterus, disordering 

 the circulation, and causing rupture of the connecting 

 vessels, or exciting the muscular action of the womb. 

 Violent sensations, as sudden immersion in cold water, 

 or a large draught of cold drink, may cause abortion. 

 Acrid medicine, or strong purgatives, or the irritation 

 of piles, 6cc. are likewise exciting causes. Violent or 

 sudden exertion, or any effort beyond the safe degree, 

 will cause abortion ; and in those who are predisposed 

 to it, the most trifling exciting causes are sufficient. 



Our object, in order to prevent abortion in those 

 who are not yet threatened with it, is to counteract, as 

 far as we can, the supposed predisposing causes, and 

 avoid with care those which are existing. Asa very 

 frequent cause is plethora, with or without delicacy of 

 the vessels of the ovum, a prominent part of atten- 

 tion is the sanguiferous system. We lessen plethora 

 by light diet, restriction in the quantity of liquids, lax- 

 atives, blood-letting, and moderate gentle exercise, if 

 that be practicable on account of the local condition. 

 Diminution of the quantity of sleep, and avoiding 

 heated rooms, and too warm beds, are also proper. 

 When there is a strong predisposition, every thing 

 which can excite the action of the uterus, or the acti- 

 vity of the vessels, must be shunned. Hence, in some 

 cases, it may be necessary to confine the patient for 

 some weeks, or even months, to a recumbent posture. 

 It is needless to add, that all stimulants must be ab- 

 stained from in such cases. When the cold bath agrees 

 with the patient, it is useful, by rendering all the func- 

 tions more perfect, and lessening the risk of plethora, 



In debilitated habits, if the cold bath do not pro- Of the 

 duce chilliness or disagreeable effects, it is of great uti- Pregnant 

 lity. The diet ought to be neither so sparing as to State ' 

 continue, far less increase, weakness ; nor, on the other * ""*" 

 hand, so full as to produce relative plethora. 



Extreme irritability is lessened by laxatives, the 

 shower bath, and, if combined with debility, by the use 

 of light infusion of bark. If connected with plethora, 

 as it often is, venesection is the best remedy. The re- 

 peated application of leeches to the neighbourhood of 

 the vagiiiH is a favourite remedy with some continental 

 practitioners. In very nervous habits, when there is 

 uneasiness in the uterine region, supposed to indicate 

 the existence of spasm, the tepid bath, with antispas- 

 modics, has been sometimes of service, and is certainly 

 by no means dangerous. 



When abortion is threatened, if we be not assured 

 that the child is dead, we ought instantly to use means 

 for stopping it. Blood-letting is a very general remedy, 

 and a useful one, but it must not be carried too far ; and 

 the practitioner ought to regulate his conduct by sci- 

 entific principles. There are chiefly two objects in 

 employing the lancet; to lessen the activity of the cir- 

 culation, and thereby diminish or check hemorrhage, 

 and stop the farther separation of the ovum ; and to 

 abate irritability. 



Spare diet, strict rest, cool air, tranquillity of mind, 

 and the other means of lessening predisposition must 

 be rigidly enforced. The application of cold water to 

 the back and perineum, by means of cloths, is often 

 highly useful ; and if the discharge be considerable, it 

 ought to be commanded by stuffing the vagina. If 

 there be any pain or general uneasiness, an opiate is 

 useful ; and, indeed, if there be no idiosyncrasy for- 

 bidding it, we ought in general to prescribe it. When 

 there is a continued but moderate discharge, or repeat- 

 ed discharges, the use of a styptic injection is proper. 



When we cannot prevent abortion from taking place, 

 our next object is to conduct the process to a safe ter- 

 mination. The principal danger arises from the loss of 

 blood, and therefore our chief attention ought to be 

 paid to the prevention of this by stuffing, and the judi- 

 cious use of cold. Faintness, feeling of sinking, or 

 actual syncope, are removed by cool air, smelling harts- 

 horn, opiates, and gentle cordials. The placenta ought 

 in general to be left to come away by the uterine ef- 

 forts ; but, in the mean time, we nuist guard against 

 hemorrhage by stuffing, or if the discharge be consider- 

 able, and the secundints can be brought away by the 

 finger without irritation, that ought to be done. 



When a portion of the placenta remains and pu tri- 

 fles, a febrile or hectic state is excited, the patient be- 

 comes sick, and the strength is much reduced both by 

 fever and repeated hemorrhages, during the intervals 

 of which foetid matter is discharged from the vagina. 

 The lower part of the belly is tumid, perhaps tender, 

 and languor alternates with hysterical symptoms. If we 

 can feel the portion, and easily extract it, this ought to 

 bedone; but we must not irritate. Injections of solutions 

 of sulphate of alumine are proper, or of strong decoc- 

 tion of oak bark. The bowels are to be kept regular, 

 the diet should be light and nourishing ; and the free 

 use of fruit or vegetable acid, with the occasional ex- 

 hibition of opiates, are proper. In prolonged cases, a 

 gentle emetic may be of service in procuring the re- 

 moval of the putrid mas*. 



It will be proper, in this place, to notice those he- 

 morrhages which occur in the latter months of preg- 

 nancy, and which are attended with the greatest dan- 



