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

It is at first little different from syncope, and during the whole time the muscles of the face are not much affected, the countenance having rather a deadly aspect. This is removed by an horizontal posture, sprinkling the face smartly with cold water, and the use of volatiles. The patient, in this case, as in epilepsy, is often unconscious of having been ill.

Regular hysteric paroxysms also sometimes accompany abortion, and are more dangerous than at other times, more especially if they seem to have been excited by the profusion of the discharge. If they last long, they either end in mortal syncope, or in stupor. If they have been brought on by some agitation of mind, they are less to be feared, though not even then void of danger.

Besides attending to the state of the discharge, the best practice is to keep the person very cool, and exhibit thirty or forty drops of tincture of opium, and two drams of tinctura valerianæ ammoniata in a little peppermint water. A clyster, composed of a pound of cold water and two drams of tincture of asafœtida, is also sometimes of service.

Those disagreeable symptoms which I have described, fortunately do not often attend abortion; but the process goes on safely, and without disturbance. In this case, after it is over, we only find it necessary to confine the person to bed for a few days, as getting up too soon is apt to produce debilitating discharge.

We must also, by proper treatment, remove any morbid symptoms which may be present, but which depending on the peculiarities of individuals, or their previous state of health, cannot here be specified. When the patient continues weakly, the use of the cold bath, and sometimes of the bark, will be of much service in restoring the strength; and, in future pregnancies, great care must be taken that abortion may not happen again at the same period.

Unfortunately we meet with some cases where the recovery does not take place with that promptitude and regularity which could be wished. This sometimes depends upon a continuance of the hemorrhage after the ovum is expelled, by which the patient is greatly weakened, and even her life put into danger.

The hemorrhage may either continue from the time of expulsion, or it may come on a week, or even longer, after it. It seems to proceed from the uterus not going on in the process of restoration to the unimpregnated state, but remaining too long enlarged, the consequence of which is, that very soon the vessels pour out blood, and fill the cavity, forming a coagulum, which presently is expelled with a considerable flow of fluid blood; and this process may be very frequently repeated.

This, which is often connected with an hysterical condition, is more especially apt to occur in those who are subject to flooding after the expulsion of the child, as this marks a natural feebleness in the womb, and a disposition to flag in its actions after delivery.

In such patients it is often preceded by ill-smelled lochial discharge, which proceeds sometimes from the original state of the secretion, but more frequently from its being retained for some time, and acquiring this smell.

This has given rise sometimes to an idea that the complaint proceeded from the retention of part of the placenta or membranes; but this retention often takes place without any such discharge succeeding; and, on the other hand, in several instances of this complaint we have certain knowledge that no part of the placenta has remained, whilst in almost every case we have a coagulum expelled, possessing exactly the shape of the uterine cavity, shewing that nothing else has been contained within it.