It is satisfactory to know that, by great care, although we may fail once or twice, yet the uterus comes at last to act more perfectly, and the woman bears children at the full time.
After these observations, it is only necessary to add, that in every instance of habitual abortion, whatever the condition may be which gives rise to it, we find that it is essential that the greatest attention be paid to the avoiding of the more evident and immediate exciting causes of miscarriage, such as fatigue, dancing, &c. In some cases, it may even be necessary to confine the patient to her room, until the period at which she usually aborts is past.
When abortion is threatened, we come to consider whether and by what means it can be stopped. I have already stated my opinion, that when the action of gestation ceases, it cannot be renewed, and that general contraction of the uterine fibres is a criterion of this cessation.
Still, as some of the means which may be supposed useful in preventing a threatened abortion are also useful in moderating the symptoms attending its progress, we may very properly have recourse to them. Some causes giving rise to abortion, do not immediately produce it, but give warning of their operation, producing uneasiness in the vicinity of the uterus, before the action of that organ be materially affected.
The detraction of a little blood at this time, if the pulse be in any measure full or frequent, and the subsequent exhibition of an anodyne clyster, or a full dose of digitalis and opium, together with a state of absolute rest for some days, will often be sufficient to prevent farther mischief, and constitute the most efficacious practice.
This is the time at which we can interfere with the most certain prospect of success; and the greatest attention should be paid to the state of the rest of the system, removing uneasiness, wherever it is present, and preventing any organ from continuing in a state of undue action. It is difficult to persuade the patient to comply with that strict attention which is necessary at this period; but being persuaded that if this period be allowed to pass over with neglect, nothing can afterwards prevent abortion. I wish particularly to impress the mind of the student with a due sense of its importance; and I must add, that as after every appearance of morbid uterine action is over, the slightest cause will renew our alarm, it is necessary that great attention be paid for some time to the patient.
Often, instead of an uneasy feeling about the loins, or lower belly, we have, before the action of gestation stops, a discharge of blood, generally in a moderate, sometimes in a trifling degree. This is more especially the case when abortion is threatened, owing to an external cause, and, if immediately checked, we may prevent contraction from beginning.
Even in those cases where we do not expect to keep off abortion, it is useful to prevent, as far as we can, the loss of blood, for as I cannot see that the hemorrhage is necessary for its accomplishment, although it always attend it, I conclude that our attempts to prevent bleeding can never do harm, for if they succeed in checking abortion, we gain our object; if they fail, they do not increase, but diminish the danger.
It should be carefully remembered, that the more we can save blood, the more do we serve our patient. As the means for checking the discharge will be immediately pointed out, it is unnecessary here to enter into any detail.
Sometimes the vessels which furnish the cervical efflorescence in the beginning of gestation, do not assume that action, but yield blood, which passes for the menses, and makes the woman mistake her condition. As the uterine vessels increase in size, the discharge becomes greater and more frequent. It is now apt to pass for menorrhagia.