MIDWIFERY. 
tlie maternal part of the placenta, will be 
*iitRcient to rupture, ttiem ; and tlie colls 
givina: way, the blood will make its escape 
between the surface of the placenta and 
membranes, so as to form haemorrhage. 
Where the flow of blood from the ruptured 
part is considerable, and it finds a different 
course between the membranes leading to 
the os uteri, it will produce then a consider- 
able degree of haemorrhage. Violent h®- 
morrhaire will also sometimes arise from 
the use of spirits in two large proportion. 
Now and then accidental injuries done to 
other parts of the body will cause a partial 
separation of the placenta from the uterus. 
Acute diseases of the mother; pleurisy, 
acute rheiimatism, continued fever, small- 
pox, scarlatina, may any of them produce 
miscarriage ; there is no disease in which 
abortion is so dangerous as in the small- 
pox. Passions of the mind will frequently 
cause it ; and none so surely as those which 
increase the action of the heart and arte- 
ries. Rage may separate the placenta 
from the uterus very soon. It is not essen- 
tially necessary that the" force of action of 
the heart and arteries in general should be 
increased, because increased local action of 
the part is quite suflicient ; whence the 
union of the sexes often causes women to 
abort ; and, to make sure of breaking the 
habit, the best way is, to separate the wife 
from her husbaml for a time. Violent ex- 
ercise of almost any of the passions may 
produce the same effect. 
With regard to the signs of approaching 
abortion, the first and most obvious cliange 
is the absence of the morning sickness, 
which sickness is always a sign of health in 
the foetus, and goes away when the foetus 
dies. Another symptom preceding a mis- 
carriage is, a subsidence of the swelling ot 
the breasts, from being hard they become 
flaccid ; by these signs will any woman, 
but particularly if she have miscarried be- 
fore, know the approach of this state. 
There are also pains about the abdomen 
and back, which are so many evidences 
that the uterus has taken on this action. 
Hemorrhage, in general, also attends these 
symptoms, though sometimes a miscarriage 
tnay happen with very little loss of blood. 
Women miscarry in various ways, with re- 
gard to the progress of the abortion. In 
some, the ovum is expelled, and in others it 
will come away in pieces. The ovum and 
its membranes may be thrown off first, 
while the decidua does not appear till after- 
wards sometimes the ovum will come 
away in a clot of blood, and it would not 
be known as an ovum, if the clot were not 
broken down and examined : at times the 
membranes will break very early, and the 
ftetus will come first. In some abortions 
there is great pain ; the grinding pains will 
sometimes equal those of labour; while in 
others there is very little, the ovum appear- 
ing to drop off from its connection with 
the Uterus, upon the os uteri being relaxed, 
just as premature fruit drops from a tree ; 
sometimes the loss of blood is great, at 
others little. 
As to the prognosis in miscarriage, it will 
be influenced by the state of the constitu- 
tion : if it depend upon the contraction of 
the uterus alone, the pains will go on as in 
labour, till the whole ovum is expelled. 
But where the miscarriage depends on 
some cause acting on the circulation, the 
woman will often lose a large quantity of 
blood, become cold, faint, and the blood 
will stop. If during her fainting she he 
revived by wine and warmth, the luemor- 
rhage will return, and the abortion perhaps 
be confirmed ; but if these stimuli be 
avoided the blood will often coagulate, 
close the breach of continuity in the pla- 
centa, and the woman will go her full time 
of pregnancy. 
Tliere is very little danger in abortion, 
generally speaking, when happening in the 
five first months. We may say, that, pro- 
vided the constitution be good, there is no 
danger before the fourth month. The ves- 
sels at this time are small, and the hmmor- 
rhage is seldom rapid, and the safety or 
danger of the patient will depend upon 
the proportional size of the vessels from 
which the blood issues, together with the 
lime in which it is lost. But if it be couti- 
rmal, though not from large vessels, it may 
at length kill either immediately, or by 
overpowering the constitution. A child 
may be bled to death by leeches, and an 
infant has been known to die under the 
operation' of a single leech ; a woman w'ho 
does not die while the blood is fl.owing, 
may die in consequence of dropsy caused 
by the loss of blood. Abortion never ends 
at once in death, but it produces weakness 
and dropsy. All miscarriages are more 
dangerous while the woman has an acitte 
disease, and most so with the small-pox ; 
the most dangerous days being from tlie 
eleventh to the thirteenth day of the erup- 
tion. When haemorrhage happens before 
abortions, it does not follow that the ovum 
must be destroyed ; enough of the placenta 
