[60] Dewees, Compendious System of Midwifery, sect. 408. A similar case is recorded by Dr. Montgomery.
[61] “Qui inter septimi et noni mensis, à prima conceptione, finem contingit partus, præmaturus vocatur: abortus vero quando ante dictum tempus embryo excidit; id quod circa tertium graviditatis mensem ut plurimum accidit. Vitalem esse præmaturum fœtum observatio nos docet, embryonem autem non manere superstitem constat.” (Rœderer, Elem. Artis Obst. cap. xxiii. § 716.)
[62] During the great influenza epidemic, abortions were remarkably frequent.
[63] This is nearly the same arrangement which has been followed by Dr. Copland, in the article Abortion, in the Dict. Pract. Med.
[64] This crotchet consists of a piece of steel of the thickness of a small quill at its handle, and gradually tapered off to its other extremity which is bent to a hook of small size. (See accompanying figure which represents the instrument one third the natural size.)
This instrument is highly useful in cases in which the flooding continues after the ovum has been broken and its contents expelled. A portion of the involucrum sometimes insinuates itself into the neck of the uterus, and prevents the degree of contraction necessary to interrupt farther bleeding. This accident most frequently attends the earlier abortions. As hæmorrhage is maintained by the cause just named it suggests the propriety of never breaking the ovum; especially before the fourth month. When the flooding is maintained by this cause, it will not cease but upon the event of its removal. This condition of the placenta and neck of the uterus is easily ascertained by an examination; it will readily be felt to be embraced by the neck of the uterus; and though a portion may protrude a little distance below the os tincæ, it cannot be extracted by the fingers; for the os uteri or cavity of the uterus will not be sufficiently large to permit the fingers to pass into it, that this mass may be removed; the crotchet should then be substituted; the mode of using it is as follows:—The fore-finger of the right hand is placed within or at the edge of the os tincæ; with the left we conduct the hooked extremity along this finger, until it is within the uterus; it is gently carried up to the fundus, and then slowly drawn downwards, which makes its curved point fix in the placenta; when thus engaged, it is gradually withdrawn, and the placenta with it.
Dr. Dewees says, that in every case in which he has used this crotchet, the discharge instantly ceased. See Art. “Abortion,” by Dr. Dewees, in American Cyclopedia of Pract. Med. and Surg. Dr. Dewees “from some late experience is induced to believe” that “in cases in which we cannot command the removal of the placenta by the fingers—that is, when this mass continues to occupy the uterine cavity, or but very little protruded through the os tincæ,” the administration of ergot, will often supercede the necessity of the crotchet. Treatise on the Diseases of Females. Sixth Edition, p. 351.—Ed.
[65] Dr. Dewees recommends the crotchet only where the flooding continues after the ovum has been broken. See preceding note. Ed.
[66] “Clysteres injiciantur, quorum irritatione expultrix uteri facultas excitatur, et depleta intestina ampliorem locum utero relinquat.” (Riverius, Prax. Med. de Partu difficili.)