Observations on Abortion / Containing an account of the manner in which it is accomplished, the causes which produced it, and the method of preventing or treating it

by John Burns

But I will not argue against the use of opiates from their abuse. They are very useful in cases of threatened abortion, more especially in accidental separation of the membranes and consequent discharge. They do not directly preserve the action of gestation, but they prevent the tendency to muscular contraction, and thus do good; for we find in the animal economy, that when two actions oppose each other, or alternately, preventing a tendency to the one has an effect in preserving the other.

Opiates are likewise useful for allaying those sympathetic pains about the bowels, and many of the nervous affections which precede or accompany abortion. They are also, especially if conjoined with digitalis, of much benefit in cases where we have considerable and protracted discharge, with trifling pains, as the uterus is not contracting sufficiently to expel the ovum, but merely to separate vessels.

By suspending, for a time, its action, it returns afterwards with more vigour and perfection, and finishes the process. But when the process is going on regularly, opiates will only tend to interfere with it, and prolong the complaint.

It was at one time the practice to endeavour to extract the fœtus and placenta, in order to stop the discharge; but this is now very properly abandoned. If the whole ovum come away at once, the discharge stops; if only the fœtus come away, it continues until the placenta and decidua are expelled; and where this process is tedious, we may derive advantage from gently irritating the os uteri with the finger, or using pretty strong saline clysters, or throwing cold water into the uterus by means of a female catheter, fitted to the elastic gum bottle used for injecting hydrocele. These means are much safer than the attempts to pull out the placenta with the finger or pincers, which were formerly so often made, and which are very apt to injure the womb.

In cases where the discharge is protracted and profuse, with little or no pain, and the ovum is still entire, we may, if the pregnancy be considerably advanced, excite the expulsive action, by rupturing the membranes.

The stomach very soon suffers, and becomes debilitated, producing a general languor and feebleness, with a disposition to faint, which seems, in abortion, to depend more upon this cause than directly upon loss of blood. Indeed, the hemorrhage produces both slighter and less permanent effects in abortion than at the full time, although less blood may have been lost in the latter than in the former case, for the vessels are smaller, and the discharge is not so sudden.

There is still another cause for this; namely, that the action of the uterus is less in the early than in the late months. Now, we know that the effect of hemorrhage from any organ is, cæteris paribus, in proportion to its degree of action. Hence the discharge is less dangerous than at the full time, and still less in menorrhagia than in abortion.

It is likewise less in cases where hydatids are contained in the uterus, than when a child is present, very astonishing discharges being sometimes sustained in that case with impunity.

The effect of abortion on the stomach seems to be in proportion to the period at which that takes place, being greater when it occurs before the fourth month than after it.

The effect, though distressing, and often productive of alarm, is nevertheless beneficial, lessening the action of the vessels in the same way with digitalis, the use of which is improper when this condition is present.